Survivors of Childhood Cancer Clinical Trial
— WINNERSOfficial title:
Cognitive Training Through Technological Gaming To Ameliorate Cognitive Effects Related To Childhood Cancer Treatment (WINNERS)
HYPOTHESIS 1. Neurocognitive deficits in cancer survivors are underestimated. They represent a very limiting long-term side effect in this group of patients. 2. An individualized, planned and limited intervention using technological gaming can improve neurocognitive function in these pediatric patients by taking advantage of the plasticity of the central nervous system (CNS) in the pediatric age. 3. Changes can be demonstrated not only at the cognitive level, but also at the structural and functional level using neuroimaging techniques after our intervention. 4. In addition to the aforementioned benefits, this therapeutic tool can improve some clinical-analytical markers used in the follow-up of cancer survivors, such as immunological markers like lymphocyte populations and inflammatory cytokines. 5. The neurocognitive effects of this therapy are not only produced at the time of the intervention, but remain until months after the intervention. 6. The positive impact of the treatment is not only observed in the patients, but also in the psychological and emotional state of the family members. VARIABLES 1. Clinically relevant improvement with moderate or large effect size in the following parameters as measured by neuropsychological tests. 2. Statistically significant changes in neuroimaging tests. 3. Statistically significant changes in immune and inflammatory biomarkers before and after treatment. STUDY DESIGN In this clinical trial, randomized versus control group, unblinded, the aim is to demonstrate the neuropsychological, structural and functional benefit of an intervention using video games in child cancer survivors. POPULATION OF THE STUDY The target population participating in the study will include patients of either sex aged 8-17 years who completed cancer treatment 1-5 years ago. They must have received treatment with neurotoxic potential: intrathecal/intraventricular chemotherapy, high-dose chemotherapy with crossing of the blood-brain barrier, CNS radiotherapy or hematopoietic stem cell transplantation (HSCT).
Status | Recruiting |
Enrollment | 56 |
Est. completion date | February 2025 |
Est. primary completion date | September 2024 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 8 Years to 17 Years |
Eligibility | Inclusion Criteria: - Patients between 8 and 17 years of age at the time of recruitment. - Have completed treatment between 1 and 6 years prior to recruitment. - Have had one of the following diagnoses: - Patients with CNS disease (posterior fossa tumors and supratentorial gliomas smaller than 1 cm affecting associative areas). - Patients with hematologic malignancies (leukemia or lymphoma). - Patients with solid tumors. - Patients with non-malignant hematological diseases and indication for allogeneic hematopoietic progenitor transplantation. - Having received at least one of the following treatments: - Central nervous system surgery. - Central nervous system radiotherapy. - Intrathecal/intraventricular chemotherapy. - Neurotoxic systemic chemotherapy. - Hematopoietic stem cell transplantation. - Informed consent signed by parent/guardian. Exclusion Criteria: - Active oncologic disease or relapse of active oncologic disease. - Prior neurological or psychiatric pathology that may preclude trial or treatment evaluations: - Psychological or neurocognitive illness or sequelae that preclude neuropsychological assessment or are expected to significantly artifact MRI results (examples: significant decrease in visual acuity, CNS surgical scar that artifacts imaging results, severe cognitive delay that precludes testing, etc.). - Psychological or neurocognitive illnesses or sequelae that prevent or contraindicate the use of video games (epilepsy that prevents the use of screens, significant decrease in visual acuity, etc.). - Mild or self-limiting neurological or psychiatric pathology that does not interfere with trial diagnosis and treatment (headache, epilepsy in remission with effective treatment, mild cognitive delay, etc.) will be allowed. - Current or recent (less than 1 year) use of other cognitive stimulation or brain training that may interfere with study results. - Refusal to abstain from the use of the study treatment games in case of being assigned to group B (control group). - Medical treatment that may significantly interfere with neuropsychological, imaging or biomarker assessments. |
Country | Name | City | State |
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Spain | Hospital La Paz | Madrid |
Lead Sponsor | Collaborator |
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Antonio Pérez Martínez | Hospital Ruber Internacional, Universidad Rey Juan Carlos |
Spain,
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* Note: There are 12 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | SDMT Test | To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests. | Baseline | |
Primary | Change in SDMT Test | To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests. | At 3 months after recruitment | |
Primary | Change in SDMT Test | To evaluate the benefits of treatment at the neurocognitive level by means of neuropsychological tests. | At 6 months after recruitment | |
Primary | "DIGITOS" Test | To evaluate the benefits of treatment at the neurocognitive level (processing speed) | Baseline | |
Primary | Change in "DIGITOS" Test | To evaluate the benefits of treatment at the neurocognitive level (processing speed) | At 3 months after recruitment | |
Primary | Change in "DIGITOS" Test | To evaluate the benefits of treatment at the neurocognitive level (processing speed) | At 6 months after recruitment | |
Primary | "TONI-4" test | To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence) | Baseline | |
Primary | Change in "TONI-4" test | To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence) | At 3 months after recruitment | |
Primary | Change in "TONI-4" test | To evaluate the benefits of treatment at the neurocognitive level (non-verbal intelligence) | At 6 months after recruitment | |
Primary | "ROCF" test | To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory) | Baseline | |
Primary | Change in "ROCF" test | To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory) | At 3 months after recruitment | |
Primary | Change in "ROCF" test | To evaluate the benefits of treatment at the neurocognitive level (visuo-constructional ability and non-verbal memory) | At 6 months after recruitment | |
Primary | "TFV" test | To evaluate the benefits of treatment at the neurocognitive level (verbal fluency) | Baseline | |
Primary | Change in "TFV" test | To evaluate the benefits of treatment at the neurocognitive level (verbal fluency) | At 3 months after recruitment | |
Primary | Change in "TFV" test | To evaluate the benefits of treatment at the neurocognitive level (verbal fluency) | At 6 months after recruitment | |
Primary | "STROOP" test | To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control) | Baseline | |
Primary | Change in "STROOP" test | To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control) | At 3 months after recruitment | |
Primary | Change in "STROOP" test | To evaluate the benefits of treatment at the neurocognitive level (selective attention and inhibitory control) | At 6 months after recruitment | |
Primary | "TAVECI" test | To evaluate the benefits of treatment at the neurocognitive level (verbal learning) | Baseline | |
Primary | Change in "TAVECI" test | To evaluate the benefits of treatment at the neurocognitive level (verbal learning) | At 3 months after recruitment | |
Primary | Change in "TAVECI" test | To evaluate the benefits of treatment at the neurocognitive level (verbal learning) | At 6 months after recruitment | |
Primary | "CPT3" | To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks) | Baseline | |
Primary | Change in "CPT3" | To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks) | At 3 months after recruitment | |
Primary | Change in "CPT3" | To evaluate the benefits of treatment at the neurocognitive level (performance in attention tasks) | At 6 months after recruitment | |
Primary | "BRIEF" survey | To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents) | Baseline | |
Primary | Change in "BRIEF" survey | To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents) | At 3 months after recruitment | |
Primary | Change in "BRIEF" survey | To evaluate the benefits of treatment at the neurocognitive level (assessment of executive functions by parents) | At 6 months after recruitment | |
Primary | "BASC" survey | To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment) | Baseline | |
Primary | Change in "BASC" survey | To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment) | At 3 months after recruitment | |
Primary | Change in "BASC" survey | To evaluate the benefits of treatment at the neurocognitive level (Behavior Assesment) | At 6 months after recruitment | |
Primary | Statistically significant changes in neuroimaging tests | Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI). | At 3 months after recruitment | |
Primary | Statistically significant changes in neuroimaging tests | Changes in structural imaging (white matter volume, gray matter volume and total intracranial volume, brain lobe volume and voxel-based morphometry), in diffusion (diffusion maps and structural connectivity) and in functional imaging (resting-state fMRI and task-based fMRI). | At 6 months after recruitment | |
Primary | Immune and inflammatory biomarkers | Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist) | Baseline | |
Primary | Statistically significant changes in immune and inflammatory biomarkers | Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist) | At 3 months after recruitment | |
Primary | Statistically significant changes in immune and inflammatory biomarkers | Study of lymphocyte populations by parametric flow cytometry (T lymphocytes, B lymphocytes, NK lymphocytes, NK T lymphocytes) and inflammatory cytokines by LUMINEX (IL-2, IL-4, IL-6, TNF alpha, IFN gamma, IL-10, IL-17a, IL-1R antagonist) | At 6 months after recruitment | |
Secondary | Prevalence | To define the prevalence of neurocognitive deficit in cancer survivors in our population. | Baseline | |
Secondary | Perception of the family measured by satisfaction survey | To analyze the psychological and emotional perception of family members after a controlled intervention using video games. | Through study completion, 6 months |
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