Advisor(s)
Donna Murdaugh
Committee Member(s)
Despina Stavrinos
Edwin Cook
Julie Wolfson
Noha Sharafeldin
School
College of Arts and Sciences
Document Type
Dissertation
Department (new version)
Psychology
Date of Award
6-4-2025
Abstract
Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk of secondary medical conditions arising from disease and treatment effects. Secondary medical conditions are associated with adverse survivorship outcomes (e.g., neurocognitive, psychosocial, and adaptive functioning/healthcare transition) in adult survivors of childhood ALL. Little is known about secondary medical conditions in pediatric ALL survivors. Further, the relationship between secondary medical conditions and survivorship outcomes has not been explored in this younger population. This dissertation examined 1) the role of secondary medical conditions in performance-based and caregiver-reported neurocognitive, psychosocial, and adaptive functioning; and 2) the roles of secondary medical conditions and neurocognitive functioning in adaptive functioning/healthcare transition readiness with an evidence-based intervention that addressed these skills. Eligible pediatric ALL survivors (n=103, average age=11.82 years) were identified from a retrospective database of oncology patients presenting for standard-of-care clinical neuropsychological evaluation. Performance-based neurocognitive data and secondary medical conditions were abstracted. Findings indicated at least one secondary medical condition in 82.5% of survivors, most frequently affecting endocrine/metabolic and neurological systems. Worse performance-based neurocognitive functioning was associated with greater number and severity of treatment-related and neurological conditions, and presence of any treatment-related, chronic, vascular, and neurological conditions. Sex-specific findings were demonstrated for female survivors with treatment-related complications and male survivors with chronic conditions. Next, pediatric ALL survivors with caregiver-reported measures were identified (n=98, average age=11.59 years) from the sample indicated above. Worse caregiver-reported neurocognitive functioning was associated with greater number and severity of resolved complications, and presence of neurological and vascular conditions. Secondary medical conditions did not predict psychosocial and adaptive functioning. Lastly, 23 pediatric ALL survivors (average age=12 years) participated in an 8-session adaptive functioning/healthcare transition readiness intervention. Neurological and resolved complications were associated with poorer transition readiness, while endocrine/metabolic, active, and chronic conditions were associated with greater transition readiness. Pre-intervention neurocognitive functioning was positively correlated with adaptive skills, transition readiness, and post-intervention independence levels in completing adaptive skills. Secondary medical conditions are prevalent in pediatric ALL survivors and are adversely related to survivorship outcomes. Findings indicate underlying treatment-related neurotoxicity and sex-based differences. Continued examination of secondary medical conditions and related interventions are necessary.
ProQuest ID
Recommended Citation
Seghatol-Eslami, Victoria, "Secondary Medical Conditions In Pediatric Survivors Of Acute Lymphoblastic Leukemia: Role In Performance-Based Neurocognitive Functioning, Caregiver-Reported Outcomes, And Adaptive Functioning And Transition Readiness Intervention" (2025). All ETDs from UAB. 7450.
https://digitalcommons.library.uab.edu/etd-collection/7450
