The impact of a blended cognitive remediation and cognitive behavioral group therapy for pediatric oncology survivors : a mixed methods approach

Advances in cancer treatment have led to a significant increase in the number of pediatric oncology survivors. These survivors often have late effects in their cognitive, academic, executive, and psychological functioning subsequent to their chemotherapy and radiation treatment. In particular, executive functioning (EF), which is crucial for cognitive and academic functioning, has been recognized as an area that is impacted by treatment. Several studies have described cognitive remediation programs that seek to improve EF skills in pediatric oncology survivors. Although these programs have led to improvements in EF skills, they are often difficult to replicate due to the extensive time requirement. Many survivors also experience distress and anxiety and would likely benefit from cognitive behavioral therapy, which has been shown to be an effective intervention for children with internalizing disorders. Thus, a brief intervention that combines treatment for executive functioning and psychological distress is warranted. A mixed methods study was conducted to evaluate the impact of a nine-week blended cognitive remediation and cognitive behavior therapy group for pediatric oncology survivors and their parents. Participants were pediatric cancer survivors, age 9-14, and their parents who were referred through a local children's hospital that specialized in oncology treatment. Pre and post measures of EF, psychological functioning, and parental stress were examined. Semi-structured interviews with participants and their parents were completed and analyzed to learn more about the function of short-term group therapy for pediatric oncology survivors. Content analysis of the parent support group sessions was also conducted. Significant changes were found for youth internalizing symptoms, youth adaptive skills, youth executive functioning, and parental stress. There was also a positive correlation between parental stress and parent-rated youth internalizing problems as well as parent-rated youth behavioral symptoms and a negative correlation between parental stress and parent-rated youth adaptive behavior. Qualitative interviews indicated that participants felt that the intervention was helpful. Themes from the parent group included the challenge of managing late effects, balancing multiple roles, and coping with distress. Implications, limitations, and recommendations for further areas of research are presented.