Abstract

Objective: Neuropsychological late effects of pediatric cancer may not become apparent for years after therapy; therefore, serial monitoring is necessary for detecting changes to ensure timely intervention. Unfortunately, lack of access to neuropsychologists, increased patient volume, insurance authorization and reimbursement issues, time required for neuropsychological evaluation, and practice effects related to repeat testing present many challenges to provision of neuropsychological care for survivors of childhood cancer. Models involving surveillance and monitoring have been proposed, though minimal data exist related to the implementation and feasibility of such models. Method: In this descriptive feasibility study, the Neuropsychology Consult Clinic (NCC) at Children’s Hospital Los Angeles is presented, outlining a methodology and algorithm for neuropsychological surveillance of survivors of non-CNS pediatric cancer and an account of the first three years of clinic implementation. Participants included 215 survivors (x̅ age = 5.6 years), including 75.3% Latinx patients. Results: The overall clinic implementation was found to be feasible, with approximately 75% of patients “passing” the screening and 25% “failing” the screening. Clinical judgment only conflicted with the algorithm 8.6% of the time. However, several limitations to feasibility were noted, including validity concerns and ability/time to complete parent-reported outcomes using Spanish forms, as well as access to bilingual examiners. Conclusions: These preliminary data support the feasibility of the NCC model with limitations as outlined above. This is the first phase in a multiphase plan to develop an appropriate screening clinic for survivors of pediatric cancer, with the next phase focusing on sensitivity/specificity of measures.

摘要

目的：小儿癌症的神经心理迟发效应可能在治疗后数年内不明显；因此，连续监测对于检测变化以确保及时干预是必要的。不幸的是，无法接触到神经心理学家、增加的患者数量、保险授权和报销问题、神经心理学评估所需的时间以及与重复测试相关的实践效果对为儿童癌症幸存者提供神经心理学护理提出了许多挑战。已经提出了涉及监视和监控的模型，尽管与此类模型的实施和可行性相关的数据很少。方法：在这项描述性可行性研究中，介绍了洛杉矶儿童医院的神经心理学咨询诊所 (NCC)，概述了对非 CNS 儿科癌症幸存者进行神经心理学监测的方法和算法，并介绍了前三年的临床实施情况。参与者包括 215 名幸存者（x̅年龄 = 5.6 岁），其中 75.3% 是拉丁裔患者。结果：发现整体诊所实施是可行的，大约 75% 的患者“通过”筛查，25% 的患者“未通过”筛查。临床判断只有 8.6% 的时间与算法相冲突。然而，注意到可行性的一些局限性，包括有效性问题和使用西班牙语表格完成家长报告结果的能力/时间，以及获得双语审查员。结论：这些初步数据支持 NCC 模型的可行性，但存在上述局限性。这是为儿童癌症幸存者开发适当筛查门诊的多阶段计划的第一阶段，下一阶段的重点是措施的敏感性/特异性。