Long-term survivors of pediatric cancer are at elevated risk for cognitive impairment, which manifests in different ways at different times throughout survivorship. Although some cognitive impairment may result from the cancer itself, as is the case with a brain tumor, impairment has been consistently associated with exposure to CNS-directed therapies like neurosurgery, cranial irradiation, intrathecal chemotherapy or high dose intravenous methotrexate or cytarabine. Additionally, survivors who do not receive CNS-directed therapies are also at elevated risk for cognitive impairment following cancer therapy that disrupts systemic organ function vital to brain health, e.g., cardiac, pulmonary or endocrine function. Risk for cognitive impairment is further exacerbated by adverse events during cancer therapy (e.g., severe infection, recurrent general anesthesia) and health behaviors following cancer therapy (e.g., physical activity, sleep). The type and severity of cognitive impairment in long-term survivors of pediatric cancer may evolve and grow over time, with emerging evidence suggesting some survivors are at risk for accelerated cognitive aging and early onset dementia. Over the course of the survivor’s lifespan, the prevalence and impact of cognitive deficits will be determined by a complex interaction between premorbid development and environment, cancer therapy and clinical care, and post-treatment recovery and physical health. The timing and type of these events will dictate the approach to screening and monitoring for cognitive impairment, and will determine the best course for therapeutic intervention to facilitate future cognitive and emotional health.

Upon conclusion of this course, learners will be able to:

1. 1. Describe direct and indirect sources of cognitive impairment in long-term survivors of pediatric cancer

2. 2. Discuss how cognitive impairment may change over the lifespan of survival following treatment for pediatric cancer

3. 3. Identify modifiable targets for interventions to facilitate cognitive health in long-term survivors of pediatric cancer