Treatment of Cognitive Deficits in Brain Cancer Survivors: Similarities With ADHD

A meta-analysis of studies that examined stimulant use in children diagnosed with brain tumors found that the medication may improve cognitive processes, just as it does for children with ADHD.

Clinicians have used stimulant medications in cancer patients over the years to treat a number of conditions, primarily fatigue and depression. Now, some researchers have determined that stimulants may help children who suffer neurocognitive consequences from brain tumor treatment. Of all long-term brain cancer survivors, between 40% and 100% will experience some degree of cognitive dysfunction. Pediatric survivors often suffer impaired attention that affects attention, memory, and information processing and encoding speed. Their performance in school may decline.

To help provide ideas for clinical guidelines and a platform for further study, researchers carried out a meta-analysis of studies that examined stimulant use in children diagnosed with brain tumors and published their results online on July 4, 2013, in the European Journal of Cancer. Based on the deficit’s similarity to ADHD and the success of stimulants in treating children with ADHD, the researchers postulated that stimulants might help childhood survivors of brain tumors as well.

The researchers called the collective results clinically “promising” when methylphenidate was used to improve attention. According to their interpretation, stimulant medication may effectively improve cognitive processes for some children. Based on their evidence, patients who were male, who were older at the time of treatment, and who had a higher baseline IQ were more likely to be responsive to methylphenidate. Common side effects in all children were sleep disturbances and decreased appetite. All side effects resolved when the methylphenidate was discontinued.

The researchers could not determine definitively whether the stimulant improved academic progress. They cite recommendations from professional experts emphasizing multidisciplinary assessment, meticulous diagnosis, and observation of consistent symptoms in different settings. They remind clinicians that co-morbidities complicate treatment planning and that documented review and outcome assessment is critical.

This research sets the stage for developing guidelines for stimulant use in childhood survivors of brain tumors. Since guidelines must address prescribing and follow-up, the researchers call for studies that include standardized outcome measures, longer-term evaluation of academic outcomes, and delineation of stimulant effectiveness by participant, tumor type, and treatment characteristics.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.