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Communication Disorders in Childhood Cancer PDF

216 Pages·1999·4.447 MB·English
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Communication Disorders in Childhood Cancer Communication Disorders in Childhood Cancer BRUCE E MURDOCH Department of Speech Pathology and Audiology The University of Queensland, Brisbane. W Whurr Publishers London 0 1999 Whurr Publishers Ltd First published 1999 by Whurr Publishers Ltd 19b Compton Terrace London N12UN England All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Whurr Publishers Limited. This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circu- lated without the publisher’s prior consent, in any form of binding or cover other than that in which it is published, and without a similar condition including this condition being imposed upon any subse- quent purchaser. British Library Cataloguing In Publication Data A catalogue record for this book is available from the British Library. ISBN 186156 115 6 Printed and bound in the UK by Athenaeum Press Ltd, Gateshead, Vne &Wear Contents Preface vii Contributors ix Chapter 1 1 Major childhood cancers: leukemia and brain turnours Bruce E Murdoch, Deborah L Boon and LisaJ Hudson Chapter 2 21 Effects of treatment for paediatric cancer on brain structure and function Bruce E Murdoch, Lisa J Hudson and Deborah L Boon Chapter 3 55 Language disorders in children treated for brain turnours Bruce E Murdoch and LisaJ Hudson Chapter 4 76 Language recovery following treatment for paediatric brain rumours Bruce E Murdoch and LisaJ Hudson Chapter 5 89 Variability in patterns of language impairment in children following treatment for posterior fossa Nmour Bruce E Murdoch and Lisa J Hudson V vi Communication Disorders in Childhood Cancer Chapter 6 126 Language disorders in children treated for acute lymphoblastic leukaemia Bruce E Murdoch and Deborah L Boon Chapter 7 158 Discourse abilities of children treated for neoplastic conditions Bruce E Murdoch, Deborah L Boon and LisaJ Hudson Chapter 8 170 Motor speech disorders in children treated for brain tumours Bruce E Murdoch, LisaJ Hudson and Susan K Horton Chapter 9 187 Assessment and treatment of speech and language disorders occurring subsequent to cancer therapy in children Susan K Horton and Bruce E Murdoch Preface The survival rates of children treated for various neoplastic conditions such as brain tumours and acute lymphoblastic leukaemia have shown a dramatic improvement during the past three decades. Unfortunately it is now being recognized that treatments applied to these conditions, such as radiotherapy and chemotherapy, may have some long-term adverse effects on brain structure and function leading to the development of a number of negative sequelae. These sequelae include cognitive deficits as well as speech and language disorders. Consequently in recent years, an increasing number of children displaying communication deficits as a consequence of treatment for childhood cancer have begun to appear in the caseloads of speech pathologists and other health professionals. Further, the recognition that treatments for childhood cancer can be associated with a number of long-term negative outcomes has lead in recent years to a shift in the emphasis of research to include, in addition to improvement in survival rates, investigation of ways of improving the quality of life of survivors of childhood cancer. During the past decade a group of researchers at the University of Queensland has undertaken a series of studies into the nature of speech and language disorders occurring in children treated for brain tumours and acute lymphoblastic leukaemia (ALL). These studies represent the most comprehensive reports of communication deficits in this popula- tion to date and have provided a platform for future research into speech and language problems occurring as an outcome of treatments such as radiotherapy and chemotherapy. The majority of these studies have been published as papers in Aphasiology -An International Znterdisciplinaty Journal. The permission of Taylor & Francis Ltd to reproduce some of the material contained in these papers in the present book is gratefully acknowledged. The aim of the present book is to provide a synopsis of the research conducted at the University of Queensland over the past 10 years into communication impairments associated with childhood cancers. Its aim is to inform speech pathologists and other health professionals of the vii viii Communication Disorders in Childhood Cancer need to monitor the communication abilities of children treated for neoplastic conditions with a view to implementing appropriate treat- ment strategies where necessary. It is also intended that the book act as a stimulus for further research into the communication impairments experienced by children treated for cancer. Bruce E Murdoch List of contributors Deborah L Boon (nCe Buttsworth) PhD Senior Speech Pathologist, Queensland Society for Crippled Children, Brisbane Susan K Horton BAppSci (Speech Pathology) Lecturer in Speech Pathology, Department of Speech Pathology & Audiology, The University of Queensland Lisa J Hudson PhD Senior Speech Pathologist, Toowoomba Base Hospital, Toowoomba, Queensland Bruce E Murdoch PhD Professor and Head of Department, Department of Speech Pathology & Audiology, The University of Queensland ix Chapter 1 Major childhood cancers: leukaemia brain and tutnours BRUCE E MURDOCH, DEBORAH L BOON AND LISA J HUDSON Introduction The long-term quality of life experienced by survivors of paediatric cancer is an issue receiving increasing attention from allied health professionals. Of the paediatric malignancies, acute leukaemias are the most common (Parkin et al., 1988). Brain and spinal tumours are the second most common childhood cancer in the developed countries of North America, Europe and Australasia, with cited incidences ranging from 20 to cases per million children (De Nully Brown et al., 1987; 35 Parkin et al., 1988; Lannering et al., 1990; McWhirter and Petroeschevsky, 1990). In particular] tumours located in the posterior cranial fossa (i.e. infratentorial tumours involving the cerebellum, fourth ventricle and/or brainstem) occur more commonly in childhood than supratentorial neoplasms, accounting for up to 70%o f all paediatric intracranial tumours (Hooper, 1975; Farwell et al., 1977; Gjerris, 1978; Segall et al., 1985; Kadota et al., 1989; Russell and Rubinstein, 1989). Recent decades have seen developments in the treatment of paedi- atric cancer that have resulted in marked improvements in the five-year survival rates of children treated for neoplastic conditions. Although almost always rapidly fatal four decades ago (Southam et al., 1951; Tivey, 1952), the five-year survival rate of children treated for paediatric leukaemia in the 1990s has risen to 72.8%( Boring et al., 1991), with some survival rates reported to be as high 80% (Cousens et al., 1990). as Similarly, the survival rates for children diagnosed with brain and nervous system tumours have also shown dramatic improvement, with figures from the USA indicating improvement from during the 35% period 1960-1963 to 59%s urvival during the period 1981-1986 (Boring et al., 1991). Although indisputably saving the lives of children with neoplastic conditions, the treatments applied to these disorders, 2 Communication Disorders in Childhood Cancer however, have been reported to induce structural and functional changes in the brain leading to the development of certain adverse long- term consequences which include, among others, speech and language deficits Uackel et al., 1990; Hudson and Murdoch, 1992; Buttsworth et al., 1993). Consequently, the improvement in survival rates of children diagnosed with cancer has lead to allied health professionals, including speechflanguage pathologists, being required to provide rehabilitation and support services to an increasing number of paediatric cancer patients, with attention now focused on improving the quality of life of the survivors of childhood leukaemia and brain tumours. The present chapter reviews the major types of paediatric cancers with regard to their epidemiology, diagnosis, aetiology, types, sympto- matology, medical course and prognosis, with emphasis given to acute lymphoblastic leukaemia (ALL) and posterior cranial fossa tumours. The medical treatments applied to each of these latter conditions are also described. The effects of these treatments on brain structure and function are discussed in detail in Chapter 2. Paediatric leukaemia General features epidemiology and Leukaemia is a progressive, malignant disease of the blood-forming organs, marked by distorted proliferation and development of leuco- cytes and their precursors in the blood and bone marrow. The most common form of leukaemia, ALL is associated with hyperplasia and overactivity of the lymphoid tissue. Most of the affected person’s leuco- cytes in this condition are lymphocytes or lymphoblasts. Although ALL is a disease of children and adults, it predominantly affects children, with an initial peak incidence of the disease occurring between three and five years of age. Neglia and Robison (1988) pointed out that this peak does not occur uniformly throughout the world, and is not present in Africa and various developing nations (Edington and Hendrikse, 1973; Ansei and Nabemezi, 1974; Davies, 1985). The incidence of ALL decreases after five years of age, and drops sharply between the ages of 10 and 14 years (Madan-Swain and Brown, 1991). The incidence of ALL is higher in males than in females (Koocher and O’Malley, 1981) and, although the exact figures vary with the particular type, this sex pattern is consistent across geographical boundaries and racial groups (Neglia and Robison, 1988). One survey in the USA found that, for children under 15 years of age, the annual incidence of ALL among males was 22.3 per million, whereas for females it was 15.7 per million voung and Miller, 1975). As indicated earlier, although in past years ALL was almost invariably a fatal condition, improvements in survival times have occurred a result as of the development and introduction of more effective treatments since

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