Neurocognitive toxicity is a common sequela of cancer and its treatment, with 40-60 % of childhood cancer survivors experiencing cancer-related cognitive impairment (CRCI) following cancer. CNS cancers and CNS-directed therapy are considered to pose the greatest risk; however, such impairment has also been reported in non-CNS cancers, the most commonly diagnosed in children. Despite initial findings, no formal systematic assimilation of evidence has previously reported estimates in pediatric populations, or identified the influence of cancer, treatment, and patient variables. Thus, this review aims to investigate the prevalence of CRCI in pediatric non-CNS cancers. A systematic search was conducted (21/04/2023 and updated 08/2024) using PubMed via MEDLINE, Scopus, PsycINFO via OvidSP, and CINAHL via EBSCOhost. Simple proportional meta-analyses were performed using PERSyst, and certainty of evidence was assessed employing GRADE. Twenty-six studies contributed to two categories - (1) cognitive function and intelligence, and (2) achievement, aptitude and school readiness. Pooled prevalence estimates suggest that survivors of non-CNS cancers experience impairments in intelligence (12.46 %-18.05 %) and attention (9.83 %-12.05 %). Non-pooled prevalence estimates ranged from 0 % to 67 % in cognitive function and intelligence, with effects on executive function (2 %-42.8 %), learning and memory (4.7 %-57 %), visuo-spatial/perceptual motor (3 %-61.9 %), and language (4 %-37 %), and 0-73 % in achievement, aptitude and school readiness. Survivors of non-CNS cancers experience significant impairments in these categories; however, certainty of evidence is generally low to very low, warranting cautious interpretation of prevalence estimates. Understanding the prevalence of CRCI can inform survivorship strategies and provide impetus for dedicated supports, such as rehabilitation and school reintegration.
Semendric et al. (Tue,) studied this question.