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 “This is the only computerized training so far in childhood cancer
survivors,” said lead author Heather M. Conklin of St. Jude
Children’s Research Hospital in Memphis, Tennessee.
The study included 68 survivors of acute lymphoblastic leukemia
(ALL), a blood cancer, or brain tumors, who had all survived at
least one year after their cancer treatment ended. All of the
children had thinking or memory problems reported by their parents.
On average, the participants were 12 years old, and had completed
cancer treatment about five years earlier. They were randomly
separated into two groups, one receiving the computer training
program, another put on a “waitlist” to serve as a comparison.
The first group was asked to complete 25 at-home sessions with the
Cogmed program over five to nine weeks. These sessions, 30 to 45
minutes each, included visual-spatial games or working memory games.
The children also had weekly coaching phone calls to collect
feedback and offer motivation to keep using the program.
Some kids who were making slower progress took advantage of five
extra sessions.
Almost 90 percent of the kids in the Cogmed group completed the
program.
Ten weeks after the study began, the youngsters’ working memory,
attention and processing speed increased more in the Cogmed group
than in waitlist group. Parents also reported bigger reductions in
their children’s “executive dysfunction,” or decision-making
problems, after they used Cogmed.
“We have done a great job in the last 30 years developing therapies
to cure kids with cancer,” said Donald Mabbott of The Hospital for
Sick Children in Toronto, who was not part of the new study.
“Most cancer patients treated in childhood survive,” but may
experience lingering cognitive problems, he said.
Radiation cancer treatment targets growing cells, including brain
cells, which is why kids have thinking problems later, he told
Reuters Health by phone.
These computerized games tax and stretch working memory ability,
asking kids to manipulate an object and hold it in their working
memory, training the brain, Mabbott said.
“By getting the neurons in the brain to fire, we can foster growth
of new white matter cells,” he said.
The kids in the computer program group had functional magnetic
resonance imaging scans of their brains taken while completing a
memory task before and after the intervention. After the study, they
appeared to have reduced activation in the language areas of the
brain.
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That’s because after using the computer program, their memory
processing was “more efficient,” Conklin said.
Cancer survivors with attention or memory problems can also take
stimulant medications like Ritalin or attend in-person sessions with
a therapist, which confer some benefit as well, but drugs can have
side effects, and some patients cannot take them, and therapy
sessions require traveling to a specific facility, Conklin said.
“Most childhood cancer survivors don’t live near somewhere that
offers it,” she said. “Computerized programs are a really nice
alternative.”
Cogmed is commercially available for adults with brain injury or
children with attention-deficit disorder, but had not been used with
childhood cancer survivors, Conklin said.
“If you are noticing problems in your child, take them to a
psychologist or neuropsychologist and have them evaluated,” she
said. If they are struggling with attention or working memory,
Cogmed may help, but it is not covered by insurance and costs
between $1,000 and $1,500 for the training program and coaching
sessions, she said.
“It’s up to the family in terms if whether they have the financial
resources to pursue it,” Conklin said.
It’s not yet clear when the optimal time might be to start
computerized “brain-training” interventions, but pending future
study it is possible the program could confer some benefit as soon
as cancer treatment ends, or even five to 10 years later, Mabbott
said.
SOURCE: http://bit.ly/1ekfGZD Journal of Clinical Oncology, online
October 12, 2015.
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