It is now generally accepted that central nervous system
treatments for childhood cancer can result in significant cognitive
impairment, most commonly in the areas of
attention/concentration. We review the literature on
attentional and neurocognitive deficits in this population,
and also efforts to remediate attentional deficits in other
brain injured populations. It was our goal to develop an
innovative, psychologically based outpatient rehabilitation
program that would improve dysfunctional attentional processes
and associated neuropsychological deficits. The characteristics
of this program and a pilot study of its effectiveness are
described. Participants were 31 off-therapy cancer survivors
with documented attention deficits. Twenty-one completed the
cognitive remediation program (CRP) and 10 served as comparisons.
All participants completed a test of vigilance attention, 2
tests with an attentional component, and an arithmetic academic
achievement measure. When the scores of the 2 groups were compared,
the CRP group exhibited statistically significant improvement
on all attentional measures. In contrast, the comparison group
did not manifest any significant changes. Neither group
demonstrated statistically significant changes on the arithmetic
achievement test. We believe that the CRP has potential for
improving attention/concentration, but generalization to
academic achievement remains unproven. Phase 3 clinical trials
and the documentation of long-term treatment gains are needed.
Furthermore, it will be necessary to demonstrate the ecological
validity of the CRP. With these caveats, this therapeutic approach
may be helpful in other populations of cognitively impaired
children and young adults, such as patients who have suffered
traumatic brain injury. (JINS, 2002, 8,
115–124.)