Examining a Novel Neuropsychological Screening Tool in Pediatric Cancer Patients and Survivors

BACKGROUND: Childhood cancer patients and survivors are vulnerable to neurocognitive deficits based on malignancy, treatment, and associated comorbidities. This study assessed a novel parent-report cognitive screening tool developed by the Clinical Neuropsychology Collaborative for Childhood Cancers (CNC3) intended to support decision-making when referring for neuropsychological evaluations, comparing it with formal neuropsychological test performance among pediatric cancer patients (PCP) and survivors (PCS). METHODS: The CNC3 Caregiver Report Questionnaire (CNC3-CRQ) was administered to parents of children completing comprehensive neuropsychological assessments. Results were examined in relation to the children's performance on administered neuropsychological measures to evaluate the CNC3-CRQ's effectiveness in identifying those at risk for neurocognitive impairment. RESULTS: Of 64 participants, 58 (90.6%) had completed therapy and 26 (40.6%) had a history of central nervous system tumor. Formal neuropsychological testing revealed relatively high rates of both mild impairment (>1SD below the population mean) and moderate impairment (>2SD below) in 49 patients (76.6%) and 30 patients (46.9%), respectively. Youden's J analyses were conducted to determine optimal symptom-percentage cutoffs for each cognitive domain assessed by the CNC3-CRQ, relative to performance on formal neuropsychological testing. A cumulative positive screen on the CNC3-CRQ was calculated based on domain positivity, with 47 (73%) patients screening positive. The CNC3-CRQ demonstrated 83.3% sensitivity and components of domains of processing speed, memory, and visual-spatial skills were significantly associated with moderate deficits on formal neuropsychological examinations. CONCLUSION: The CNC3-CRQ is a helpful, efficient tool to identify PCP and PCS who would benefit from referral to neuropsychology services.