Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services

Background:Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent.Objective:To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK.Method:We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data.Results:Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate.Conclusion:We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.