Lillian Nail's article "Cognitive Changes in Cancer Survivors" (State of the Science on Nursing Approaches to Managing Late and Long-Term Sequelae of Cancer and Cancer Treatment, supplement, March 2006; available online at http://www.nursingcenter.com/ajncancersurvivors/) brings to light a significant issue facing the growing population of cancer survivors.

As Nail reports, increased attention to cognitive impairment as a consequence of cancer therapy initially resulted from research with children treated for acute lymphoblastic leukemia. She points out that there are no guidelines for screening and treatment. While this is the case for adult cancer survivors, screening guidelines addressing issues related to neurocognitive impairment have been developed for survivors of childhood cancer. The Children's Oncology Group, of which we're members, has issued Long-Term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (http://www.survivorshipguidelines.org). 1 Screening recommendations for survivors who received therapy that can alter neurocognitive functioning (high-dose cytarabine [Cytosar-U], high-dose and intrathecal methotrexate [Rheumatrex, Trexall], neurosurgery, and radiation to the brain or total body) include a formal baseline neurocognitive evaluation (repeated as clinically indicated) and yearly assessment of the survivor's educational or vocational progress.

Wendy Landier, MSN, RN, CPNP, CPON

Duarte, CA

Kathleen Ruccione, MPH, RN, CPON, FAAN

Los Angeles, CA

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