Growing Up After Chemo: A Review of Cognitive, Behavioral, and Psychosocial Outcomes in Pediatric Cancer Survivors

Abstract

Background. Advances in pediatric oncology have increased survival rates above 80% in high-income countries, shifting attention toward long-term complications such as chemotherapy-induced cognitive impairment (CICI), commonly referred to as “chemobrain.” This condition may persist beyond treatment and significantly affect cognitive, behavioral, and psychosocial functioning in childhood cancer survivors. 

Aim. This review summarizes current knowledge on CICI in pediatric cancer survivors, which is a common late effect associated with cognitive, academic, and psychosocial difficulties that can reduce quality of life.

Material and methods. This systematic review adhered to PRISMA guidelines, searching PubMed for English-language literature (January 2015 - March 2026) regarding chemotherapy-induced cognitive impairment (CICI) in pediatric oncology populations. Search strings integrated keywords including “chemobrain,” “CRCI,” and “pediatric.” Studies were excluded if they focused on adult cohorts, lacked cognitive assessments, or were published in languages other than English. Extracted data encompassed patient demographics, treatment protocols, and cognitive outcomes. 

Results. Pediatric CICI prevalence is estimated at 40-60%, involving neuroinflammation, white matter compromise, and accelerated brain aging. Resulting deficits in memory and executive function lead to significant academic and social impairment. Diagnosis requires a multimodal framework integrating neuropsychological evaluations, neuroimaging, and biological markers.

Conclusions. CICI is a significant yet underrecognized late effect of pediatric cancer that broadly impacts cognitive, emotional, and academic development. Mitigating these effects requires early multidisciplinary management alongside research into standardized diagnostic tools and targeted interventions.