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Adaptive functioning and academic achievement in survivors of childhood acute lymphoblastic leukemia: A report from the Children's Oncology Group
Author(s) -
Jacola Lisa M.,
Baran Julie,
Noll Robert B.,
Willard Victoria W.,
Hardy Kristina K.,
Embry Leanne,
Hullmann Stephanie E.,
Larsen Eric C.,
Winick Naomi,
Kairalla John A.
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28913
Subject(s) - medicine , neurocognitive , logistic regression , randomization , clinical trial , pediatrics , psychiatry , cognition
Purpose To characterize academic and adaptive skill outcomes in survivors of high‐risk B‐lineage acute lymphoblastic leukemia (HR B‐ALL). Methods Participants were 178 patients enrolled on a nontherapeutic clinical trial that aimed to characterize neurocognitive and functional outcomes (ie, academic achievement and adaptive skills) following treatment for childhood HR B‐ALL. Eligible patients were treated on Children's Oncology Group AALL0232 clinical trial that included two treatment randomizations: methotrexate delivery (high or escalating dose) and corticosteroid (dexamethasone or prednisone). Academic achievement and adaptive skills were evaluated at one time point, 8‐24 months after completing treatment. Results Multivariable logistic regression showed no significant association between treatment variables and outcomes after accounting for age at diagnosis, sex, and insurance status. In multivariable analyses accounting for sex and insurance status, survivors <10 years old at diagnosis had significantly lower scores in Math ( P = .02). In multivariable analyses accounting for sex and age at diagnosis, scores for children with US public health insurance were significantly lower than those with US private or military insurance across all academic and adaptive skills (all P ‐values ≤.04). Results from univariate analyses showed that boys had significantly lower scores than girls across all adaptive skill domains (all P ‐values ≤.04). Conclusion Regardless of treatment randomization, survivors of HR B‐ALL <10 years at diagnosis are at risk for deficits in Math and overall adaptive functioning; overall adaptive skills for boys were significantly poorer. Screening and early intervention for patients at highest risk, particularly young patients and lower resourced families, should be prioritized.