Abstract
Neurocognitive late effects following the diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) commonly include impaired executive functions (EFs), with negative consequences for one’s health-related quality of life and mental health. However, interventions for EF impairments are scarce. Thus, the aims of this study were to (1) explore the feasibility and acceptability of the cognitive rehabilitation program Goal Management Training (GMT) and (2) examine whether GMT is associated with positive outcomes across cases of ALL survivors with EF complaints. Four participants (median age 31.5 years) underwent nine GMT modules in a total of five group sessions. Rehabilitation was focused on compensatory strategies to improve real-life EFs. Participants were evaluated at 2-week and 6-month follow-ups. Evaluation of feasibility and acceptability included adherence, a semi structured interview, self-reports, and safety. Additionally, therapists’ experience with implementation was evaluated. Outcome measures included self-reports and neurocognitive tests of attention, EF, and processing speed. All participants completed GMT and rated the intervention as useful, suitable, and satisfactory. The reliable change index showed improved daily life EFs (two participants) and neurocognitive performance (three participants) at 6-month follow-up. Additionally, all participants improved on a “real-life” task involving EF. A future randomized controlled trial is recommended.
Highlights
Since the 1970s, prognosis has progressively improved for childhood acute lymphoblastic leukemia (ALL), and 5-year survival is approaching 90% (Smith et al, 2014; Toft et al, 2018; Jeha et al, 2019)
While Goal Management Training (GMT) is a promising program for the rehabilitation of neurocognitive late effects, information regarding the feasibility of GMT for adult ALL survivors is lacking
A future randomized controlled trial (RCT) is invaluable for examining the effect of an intervention and will reduce the influence of the methodological problems stated above. This is the first study to explore the feasibility of GMT for adult survivors of childhood ALL
Summary
Since the 1970s, prognosis has progressively improved for childhood acute lymphoblastic leukemia (ALL), and 5-year survival is approaching 90% (Smith et al, 2014; Toft et al, 2018; Jeha et al, 2019). Less severe than those seen in survivors of childhood brain tumors (Krull et al, 2018), ALL survivors show significant late effects in several neurocognitive functions. These most commonly include problems with attention (Conklin et al, 2012; Jacola et al, 2016), processing speed (Edelstein et al, 2011; Kanellopoulos et al, 2016) and executive functions (EFs) (Walsh et al, 2015; Liu et al, 2018). EFs comprise higher-level abilities such as planning, decision-making, and effective performance (Lezak et al, 2012). The widely distributed and intricate nature of EF brain sites (Lezak et al, 2012) makes them susceptible to injury
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