Diagnosis and management of neuropsychological sequelae in pediatric cancer survivors: a multicenter survey of healthcare professionals in Spain (SENECA-PED)

For decades, the story of childhood cancer was defined by a single, urgent goal: survival. Thanks to remarkable medical advances, that goal is now being met for a growing number of children. Yet, as more young patients live long, healthy lives after their treatment ends, doctors and families are facing a new, quieter challenge. The very therapies that save lives—powerful drugs and radiation—can sometimes leave behind subtle but lasting marks on the developing brain. These marks are not physical scars, but changes in how a child thinks, learns, and processes information. They might show up as trouble remembering a story, difficulty focusing in a noisy classroom, or a struggle to organize daily tasks. While these issues are well-known in medical circles, they often go unnoticed in the busy rhythm of a hospital visit, leaving families to navigate school struggles and social hurdles without clear guidance.

A recent national study in Spain sought to understand how well the medical system is prepared to handle these invisible aftereffects. The researchers, led by a team of pediatric oncologists and psychologists, wanted to know if the doctors and nurses who care for these survivors actually see these problems, if they feel confident in spotting them, and whether the hospitals have the right tools to help. They surveyed healthcare professionals across the country, asking them to describe their daily experiences with children who have finished cancer treatment. The goal was not just to count how many children are affected, but to map the landscape of care itself: where the support exists, where it is missing, and what stands in the way of getting help to the families who need it.

The study, known as SENECA-PED, gathered responses from seventy professionals working in thirty-two different hospitals. These were the doctors, nurses, and specialists who see these children regularly. The results painted a picture of a medical community that is fully aware of the problem but often feels ill-equipped to solve it. When asked, seventy percent of the professionals said that these thinking and learning difficulties are highly important, acknowledging that they can deeply affect a child's life. However, a stark gap appeared when the researchers asked about confidence. Only about twenty-nine percent of those surveyed felt they could reliably recognize or assess these problems when they saw them. In their daily work, fewer than one-third said they frequently identified these difficulties during routine check-ups. It is as if the medical team knows a storm is coming, but many feel they do not have the right instruments to measure the wind or the rain.

The professionals identified specific areas where children struggle most. Almost everyone agreed that attention and concentration are the first to suffer, followed closely by memory, the speed at which the brain processes information, and the ability to plan and organize. When asked about the real-world impact, the answer was consistent: school performance is the area most heavily affected. More than sixty percent of the respondents said that academic achievement is the domain most likely to be harmed by these brain changes. This makes sense, given that these children are often in the middle of their most critical learning years. While family life and social relationships were also seen as impacted, the classroom remained the primary battleground where these invisible deficits become visible.

Despite this clear understanding of the risks, the way hospitals handle these issues varies wildly from one place to another. Only about twenty-nine percent of the centers surveyed had a clear, written plan for referring a child to a specialist when thinking problems were suspected. In many hospitals, the process was informal or depended entirely on the individual doctor's experience. Often, a referral was only made after a child started failing in school or if the child had received radiation directly to the brain. This reactive approach means that many children with more subtle difficulties might slip through the cracks, waiting until a problem becomes severe before getting help. Furthermore, the resources to actually treat these problems are scarce. Less than half of the professionals reported having access to a neuropsychologist—a specialist in brain function—who focuses specifically on pediatric cancer patients. Even fewer, only twenty percent, said their hospital offered a structured program to help children retrain their brains and improve their cognitive skills.

The barriers to better care were identified clearly by the professionals themselves. The most common obstacle was simply a lack of specialized staff; nearly eighty percent said there were not enough experts available to help. This was followed by a shortage of intervention resources, the absence of standard rules or protocols to follow, and a feeling that they had not received enough training to handle these complex cases. Interestingly, the study found that the more experienced a doctor was, the more likely they were to feel that the available resources were inadequate. This suggests that as professionals spend more time with these patients, they become more acutely aware of the gap between what the children need and what the system can provide.

The researchers concluded that while Spanish doctors recognize the importance of these neuropsychological issues, the actual care provided is uneven and often limited by local resources. The study does not claim that the problem is unsolvable, but it highlights that the current system relies too much on chance and individual initiative rather than a coordinated national strategy. The authors suggest that the path forward involves creating simple screening tools that families and teachers can use to flag potential problems early, establishing clear rules for when a child should see a specialist, and building a network of support that connects hospitals with schools. Until these structures are in place, many survivors will continue to face the challenge of a brain that works differently, without the specific guidance they need to thrive. The study serves as a call to move from simply knowing the problem exists to building a system that can effectively address it.