Exploring Cultural Risk and Protective Factors for Self-Regulatory Late Effects in a Hispanic Pediatric Leukemia Survivor: a Case Study

Abstract Objective Childhood cancer survivors (CCS) are at risk for neurocognitive late effects in attention, executive function, and psychosocial functioning. Pediatric leukemia disproportionately affects Hispanic/Latino youth and approximately half of Latino CCS experience cognitive and psychosocial difficulties. While acculturation, bilingualism, family support, and/or stigma have been associated with self-regulation broadly and among Latino CCS, cultural risk and protective factors for self-regulation among Hispanic/Latino CCS remain understudied. Method Case study patient is a 10-year-old Hispanic bilingual (English/Spanish) male with Burkitt leukemia three years status-post treatment who underwent comprehensive outpatient neuropsychological testing. Cultural factors such as racial/ethnic identity, language exposure, familial stressors/support, and stigma were elicited during the intake interview. Intellectual, executive, language, memory, fine/visuo-motor, psychoemotional, and adaptive functioning were assessed. Parent-, teacher-, and self-reports of adaptive and psychoemotional functioning were also collected. Results Cognitive flexibility, fluency, inhibition, processing speed, and working memory abilities ranged from average to exceptionally high. Specifically, working memory, semantic memory, and verbal fluency abilities significantly exceeded age expectations. Subclinical inattention was endorsed by patient’s mother and teachers. Intellectual function (FSIQ = 102) and memory was preserved. Subclinical to clinically significant behavioral/emotional dysregulation was endorsed on parent-, teacher-, and self-reports. Conclusion Cognitive regulatory abilities were largely preserved, which may partially be attributed to protective factors such as bilingualism and family support. In contrast, behavioral and emotional dysregulation may have been exacerbated by family stressors and delayed help-seeking. Importantly, emotional distress can hinder resilience among CCS. Future studies on CCS late effects should examine cultural factors in addition to age at diagnosis, sex, and chemotherapy dose.