Risk-Stratified Neurocognitive Monitoring

An Alternative Approach: Risk Stratified Neurocognitive Monitoring in Pediatric Oncology

Eman K. Rettig, Psy.D.

Pediatric Neuropsychologist at Children’s Health Medical Center, Assistant Professor at the University of Texas Southwestern Medical School

^{Live lecture date: 05/19/2025}

These learning questions are brought to you by KnowNeuropsychology & the Association for Doctoral Education in Clinical Neuropsychology (ADECN).

*This quiz has 4 multiple-choice questions and 1 discussion question.

1 / 5

Which of the following most accurately describes the level of assessment and intervention in risk-stratified neurocognitive monitoring:

Primary level (includes targeted screening for at-risk patients / targeted supports based on strengths & weaknesses); secondary level (includes universal monitoring and psychoeducation for all patients); tertiary level (includes comprehensive evaluation and intensive rehabilitation).

Primary level (includes universal monitoring and psychoeducation for all patients); secondary level (includes targeted screening for at-risk patients / targeted supports based on strengths & weaknesses); tertiary level (includes comprehensive evaluation and intensive rehabilitation).

Primary level (includes comprehensive evaluation and intensive rehabilitation ); secondary level (includes targeted screening for at-risk patients / targeted supports based on strengths & weaknesses); tertiary level (includes universal monitoring and psychoeducation for all patients).

Primary level (includes targeted screening for at-risk patients / targeted supports based on strengths & weaknesses); secondary level (includes comprehensive evaluation and intensive rehabilitation); tertiary level (includes universal monitoring and psychoeducation for all patients).

2 / 5

Which of the following are true about a population based model for neurocognitive assessment in pediatric oncology?

This is the most common based model currently implemented.

Assessment of cognition starts after treatment completion.

It’s easy for these patients and families to get lost to treatment follow-up.

Comprehensive pediatric neuropsychological evaluations may not be appropriate for all patients, which may result in long waitlists, and delays to access to care.

All of the above are true.

3 / 5

What factors have not impacted the increased need for clinical monitoring of neurocognitive outcomes?

Dramatic increase in survival rate (i.e., 5-year survival rate for acute lymphoblastic leukemia [ALL] is 92.3%- the most common childhood cancer).

Patients are likely receiving intensive treatments during sensitive neurodevelopment periods, impacting brain development.

Advances in therapeutic treatment modalities have involved contemporary therpaies that favor radiation sparing and risk adapted protocols; life saving treatments continue to result in cancer related cognitive impairments.

Increase in use of cranial radiation for pediatric patients.

Early onset of some pediatric cancers benefit from increased clinical monitoring.

4 / 5

Which are the following are not true about cancer-related cognitive impairments?

They are the most common and life-changing sequalae of childhood cancer.

They mostly present about 2-3 years post-treatment completion.

They are generally acute, and not late effects.

Cognitive domains most often impacted include sustained attention, working memory, and processing speed.

5 / 5

DISCUSSION: Discuss some of the benefits for using a risk-stratified model for neurocognitive monitoring in pediatric oncology.

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