Communication Disorders in Childhood Cancer

216 Pages·1999·4.447 MB·English

by  Bruce E Murdoch(auth.)

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,
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This publication is sold subject to the conditions that it shall not, by
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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