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Brown M, Pearce M, Bailey S, Skinner R. The long-term psychosocial impact of cancer: the views of young adult survivors of childhood cancer. Eur J Cancer Care (Engl) 2015; 25:428-39. [DOI: 10.1111/ecc.12380] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M.C. Brown
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | - M.S. Pearce
- Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | - S. Bailey
- Great North Children's Hospital; The Royal Victoria Infirmary; Newcastle upon Tyne UK
- Northern Institute for Cancer Research; Newcastle University; Newcastle upon Tyne UK
| | - R. Skinner
- Great North Children's Hospital; The Royal Victoria Infirmary; Newcastle upon Tyne UK
- Northern Institute for Cancer Research; Newcastle University; Newcastle upon Tyne UK
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Bull KS, Liossi C, Peacock JL, Yuen HM, Kennedy CR. Screening for cognitive deficits in 8 to 14-year old children with cerebellar tumors using self-report measures of executive and behavioral functioning and health-related quality of life. Neuro Oncol 2015. [PMID: 26203065 DOI: 10.1093/neuonc/nov129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to identify a brief screening measure for detection of cognitive deficit in children treated for cerebellar tumors that would be useful in clinical practice. METHODS A sample of 72 children, aged 8-14 years, and within 3 years post diagnosis for standard-risk medulloblastoma (n = 37) or low-grade cerebellar astrocytoma (n = 35) and 38 children in a nontumor group were assessed using teacher-, parent-, and child-report of the Behavior Rating Inventory of Executive Function (BRIEF), Strengths and Difficulties Questionnaire (SDQ), and Pediatric Quality of Life Inventory (PedsQL). The accuracy of these scores as a screen for a full-scale Intelligence Quotient (FSIQ) < 80 on the Wechsler Intelligence Scale for Children (WISC-IV UK) was assessed using their receiver operating characteristic (ROC) curves. RESULTS The questionnaires with the highest areas under the ROC curves were the child- and parent-report PedsQL, the teacher-report BRIEF, and the SDQ. At optimal cutoff scores, their sensitivities (95% CIs) to cases of FSIQ < 80 were 84 (60-96)%, 65 (41-84)%, 79 (54-93)%, and 84 (60-96)%, and their specificities (95% CIs) were 79 (68-86)%, 87 (77-93)%, 77 (66-86)%, and 71 (64-84)% respectively. All cases of FSIQ < 80 screened positive on either teacher-report SDQ or self-report PedsQL. CONCLUSIONS The PedsQL child- and parent-report and the teacher-report BRIEF and SDQ have moderately good accuracy for discriminating between children with and without a FSIQ < 80. The PedsQL could be used in a clinical setting, and the BRIEF and SDQ in an educational setting, to screen for cases with FSIQ < 80 in children treated for brain tumors.
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Affiliation(s)
- Kim S Bull
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Christina Liossi
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Janet L Peacock
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
| | - Colin R Kennedy
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK (K.S.B., H.M.Y, C.R.K.); University Hospital Southampton NHS Foundation Trust, Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK (C.L.); Division of Health and Social Care Research, King's College London, London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK (J.L.P.)
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Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study. Br J Cancer 2015; 112:1857-65. [PMID: 25989269 PMCID: PMC4580396 DOI: 10.1038/bjc.2015.159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 12/02/2022] Open
Abstract
Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study. Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital status, alcohol and smoking habits, and educational qualifications were investigated for survivors who completed a questionnaire. Results: Survivors were seven times more likely to experience all-cause mortality than expected, and there were substantial differences in risk depending on tumour type. Beyond 25 years follow-up the risk of dying from all-causes was comparable to the general population. This is in contrast to dying before 25 years where the risk was 12.7-fold that expected. Survivors were also four times more likely to develop a SPN than expected, where the excess was restricted to 5–24 years post diagnosis. Increased health-care usage and poor health status were also found. Nonetheless, for some psychosocial outcomes survivors were better off than expected. Conclusions: Up to 25 years after 5-year survival, bone sarcoma survivors are at substantial risk of death and SPNs, but this is greatly reduced thereafter. As 95% of all excess deaths before 25 years follow-up were due to recurrences and SPNs, increased monitoring of survivors could prevent mortality. Furthermore, bone and breast SPNs should be a particular concern. Since there are variations in the magnitude of excess risk depending on the specific adverse outcome under investigation and whether the survivors were initially diagnosed with osteosarcoma or Ewing sarcoma, risks need to be assessed in relation to these factors. These findings should provide useful evidence for risk stratification and updating clinical follow-up guidelines.
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Educational attainment among long-term survivors of cancer in childhood and adolescence: a Norwegian population-based cohort study. J Cancer Surviv 2015; 10:87-95. [PMID: 25929213 DOI: 10.1007/s11764-015-0453-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The number of young cancer survivors has increased over the past few decades due to improvement in treatment regimens, and understanding of long-term effects among the survivors has become even more important. Educational achievements and choice of educational fields were explored here. METHODS Five-year cancer survivors born in Norway during 1965-1985 (diagnosed <19 years) were included in our analysis by linking Norwegian population-based registries. Cox regression was applied to study the educational attainment among survivors of central nervous system (CNS) tumours, those assumed to have received CNS-directed therapy, and other cancer survivors relative to the cancer-free population. Logistic regression was used to compare the choice of educational fields between the cancer survivors at undergraduate and graduate level and the cancer-free population. RESULTS Overall, a lower proportion of the cancer survivors completed intermediate (67 vs. 70 %), undergraduate (31 vs. 35 %) and graduate education (7 vs. 9 %) compared with the cancer-free population. Deficits in completion of an educational level were mainly observed among survivors of CNS-tumours and those assumed to have received CNS-directed therapy. Choices of educational fields among cancer survivors were in general similar with the cancer-free population at both undergraduate and graduate levels. CONCLUSION Survivors of CNS-tumours and those assumed to have received CNS-directed therapy were at increased risk for educational impairments compared with the cancer-free population. Choices of educational fields were in general similar. IMPLICATIONS FOR CANCER SURVIVORS Careful follow-up of the survivors of CNS-tumours and those assumed to have received CNS-directed therapy is important at each level of education.
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Dumas A, Cailbault I, Perrey C, Oberlin O, De Vathaire F, Amiel P. Educational trajectories after childhood cancer: When illness experience matters. Soc Sci Med 2015; 135:67-74. [PMID: 25957162 DOI: 10.1016/j.socscimed.2015.04.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With the increase in survival from childhood cancer, research has increasingly focused on the educational and professional achievements of childhood cancer survivors. Yet, if large-scale studies provide an acute description of the current situation of childhood cancer survivors, little is known about their trajectories and the social processes shaping these trajectories. Using a qualitative methodology, drawing from a life course perspective, this study sought to describe the role of childhood cancer and its side effects in educational trajectories, as perceived by the participants. We investigated related processes of social adjustment to cancer, that is to say, choices or decisions that survivors related to the illness in the making of their career plans. Eighty long-term French childhood cancer survivors participating in the Euro2K longitudinal study were interviewed through in-depth, face-to-face interviews undertaken in 2011-2012. There were various types of impact described by respondents of the diagnosis of cancer on their trajectories. These varied according to gender. In women, childhood cancer tended to result in poor educational achievement, or in steering the individual towards a health care or child care occupation. This was justified by a desire to return the support that had been offered to them as patients. In men, however, childhood cancer led to a shift in career plans, because of physical sequelae, or because of concerns about their future health. Paradoxically, this limitation had a positive impact in their occupational achievement, as most of these men disregarded blue-collar jobs and chose more qualified white-collar occupations. Overall, findings suggest that childhood cancer influenced educational trajectories and, thus, socioeconomic status in adulthood, through mechanisms embedded in gender norms. These mechanisms could explain gender inequalities in educational achievement after childhood cancer reported in large-scale cohort studies.
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Affiliation(s)
- A Dumas
- Gustave Roussy, Department of Clinical Research, Social and Human Sciences Research Unit, Villejuif, F-94805, France.
| | - I Cailbault
- Gustave Roussy, Department of Clinical Research, Social and Human Sciences Research Unit, Villejuif, F-94805, France.
| | - C Perrey
- Gustave Roussy, Department of Clinical Research, Social and Human Sciences Research Unit, Villejuif, F-94805, France.
| | - O Oberlin
- Gustave Roussy, Department of Pediatric and Adolescent Oncology, Villejuif, F-94805, France.
| | - F De Vathaire
- CESP Centre for Research in Epidemiology and Population Health, U1018, Radiation Epidemiology Team, Villejuif, F-94807, France; Gustave Roussy, Villejuif, F-94805, France; Université Paris XI, Villejuif, 94800, France.
| | - P Amiel
- Gustave Roussy, Department of Clinical Research, Social and Human Sciences Research Unit, Villejuif, F-94805, France.
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Bonneau J, Dugas K, Louis A, Morel L, Toughza J, Frappaz D. [Educational and social outcome after childhood cancer]. Bull Cancer 2015; 102:691-7. [PMID: 25917346 DOI: 10.1016/j.bulcan.2015.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/22/2015] [Indexed: 11/26/2022]
Abstract
The survival rate improvement of childhood cancer survivors lead to question about their educational and social outcome. Authors suggest an international review in order to find risk factors of school or social failure after cancer experience. Principal cohort is studied in USA (the Children Cancer Survivor Study). Nevertheless, European studies are also published. The results vary, depending on subpopulation studied and on control choice (siblings or general population). Treatment improvement and supportive care make difficult to compare studies with current situations. Moreover, there are not international standard of education or social outcome. School and social behaviour are influenced by: types of tumor (cerebral tumor but also sometimes hemopathy and osteosarcoma), age at diagnosis (very young children and adolescent), treatments (neurotoxical treatments, hematopoietic stem cell transplant), and social or educational status of the parents.
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Affiliation(s)
- Jacinthe Bonneau
- CHU, hôpital Sud, unité d'hématologie oncologie pédiatrique, 35203 Rennes, France.
| | - Karyn Dugas
- CHU de Pellegrin, maison Aquitaine ressources pour les adolescents et jeunes adultes (MARADJA), 33000 Bordeaux, France
| | - Aurélien Louis
- Centre hospitalier de Chalon-sur-Saône, unité de Pédiatrie, 71321 Chalon-sur-Saone, France
| | - Laëtitia Morel
- CHU, hôpital Sud, unité d'hématologie oncologie pédiatrique, 35203 Rennes, France
| | - Jihane Toughza
- Institut hématologie oncologie pédiatrique (IHOP), oncologie pédiatrique, 69008 Lyon, France
| | - Didier Frappaz
- Institut hématologie oncologie pédiatrique (IHOP), oncologie pédiatrique, 69008 Lyon, France
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Neurocognitive outcomes and school performance in solid tumor cancer survivors lacking therapy to the central nervous system. J Pers Med 2015; 5:83-90. [PMID: 25867598 PMCID: PMC4493487 DOI: 10.3390/jpm5020083] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/27/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022] Open
Abstract
School performance in patients who have received therapy for childhood cancers has been studied in depth. Risk factors have historically included cranial radiation, intrathecal chemotherapy, and high doses of chemotherapy, including methotrexate and cytarabine. Leukemia and brain tumor survivors who receive such therapy have been the primary focus of this area of investigation. Extracranial solid tumor cancer patients lacking such risk factors have historically been expected to have normal school performance. We examined the medical records of 58 young pediatric extracranial solid tumor patients who lacked CNS-directed therapy or other known risk factors for cognitive impairment to evaluate the incidence of reported difficulties or abnormalities in neuropsychological testing. Thirty-one percent of patients were found to have at least one reported difficulty or abnormality. Of note, 34% of patients with Wilms tumor possessed difficulties compared to 23% of patients with other extracranial solid tumors. Extracranial solid tumor cancer survivors without known risk factors for school performance difficulties appear to have a higher incidence of problems than expected.
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Winterling J, Jervaeus A, af Sandeberg M, Johansson E, Wettergren L. Perceptions of School Among Childhood Cancer Survivors. J Pediatr Oncol Nurs 2015; 32:201-8. [DOI: 10.1177/1043454214563405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim was to investigate how childhood cancer survivors perceive school and whether their perceptions differ from corresponding descriptions of peers. Survivors (n = 48) currently attending educational institutions (median 5 years post diagnosis; now aged 12-21 years) from a national cohort of school-age children were compared with matched peers (n = 47). Data were collected through interviews and analyzed qualitatively and quantitatively. The results indicate that survivors and peers perceive school similarly; almost 90% described high well-being in school and indicated that they were motivated and received no additional tutoring; approximately 60% reported no difficulties achieving learning objectives. A few differences were found; survivors described themselves as more satisfied with their academic performance and school environment, but less satisfied with friends, than peers did. Previous treatment with radiation was associated with lower academic satisfaction among survivors. It is suggested that survivors perceive school overall as positive and do not have more problems reaching educational goals than their peers. However, quality of relationships with friends needs further investigation.
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Affiliation(s)
- Jeanette Winterling
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Jervaeus
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Margareta af Sandeberg
- Department of Women’s and Children’s Health, Karolinska Institutet, and Department of Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Johansson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lena Wettergren
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
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Bull KS, Liossi C, Culliford D, Peacock JL, Kennedy CR. Child-related characteristics predicting subsequent health-related quality of life in 8- to 14-year-old children with and without cerebellar tumors: a prospective longitudinal study. Neurooncol Pract 2014; 1:114-122. [PMID: 26034623 DOI: 10.1093/nop/npu016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We identified child-related determinants of health-related quality of life (HRQoL) in children aged 8-14 years who were treated for 2 common types of pediatric brain tumors. METHODS Questionnaire measures of HRQoL and psychometric assessments were completed by 110 children on 3 occasions over 24 months. Of these 110, 72 were within 3 years of diagnosis of a cerebellar tumor (37 standard-risk medulloblastoma, 35 low-grade cerebellar astrocytoma), and 38 were in a nontumor group. HRQoL, executive function, health status, and behavioral difficulties were also assessed by parents and teachers as appropriate. Regression modeling was used to relate HRQoL z scores to age, sex, socioeconomic status, and 5 domains of functioning: Cognition, Emotion, Social, Motor and Sensory, and Behavior. RESULTS HRQoL z scores were significantly lower after astrocytoma than those in the nontumor group and significantly lower again in the medulloblastoma group, both by self-report and by parent-report. In regression modeling, significant child-related predictors of poorer HRQoL z scores by self-report were poorer cognitive and emotional function (both z scores) and greater age (years) at enrollment (B = 0.038, 0.098, 0.136, respectively). By parent-report, poorer cognitive, emotional and motor or sensory function (z score) were predictive of lower subsequent HRQoL of the child (B = 0.043, 0.112, 0.019, respectively), while age at enrollment was not. CONCLUSIONS Early screening of cognitive and emotional function in this age group, which are potentially amenable to change, could identify those at risk of poor HRQoL and provide a rational basis for interventions to improve HRQoL.
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Affiliation(s)
- Kim S Bull
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Christina Liossi
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - David Culliford
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Janet L Peacock
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Colin R Kennedy
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
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Neurodevelopmental Outcome of Childhood Cancer Survivors Treated at the Eric Williams Medical Sciences Complex. W INDIAN MED J 2014; 63:582-7. [PMID: 25803371 DOI: 10.7727/wimj.2013.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/24/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the neurodevelopmental outcome of childhood cancer survivors treated at the Eric Williams Medical Sciences Complex (EWMSC). METHODS Study participants were children treated at EWMSC from January 2003 to March 31, 2012 for various childhood cancers. All had completed treatment and were in remission. The McCarthy Scales of Children's Abilities (MSCA) was administered. The study was conducted from December 2011 to March 31, 2012. RESULTS Twenty-six children were evaluated, a response rate of 74%. There were 12 males and 14 females. Ages ranged from 3.25 to 9.00 years. Four (15.4%) children scored a general cognitive index (GCI) < 68. One child (3.8%) scored a GCI > 132. The children's mean estimated mental age was found to be significantly lower than their mean actual age (p = 0.0086). Children treated for solid tumours had the least difference between their actual ages and estimated mental ages (p = 0.0301). The mean GCI for the genders was 97.4 for females and 81.0 for males; this difference was statistically significant (p = 0.0302). Age at diagnosis, type and length of treatment were not found to significantly affect development. CONCLUSION The paediatric cancer survivors in this survey were found to have delays in their development. This group of children should have their development closely monitored. This would ensure that any delays in development can be discovered early and appropriate interventions instituted, so that childhood cancer survivors are adequately prepared for adult life beyond cancer.
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61
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Roberts RM, Robins T, Gannoni AF, Tapp H. Survivors of Childhood Cancer in South Australia Attending a Late-Effects Clinic: A Descriptive Report of Psychological, Cognitive, and Academic Late-Effects. J Psychosoc Oncol 2014; 32:152-66. [DOI: 10.1080/07347332.2013.873998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Howard AF, Tan de Bibiana J, Smillie K, Goddard K, Pritchard S, Olson R, Kazanjian A. Trajectories of social isolation in adult survivors of childhood cancer. J Cancer Surviv 2014; 8:80-93. [PMID: 24202698 PMCID: PMC3923114 DOI: 10.1007/s11764-013-0321-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 10/15/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Long-term childhood cancer survivors may be at increased risk for poor social outcomes as a result of their cancer treatment, as well as physical and psychological health problems. Yet, important challenges, namely social isolation, are not well understood. Moreover, survivors' perspectives of social isolation as well as the ways in which this might evolve through young adulthood have yet to be investigated. The purpose of this research was to describe the trajectories of social isolation experienced by adult survivors of a childhood cancer. METHODS Data from 30 in-depth interviews with survivors (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, constant comparative methods. RESULTS Experiences of social isolation evolved over time as survivors grew through childhood, adolescence and young adulthood. Eleven survivors never experienced social isolation after their cancer treatment, nor to the present day. Social isolation among 19 survivors followed one of three trajectories; (1) diminishing social isolation: it got somewhat better, (2) persistent social isolation: it never got better or (3) delayed social isolation: it hit me later on. CONCLUSIONS Knowledge of when social isolation begins and how it evolves over time for different survivors is an important consideration for the development of interventions that prevent or mitigate this challenge. IMPLICATIONS FOR CANCER SURVIVORS Assessing and addressing social outcomes, including isolation, might promote comprehensive long-term follow-up care for childhood cancer survivors.
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Affiliation(s)
- A Fuchsia Howard
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada,
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Abstract
Survival rates for most paediatric cancers have improved at a remarkable pace over the past four decades. In developed countries, cure is now the probable outcome for most children and adolescents who are diagnosed with cancer: their 5-year survival rate approaches 80%. However, the vast majority of these cancer survivors will have at least one chronic health condition by 40 years of age. The burden of responsibility to understand the long-term morbidity and mortality that is associated with currently successful treatments must be borne by many, including the research and health care communities, survivor advocacy groups, and governmental and policy-making entities.
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Affiliation(s)
- Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
| | - Melissa M Hudson
- 1] Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA. [2] Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA
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Landy DC, Lipsitz SR, Kurtz JM, Hinkle AS, Constine LS, Adams MJ, Lipshultz SE, Miller TL. Dietary quality, caloric intake, and adiposity of childhood cancer survivors and their siblings: an analysis from the cardiac risk factors in childhood cancer survivors study. Nutr Cancer 2013; 65:547-55. [PMID: 23659446 DOI: 10.1080/01635581.2013.770042] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors are at increased risk of cardiovascular disease, in part because of adiposity. Whether survivors have healthy diets and whether dietary quality is associated with adiposity among survivors are not known. Survivors and siblings from the Cardiac Risk Factors in Childhood Cancer Survivors Study completed 3-day food records that were used to estimate daily caloric intake relative to recommended and dietary quality using the Healthy Eating Index-2005 (HEI). Medical records were reviewed for cancer therapies. Body composition was measured by dual-energy x-ray absorptiometry. Of 91 childhood cancer survivors and 30 sibling controls, there were no marked differences in mean daily caloric intakes (98% vs. 100% of recommended) or HEI total scores (55.5 vs. 53.3), respectively, with both groups scoring worst for the consumption of dark green vegetables and whole grains. Survivors exposed to cranial irradiation had lower total HEI scores (-6.4, P = 0.01). Among survivors, better dietary quality, as reflected by the total HEI score, was associated with decreasing percent body fat (β = -0.19, P = 0.04). Survivors consume diets similar to their siblings although these diets are only moderately adherent to current guidelines. Decreased dietary quality is associated with higher body fat and receipt of cranial irradiation in survivors.
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Affiliation(s)
- David C Landy
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida 33101, USA
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Study protocol: Rehabilitation including Social and Physical activity and Education in Children and Teenagers with Cancer (RESPECT). BMC Cancer 2013; 13:544. [PMID: 24229362 PMCID: PMC3832686 DOI: 10.1186/1471-2407-13-544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 10/24/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND During cancer treatment children have reduced contact with their social network of friends, and have limited participation in education, sports, and leisure activities. During and following cancer treatment, children describe school related problems, reduced physical fitness, and problems related to interaction with peers. METHODS/DESIGN The RESPECT study is a nationwide population-based prospective, controlled, mixed-methods intervention study looking at children aged 6-18 years newly diagnosed with cancer in eastern Denmark (n=120) and a matched control group in western Denmark (n=120). RESPECT includes Danish-speaking children diagnosed with cancer and treated at pediatric oncology units in Denmark. Primary endpoints are the level of educational achievement one year after the cessation of first-line cancer therapy, and the value of VO2max one year after the cessation of first-line cancer therapy. Secondary endpoints are quality of life measured by validated questionnaires and interviews, and physical performance. RESPECT includes a multimodal intervention program, including ambassador-facilitated educational, physical, and social interventions. The educational intervention includes an educational program aimed at the child with cancer, the child's schoolteachers and classmates, and the child's parents. Children with cancer will each have two ambassadors assigned from their class. The ambassadors visit the child with cancer at the hospital at alternating 2-week intervals and participate in the intervention program. The physical and social intervention examines the effect of early, structured, individualized, and continuous physical activity from diagnosis throughout the treatment period. The patients are tested at diagnosis, at 3 and 6 months after diagnosis, and one year after the cessation of treatment. The study is powered to quantify the impact of the combined educational, physical, and social intervention programs. DISCUSSION RESPECT is the first population-based study to examine the effect of early rehabilitation for children with cancer, and to use healthy classmates as ambassadors to facilitate the normalization of social life in the hospital. For children with cancer, RESPECT contributes to expanding knowledge on rehabilitation that can also facilitate rehabilitation of other children undergoing hospitalization for long-term illness. TRIAL REGISTRATION Clinical Trials.gov: file. NCT01772849 and NCT01772862.
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Glaser A, Levitt G, Morris P, Tapp J, Gibson F. Enhanced quality and productivity of long-term aftercare of cancer in young people. Arch Dis Child 2013; 98:818-24. [PMID: 23966026 DOI: 10.1136/archdischild-2013-304348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Long-term morbidity associated with survival from childhood cancer is well defined. Traditional models of hospital-based long-term aftercare are not sustainable and may not be necessary for all. A programme to support development and implementation of redesigned care pathways is reported. METHOD Application of service improvement methodologies to identify the case for change, to evidence development of, and test, new aftercare pathways. RESULTS Four models of aftercare were identified; traditional cancer centre-delivered medical follow-up, shared care with local hospitals or primary care, specialist nurse-led supported management and self-management. Key components required for successful implementation of risk-stratified care included; comprehensive information transfer with treatment summaries and care plans, provision of care coordinators, effective transition across services, remote monitoring systems, educating professionals, maintaining patient choice. CONCLUSIONS Adoption of risk-stratified evidence-based aftercare pathways, generated through application of service improvement methodologies, can result in the delivery of enhanced quality and productivity.
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Affiliation(s)
- Adam Glaser
- Department of Paediatric and Adolescent Oncology, Leeds Teaching Hospitals NHS Trust, , Leeds, UK
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Yilmaz MC, Sari HY, Cetingul N, Kantar M, Erermis S, Aksoylar S. Determination of School-Related Problems in Children Treated for Cancer. J Sch Nurs 2013; 30:376-84. [DOI: 10.1177/1059840513506942] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This descriptive and case–control study was carried out in a pediatric oncology outpatient clinic to determine the school-related physical, social, and psychological problems and problems experienced in academic achievement of children treated for cancer. The sample of the study consisted of 56 Turkish patients with cancer, aged 7–18 years, who were in remission and attending school as well as their parents, a control group of patients who did not have cancer, and their teachers. A Child Information Form, a Child Health Questionnaire Parent’s Form of 50 questions, a Behavior Evaluation Scale for Children, and Young People and a Teacher’s Report Form were used as data collection tools in the study. Of the children, 30.3% experienced various physical difficulties stemming from cancer therapy that affected their school life. The number of late enrollments, the number of children repeating a grade, and the rates of school absenteeism were also found to be higher in the survivors than in the controls.
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Affiliation(s)
- Medine C. Yilmaz
- Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Hatice Yildirim Sari
- Nursing Department, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Nazan Cetingul
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Kantar
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serpil Erermis
- Child Psychiatric Department, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serap Aksoylar
- Pediatric Oncology Department, Ege University Faculty of Medicine, Izmir, Turkey
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Quigg TC, Mahajerin A, Sullivan PD, Pradhan K, Bauer NS. Ages and Stages Questionnaires-3 developmental screening of infants and young children with cancer. J Pediatr Oncol Nurs 2013; 30:235-41. [PMID: 23867965 PMCID: PMC4026287 DOI: 10.1177/1043454213493510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Ages and Stages Questionnaires-3® (ASQ-3) for developmental screening in our young oncology patients was pilot tested in children 4 to 48 months of age with newly diagnosed cancer. Subjects were screened within 28 days of diagnosis (baseline), at 6 and 12 months. Twenty-six of 30 enrolled parents (87%) completed all 3 screens. Screens were completed by parents within 15 minutes. ASQ-3 screening identified unsuspected developmental delays as follows: 7 at baseline, 4 at 6 months, and 3 at 12 months. ASQ-3 developmental screening is feasible, identifies early developmental delays in young children with cancer, and helps initiate appropriate referrals.
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Affiliation(s)
- Troy C. Quigg
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Arash Mahajerin
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Paula D. Sullivan
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Kamnesh Pradhan
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Nerissa S. Bauer
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Krull KR, Zhang N, Santucci A, Srivastava DK, Krasin MJ, Kun LE, Pui CH, Robison LL, Hudson MM, Armstrong GT. Long-term decline in intelligence among adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiation. Blood 2013; 122:550-3. [PMID: 23744583 PMCID: PMC3724191 DOI: 10.1182/blood-2013-03-487744] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/31/2013] [Indexed: 11/20/2022] Open
Abstract
Survivors of childhood acute lymphoblastic leukemia (ALL) treated with cranial radiation therapy (CRT) are at risk for cognitive impairment, although whether impairment progresses with age into adulthood is unknown. We report change in intelligence for 102 adult survivors of childhood ALL (age range, 26.6-54.7 years) during a median interval of 28.5 years. Survivors demonstrated lower Performance intelligence (mean, 95.3; standard deviation, 16.5; P = .005) but not Verbal IQ (mean, 97.4; standard deviation, 15.44; P = .09) at initial testing. Verbal intelligence declined an average of 10.3 points (P < .0001) during the follow-up interval with no decline in Performance intelligence. Decline was associated with current attention problems (P = .002) but not gender, CRT dose, age at CRT exposure, or years between testing. Results suggest long-term survivors of childhood ALL treated with CRT are at risk for progressive decline in verbal intellect, which may be driven by attention deficits. This trial was registered at clinicaltrials.gov as no. NCT00760656.
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Affiliation(s)
- Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105-3678, USA.
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McLoone JK, Wakefield CE, Cohn RJ. Childhood cancer survivors' school (re)entry: Australian parents' perceptions. Eur J Cancer Care (Engl) 2013; 22:484-92. [PMID: 23730821 DOI: 10.1111/ecc.12054] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2013] [Indexed: 11/27/2022]
Abstract
Starting or returning to school after intense medical treatment can be academically and socially challenging for childhood cancer survivors. This study aimed to evaluate the school (re)entry experience of children who had recently completed cancer treatment. Forty-two semi-structured telephone interviews were conducted to explore parents' perceptions of their child's (re)entry to school after completing treatment (23 mothers, 19 fathers, parent mean age 39.5 years; child mean age 7.76 years). Interviews were analysed using the framework of Miles and Huberman and emergent themes were organised using QSR NVivo8. Parents closely monitored their child's school (re)entry and fostered close relationships with their child's teacher to ensure swift communication of concerns should they arise. The most commonly reported difficulty related to aspects of peer socialisation; survivors either displayed a limited understanding of social rules such as turn taking, or related more to older children or teachers relative to their peers. Additionally, parents placed a strong emphasis on their child's overall personal development, above academic achievement alone. Improved parent, clinician and teacher awareness of the importance of continued peer socialisation during the treatment period is recommended in order to limit the ongoing ramifications this may have on school (re)entry post-treatment completion.
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Affiliation(s)
- J K McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.
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Adults with Childhood Onset Disabilities: A Focused Review of Three Conditions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0012-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zynda A, Reinmuth S, Pfitzer C, Hohmann C, Keil T, Borgmann-Staudt A. Childhood leukemia and its impact on graduation and having children: results from a national survey. Leuk Lymphoma 2013; 53:2419-22. [PMID: 22667337 DOI: 10.3109/10428194.2012.688965] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To assess the level of graduation, the wish to have children and the course of pregnancy among former patients with childhood leukemia in comparison to the general German population and depending on gender, a nationwide survey was conducted in 2008. In total 63.6% (1476/2319) of the contacted survivors of childhood leukemia participated (mean age 25.7 years, range 19-43 years). Survivors graduated at higher levels of school compared to the general population, with 48.6% (female) versus 38.0% and 52.6% (male) versus 35.8% (p < 0.001). Also, 93.3% of female and 89.3% of male survivors indicated a similar general wish to have children compared to the general population. Survivors reported parenthood less frequently compared to the general population (p < 0.001). The course of pregnancy in survivors was characterized by fewer abortions (p < 0.001). Having leukemia in childhood and adolescence impairs the likelihood of becoming a parent but reduces neither the wish to have children nor the level of graduation.
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Affiliation(s)
- Anne Zynda
- Department of Pediatric Oncology/Hematology/Stem Cell Transplantation, Charité University Medical Center Berlin, Germany
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73
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Yağci-Küpeli B, Yalçin B, Küpeli S, Varan A, Akyüz C, Kutluk T, Büyükpamukçu M. Educational achievement, employment, smoking, marital, and insurance statuses in long-term survivors of childhood malignant solid tumors. J Pediatr Hematol Oncol 2013; 35:129-33. [PMID: 23412588 DOI: 10.1097/mph.0b013e318284127d] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE Survivors of childhood cancer experience many social adaptation problems. We aimed to identify social, educational, and occupational issues of this growing population. PATIENTS AND METHODS Survivors treated for childhood malignant solid tumors who were older than 18 years and in remission for at least 3 years were surveyed. The educational achievement, employment, type of habitation, marital status, parenthood, social insurance, and smoking status of the patients were inquired and recorded. RESULTS Two hundred one patients (126 male patients/75 female patients) were included in the study between 2007 and 2009. The median ages at the time of diagnosis and at the time of study were 10 years (range, 0 to 19 y) and 23 years (range, 18 to 39 y), respectively. The median follow-up duration was 13.5 years (range, 3 to 31 y). Nearly half of the participants were lymphoma survivors. One hundred eleven (55.5%) survivors were high school graduates and 47 (23%) were university graduates. Unemployment rate was 36.8%. Public social insurance rate was 90.5%. Fifty-three (26.4%) survivors had independent habitation. Thirty percent of survivors were married and 7.5% had at least 1 child. Marriage rates were significantly higher in survivors who were older than 23 years, had a follow-up duration of >13 years, had a job, and lived independently (for each parameter P=0.001). University degree was significantly lower in survivors who were treated for central nervous system tumors. CONCLUSIONS Our results have drawn a more marked picture with lower educational achievement and marital rates when compared with the results of large survivorship studies conducted in developed countries. However, they can be interpreted as intriguing when limited resources are taken into account.
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Affiliation(s)
- Begül Yağci-Küpeli
- Department of Pediatric Oncology, Hacettepe University, Sihhiye, Ankara, Turkey.
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School attendance in childhood cancer survivors and their siblings. J Pediatr 2013; 162:160-5. [PMID: 22835883 DOI: 10.1016/j.jpeds.2012.06.066] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 06/06/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate school absenteeism among childhood cancer survivors and their siblings and examine factors related to absenteeism in survivors. STUDY DESIGN A cross-sectional study was conducted among consecutive cancer survivors attending a large pediatric cancer survivor clinic. Absenteeism rates were obtained for survivors and their closest in age sibling from school report cards. Absenteeism was compared with a population control group of 167752 students using 1-sample t tests. The Child Vulnerability Scale, Pediatric Quality of Life Inventory, and Behavior Assessment System for Children were administered to survivors. Univariate and multiple regression analyses assessed variables associated with days absent. RESULTS One hundred thirty-one survivors (median age at assessment: 13.4 years, range 8.0-19.2; median age at diagnosis: 9.4 years, range 4.3-17.3) and 77 siblings (median age at assessment: 13 years, age range 7-18) participated. Survivors and siblings missed significantly more school days than the population control group (mean ± SD: 9.6 ± 9.2 and 9.9 ± 9.8 vs 5.0 ± 5.6 days, respectively, P < .0001). Among matched survivor-sibling pairs (N = 77), there was no difference in absenteeism (9.6 ± 9.2 vs 9.9 ± 9.8 days, P = .85). Absenteeism in survivors was significantly associated with a low Pediatric Quality of Life Inventory Physical Health Summary Score (P = .01). Parents' perception of their child's vulnerability and emotional and social functioning were not associated with absenteeism. CONCLUSIONS Childhood cancer survivors and siblings miss more school than the general population. The only predictor of absenteeism in survivors is poor physical quality of health. More research should be devoted to school attendance and other outcomes in siblings of childhood cancer survivors.
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Thompson LA, Ferdig R, Black E. Online schools and children with special health and educational needs: comparison with performance in traditional schools. J Med Internet Res 2012; 14:e62. [PMID: 22547538 PMCID: PMC3384422 DOI: 10.2196/jmir.1947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/26/2012] [Accepted: 02/28/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States, primary and secondary online schools are institutions that deliver online curricula for children enrolled in kindergarten through 12th grade (K-12). These institutions commonly provide opportunities for online instruction in conjunction with local schools for students who may need remediation, have advanced needs, encounter unqualified local instructors, or experience scheduling conflicts. Internet-based online schooling may potentially help children from populations known to have educational and health disadvantages, such as those from certain racial or ethnic backgrounds, those of low socioeconomic status, and children with special health care needs (CSHCN). OBJECTIVE To describe the basic and applied demographics of US online-school users and to compare student achievement in traditional versus online schooling environments. METHODS We performed a brief parental survey in three states examining basic demographics and educational history of the child and parents, the child's health status as measured by the CSHCN Screener, and their experiences and educational achievement with online schools and class(es). Results were compared with state public-school demographics and statistical analyses controlled for state-specific independence. RESULTS We analyzed responses from 1971 parents with a response rate of 14.7% (1971/13,384). Parents of online-school participants were more likely to report having a bachelor's degree or higher than were parents of students statewide in traditional schools, and more of their children were white and female. Most notably, the prevalence of CSHCN was high (476/1971, 24.6%) in online schooling. Children who were male, black, or had special health care needs reported significantly lower grades in both traditional and online schools. However, when we controlled for age, gender, race, and parental education, parents of CSHCN or black children reported significantly lower grades in online than in traditional schooling (adjusted odds ratio [aOR] 1.45, 95% confidence interval [CI] 1.29-1.62 for CSHCN, P < .001; aOR 2.73, 95% CI 2.11-3.53 for black children, P < .001.) In contrast, parents with a bachelor's degree or higher reported significantly higher online-school grades than traditional-school grades for their children (aOR 1.45, 95% CI 1.15-1.82, P < .001). CONCLUSIONS The demographics of children attending online schools do not mirror those of the state-specific school populations. CSHCN seem to opt into online schools at a higher rate. While parents report equivalent educational achievement in online and traditional classrooms, controlling for known achievement risks suggests that CSHCN and black children have lower performance in online than in traditional schools. Given the millions of students now in online schools, future studies must test whether direct assistance in online schools, such as taking individualized education plans into consideration, will narrow known disparities in educational success. Only then can online schools emerge as a true educational alternative for at-risk populations.
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Affiliation(s)
- Lindsay A Thompson
- Department of Pediatrics, University of Florida, Gainesville, FL 32608, United States
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Kuehni CE, Strippoli MPF, Rueegg CS, Rebholz CE, Bergstraesser E, Grotzer M, von der Weid NX, Michel G. Educational achievement in Swiss childhood cancer survivors compared with the general population. Cancer 2011; 118:1439-49. [PMID: 21823113 DOI: 10.1002/cncr.26418] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to describe educational achievements of childhood cancer survivors in Switzerland compared with the general population. In particular, the authors investigated educational problems during childhood, final educational achievement in adulthood, and its predictors. METHODS Childhood cancer survivors who were aged <16 years at diagnosis from 1976 to 2003 who had survived for ≥5 years and were currently ages 20 to 40 years received a postal questionnaire during 2007 to 2009. Controls were respondents of the Swiss Health Survey ages 20 to 40 years. Educational achievement included compulsory schooling, vocational training, upper secondary schooling, and university degree. The analysis was weighted to optimize comparability of the populations. The authors analyzed the association between demographic and clinical predictors and educational achievement using multivariable logistic regression. Subgroup analyses focused on survivors aged ≥27 years. RESULTS One-third of survivors encountered educational problems during schooling (30% repeated 1 year, and 35% received supportive tutoring). In the total sample, more survivors than controls achieved compulsory schooling only (8.7% vs 5.2%) and fewer acquired a university degree (7.3% vs 11%), but more survivors than controls achieved an upper secondary education (36.1 vs 24.1%). In those aged ≥27 years, differences in compulsory schooling and university education largely disappeared. In survivors and controls, sex, nationality, language region, and migration background were strong predictors of achievement. Survivors of central nervous system tumors or those who had a relapse had poorer outcomes (P < .05). CONCLUSIONS Childhood cancer survivors encountered problems during schooling and completed professional education with some delay. However, with the exception of patients who had central nervous system tumors and those who experienced a relapse, the final educational achievement in survivors of child cancer was comparable to that of the general population.
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Affiliation(s)
- Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Growing up with a chronic illness: social success, educational/vocational distress. J Adolesc Health 2011; 49:206-12. [PMID: 21783055 PMCID: PMC3414253 DOI: 10.1016/j.jadohealth.2010.12.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/27/2010] [Accepted: 12/02/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative U.S. sample. METHODS We used data from Wave IV (2008) of the National Longitudinal Study of Adolescent Health. We compared respondents who reported childhood-onset cancer, heart disease, diabetes, or epilepsy with young adults without these chronic illnesses in terms of marriage, having children, living with parents, romantic relationship quality, educational attainment, income, and employment. Multivariate models controlled for sociodemographic factors and adult-onset chronic illness. RESULTS As compared with those without childhood chronic illness, respondents with childhood chronic illness had similar odds of marriage (odds ratios [OR] = .89, 95% CI: .65-1.24), having children (OR = .99, 95% CI: .70-1.42), and living with parents (OR = 1.49, 95% CI .94-2.33), and similar reports of romantic relationship quality. However, the chronic illness group had lower odds of graduating college (OR = .49, 95% CI: .31-.78) and being employed (OR = .56, 95% CI: .39-.80), and higher odds of receiving public assistance (OR = 2.13, 95% CI: 1.39-3.25), and lower mean income. CONCLUSIONS Young adults growing up with chronic illness succeed socially, but are at increased risk of poorer educational and vocational outcomes.
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Subspecialisation in neurosurgery-does size matter? Acta Neurochir (Wien) 2011; 153:1231-6. [PMID: 21547494 DOI: 10.1007/s00701-011-0970-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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Ishida Y, Honda M, Kamibeppu K, Ozono S, Okamura J, Asami K, Maeda N, Sakamoto N, Inada H, Iwai T, Kakee N, Horibe K. Social outcomes and quality of life of childhood cancer survivors in Japan: a cross-sectional study on marriage, education, employment and health-related QOL (SF-36). Int J Hematol 2011; 93:633-644. [PMID: 21519844 DOI: 10.1007/s12185-011-0843-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/30/2022]
Abstract
Social outcomes and quality of life (QOL) of childhood cancer survivors (CCSs) remain unknown in Japan. We investigated these outcomes in young adult CCSs compared to those of their siblings in Japan, and analyzed the association between social outcome and SF-36 health survey subscale scores. Between 2007 and 2009, we performed a cross-sectional survey using self-rating questionnaires. We estimated social outcomes and health-related QOL by performing the SF-36 in each group: CCSs with or without stem cell transplantation (SCT)/radiotherapy (RT) and their siblings. Adjusted odds ratios for outcomes of interest were estimated using logistic regression analysis. Questionnaires from 185 CCSs and 72 CCS's siblings were analyzed. There were no differences in educational attainment or annual income. The SF-36 subscale scores of CCSs with SCT and RT were significantly lower than those of siblings in physical functioning (PF) (p < 0.001 and 0.003, respectively) and general health (GH) (both p = 0.001). Lower PF scores correlated with recurrence (p = 0.041) and late effects (p = 0.010), and poor GH scores with late effects (p = 0.006). The CCSs had made efforts to attain educational/vocational goals; however, a significant proportion of CCSs who had experienced late effects remain at increased risk of experiencing diminished QOL.
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Affiliation(s)
- Yasushi Ishida
- Department of Pediatrics, St. Luke's International Hospital, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
| | - Misato Honda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, The University of Tokyo, Tokyo, Japan
| | - Shuichi Ozono
- Department of Pediatrics, Kurume University School of Medicine, Fukuoka, Japan
| | - Jun Okamura
- Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
| | - Keiko Asami
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoko Maeda
- Department of Pediatrics, Center for Clinical Research, Nagoya Medical Center, Aichi, Japan
| | - Naoko Sakamoto
- Department of Epidemiology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hiroko Inada
- Department of Pediatrics, Kurume University School of Medicine, Fukuoka, Japan
| | - Tsuyako Iwai
- Department of Hemato-Oncology, Kagawa Children's Hospital, Kagawa, Japan
| | - Naoko Kakee
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Keizo Horibe
- Department of Pediatrics, Center for Clinical Research, Nagoya Medical Center, Aichi, Japan
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81
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Tabone MD, Berger C, Pacquement H, Poirée M, Plantaz D, Michel G. État de santé et qualité de vie à long terme après guérison d’un cancer traité durant l’enfance. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2002-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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82
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Lund LW, Schmiegelow K, Rechnitzer C, Johansen C. A systematic review of studies on psychosocial late effects of childhood cancer: structures of society and methodological pitfalls may challenge the conclusions. Pediatr Blood Cancer 2011; 56:532-43. [PMID: 21298737 DOI: 10.1002/pbc.22883] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 09/28/2010] [Indexed: 11/11/2022]
Abstract
High survival rates after childhood cancer raise attention to possible psychosocial late effects. We focus on predictors of psychosocial outcomes based on diagnosis, treatment, demography, somatic disease, and methodological problems. Overall, survivors evaluate their health-related quality of life to be normal or even better than controls, although virtually all diagnostic subgroups report psychosocial impairment. Central nervous system tumor survivors have significant psychosocial problems. Negative outcomes were associated with cranial radiation therapy, female gender, and young age at diagnosis. Significant methodological problems hamper current knowledge. Systematic registration of psychosocial and somatic problems at diagnosis and prospectively through protocols is needed.
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Affiliation(s)
- Lasse Wegener Lund
- Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
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83
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Dieluweit U, Debatin KM, Grabow D, Kaatsch P, Peter R, Seitz DCM, Goldbeck L. Educational and vocational achievement among long-term survivors of adolescent cancer in Germany. Pediatr Blood Cancer 2011; 56:432-8. [PMID: 21072822 DOI: 10.1002/pbc.22806] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer. PROCEDURE Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-matched sample from the general population (German Socio-Economic Panel, n = 820, age: M = 30.4, SD = 6.7). Risk factors for educational and vocational underachievement were identified by subgroup analyses. RESULTS Compared to peers from the general population, survivors of cancer during adolescence achieved higher educational and vocational levels. A higher proportion of survivors was employed; however, survivors were significantly older when starting their first occupation. Subgroup analyses revealed that neuropsychological late effects were associated with reduced rates of graduation from university and of employment among the survivors. No such effect of neuro-cognitive late effects occurred for high school graduation. CONCLUSIONS Most German survivors of cancer during adolescence participate in school and vocational life without major difficulties. Problems particularly arise for survivors with neuropsychological sequelae. Further research should investigate whether these results can be attributed to the German support system for pediatric cancer patients or to sample effects.
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Affiliation(s)
- Ute Dieluweit
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany.
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84
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Robison LL. Late effects of acute lymphoblastic leukemia therapy in patients diagnosed at 0-20 years of age. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2011; 2011:238-242. [PMID: 22160040 DOI: 10.1182/asheducation-2011.1.238] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Survival rates for children with acute lymphoblastic leukemia (ALL) have increased dramatically over the past 4 decades, with 5-year survival rates of > 90% in recent trials. With the increasing number of children and adolescents cured of ALL, identifying and characterizing the occurrence of long-term adverse late effects has become increasingly important. In this young population, successful treatment of ALL is associated with increased risk of adverse outcomes such as late mortality, second neoplasms, chronic health conditions, endocrine dysfunction, and psychological function. Research efforts conducted through large survivor cohorts, such as the Childhood Cancer Survivor Study, are providing new and important insights into the very long-term consequences of ALL therapy, while providing direction for screening recommendations and intervention-based approaches for reducing late morbidity and mortality.
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Affiliation(s)
- Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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85
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Michel G, Kuehni CE, Rebholz CE, Zimmermann K, Eiser C, Rueegg CS, von der Weid NX. Can health beliefs help in explaining attendance to follow-up care? The Swiss Childhood Cancer Survivor Study. Psychooncology 2010; 20:1034-43. [DOI: 10.1002/pon.1823] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 06/25/2010] [Accepted: 06/25/2010] [Indexed: 11/11/2022]
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