All ETDs from UAB

Advisory Committee Chair

Donna L Murdaugh

Advisory Committee Members

Sylvie Mrug

Wendy Landier

Noha Sharafeldin

Despina Stavrinos

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Pediatric cancer and cancer-related treatments may disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Identifying distinct patterns in outcomes across cancer types has been challenging, which has limited the implementation of systematic neurocognitive screening protocols. Emerging research indicates that processing efficiency (PE) impairment, or inefficient neural processing as measured by working memory (WM) and processing speed (PS) abilities, is a frequently reported but poorly defined cognitive late effect in survivors of both primary central nervous system (CNS) cancers and cancers of non-CNS origin. This dissertation attempts to 1) review and conceptualize PE skills in pediatric cancer survivors, 2) characterize PE skills across both primary CNS and non-CNS cancer types and 3) explore risk factors and translational impacts of PE deficits in a mixed retrospective sample of pediatric cancer survivors. First, a conceptual model highlighting the associations between biological and environmental factors with underlying neurobiological substrates that precede cognitive late effects and functional abilities following cancer treatment was proposed. Next, participants (n = 160; age range = 6-21) were selected from a retrospective clinical database of pediatric cancer survivors who presented for comprehensive neuropsychological evaluation. Participants demonstrated greater rates of impairment across PE measures (24.8-38.1%) compared to normative samples (15.9%). Rates of iv impairment between primary CNS and non-CNS cancer survivors only differed for PS scores, with 63.6% of the CNS group and 31.5% of the non-CNS group demonstrating impairment. Only two of the well-documented risk factors of cognitive late effects were associated with PE skills, such that primary CNS tumor and male sex predicted lower PE scores. Higher PE scores predicted better performance on other cognitive measures and global academic skills. Performance-based PE scores were unrelated to parent ratings of behavioral and emotional health. In sum, substantial weaknesses in PE skills were observed in both primary CNS and non-CNS pediatric cancer survivors and were related to other cognitive skills and academic outcomes. Implementing a standard approach for assessing and communicating PE skills within outcomes research and routine clinical practice may carry significant translational impacts for survivors.



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