Capturing Deficits at Diagnosis: The Case for Early Speech-language Pathology Assessment of Pediatric Patients with Non-neural Cancer

Research Objectives: To ascertain the prevalence of deficits within the Speech-Language Pathology (SLP) scope of practice in children recently diagnosed with non-neural cancers.

Design: Retrospective review of speech, language, feeding, swallowing, and cognitive function surveyed via a battery of paper-based screening instruments administered at cancer diagnosis. Demographic information was extracted from the electronic health record. Descriptive statistics were used to summarize participant characteristics and screening survey results.

Setting: Inpatient oncology units at free standing, academic-affiliated healthcare system in the Southern United States.

Participants: Fifty patients between 9 months and 19 years assessed within 7 days of non-neural cancer diagnosis.

Interventions: Not Applicable

Main Outcome Measures: The battery of screening instruments included: Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Cognitive Function- Short Form 7a, Quality of Life in Neurological Disorders (Neuro-QOL) Pediatric Cognitive Function- Short Form, National Institute on Deafness and Other Communication Disorders Speech and Language Developmental Milestones, Neonatal Eating Assessment Tool Screening Instruments (NeoEAT), Pediatric Eating Assessment Tool Screening Instruments(PediEAT), and the Children’s Health Speech Therapy Oncology Screening questionnaire.

Results: At cancer diagnosis, 20% of children had prior SLP intervention and 26% had a history of disorders within the SLP scope of practice. 50% of caregivers reported their children had not attained milestones, particularly in word acquisition, word chaining, and speech sounds. Results of the Feeding Flock Screening instruments indicate that 65% of children had behaviors necessitating SLP assessment consistent with sensory aversions, oral motor delays, and feeding refusal. PROMIS and Neuro QOL screener results concurrently indicated cognitive deficits in 30% of children.

Conclusions: Caregivers reported over 1 in 4 children had disorders within the SLP scope of practice at cancer diagnosis, higher than the 6-15% documented in the non-cancer pediatric population. Our findings suggest the prevalence of disorder may be even higher, with 50% of children failing to meet speech-language milestones, 65% with concerning feeding behaviors, and 30% with cognitive deficits, possibly reflecting more recent functional change between cancer onset and diagnosis. While deficits in children with non-neural cancers are commonly attributed to the sequelae of neurotoxic treatment and abnormal developmental environment, their presence at cancer diagnosis suggests there may be other influencing factors. Further investigation is needed to determine the presence of deficits in patients not hospitalized at diagnosis as well as the benefits of early screening, SLP treatment, and other supportive care interventions in mitigating the impact of developmental, feeding, and cognitive deficits experienced by patients with childhood cancer.

Author(s) Disclosures: Author has no conflict of interest to declare.