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Hernádfői MV, Koch DK, Kói T, Imrei M, Nagy R, Máté V, Garai R, Donnet J, Balogh J, Kovács GT, Párniczky A, Hegyi P, Garami M. Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:548-566. [PMID: 38619829 PMCID: PMC11019450 DOI: 10.1001/jamapediatrics.2024.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024]
Abstract
Importance Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer. Objective To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers. Data Sources A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023. Study Selection Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors. Data Extraction and Synthesis Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model. Results The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls. Conclusion and Relevance Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.
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Affiliation(s)
- Márk Viktor Hernádfői
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Dóra Kornélia Koch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Vanda Máté
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Réka Garai
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Jessica Donnet
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József Balogh
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Andrea Párniczky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
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Employment among Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14194586. [PMID: 36230516 PMCID: PMC9559689 DOI: 10.3390/cancers14194586] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
To date, there are heterogeneous studies related to childhood cancer survivors’ (CCS) employment rates. Given the importance of this topic, we aimed to perform a systematic review and meta-analysis to investigate the prevalence of employment among CCS and to examine its association with socio-demographic and clinical factors. We followed the PRISMA guidelines to search for pertinent articles in relevant electronic databases. Eighty-nine articles comprising 93 cohorts were included. The overall prevalence of employment was 66% (CI: 95% 0.63–0.69). Subgroup meta-analyses showed that lower rates were found for central nervous system tumor survivors (51%, CI: 95% 0.43–0.59), and for CCS treated with cranial-radiotherapy (53%, CI: 95% 0.42–0.64) or haematopoietic stem-cell transplantation (56%, CI: 95% 0.46–0.65). The studies conducted in Asia highlighted employment rates of 47% (CI: 95%, 0.34–0.60). Univariate meta-regressions identified the following socio-demographic factors associated with higher rates of employment: a female gender (p = 0.046), a higher mean age at the time of investigation (p = 0.00), a longer time since diagnosis (p = 0.00), a higher educational level (p = 0.03), and a married status (p = 0.00). In conclusion, this systematic review and meta-analysis provides evidence that two-thirds of CCS are employed worldwide. Identifying vulnerable groups of CCS may allow for the design of multidisciplinary support strategies and interventions to promote employment in this population.
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Devine KA, Christen S, Mulder RL, Brown MC, Ingerski LM, Mader L, Potter EJ, Sleurs C, Viola AS, Waern S, Constine LS, Hudson MM, Kremer LCM, Skinner R, Michel G, Gilleland Marchak J, Schulte FSM. Recommendations for the surveillance of education and employment outcomes in survivors of childhood, adolescent, and young adult cancer: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Cancer 2022; 128:2405-2419. [PMID: 35435238 PMCID: PMC9321726 DOI: 10.1002/cncr.34215] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
Educational achievement and employment outcomes are critical indicators of quality of life in survivors of childhood, adolescent, and young adult (CAYA) cancer. This review is aimed at providing an evidence-based clinical practice guideline (CPG) with internationally harmonized recommendations for the surveillance of education and employment outcomes in survivors of CAYA cancer diagnosed before the age of 30 years. The CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of 4 existing CPGs, the authors performed a systematic literature search through February 2021. They screened articles for eligibility, assessed quality, and extracted and summarized the data from included articles. The authors formulated recommendations based on the evidence and clinical judgment. There were 3930 articles identified, and 83 of them, originating from 17 countries, were included. On a group level, survivors were more likely to have lower educational achievement and more likely to be unemployed than comparisons. Key risk factors for poor outcomes included receiving a primary diagnosis of a central nervous system tumor and experiencing late effects. The authors recommend that health care providers be aware of the risk of educational and employment problems, implement regular surveillance, and refer survivors to specialists if problems are identified. In conclusion, this review presents a harmonized CPG that aims to facilitate evidence-based care, positively influence education and employment outcomes, and ultimately minimize the burden of disease and treatment-related late adverse effects for survivors of CAYA cancers. LAY SUMMARY: A multidisciplinary panel has developed guidelines for the surveillance of education and employment outcomes among survivors of childhood, adolescent, and young adult cancer. On the basis of evidence showing that survivors are at risk for lower educational achievement and unemployment, it is recommended that all survivors receive regular screening for educational and employment outcomes.
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Affiliation(s)
- Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Salome Christen
- Health Science and Health Policy, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.,Newcastle University Centre for Cancer, Newcastle Upon Tyne, United Kingdom
| | - Lisa M Ingerski
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Luzius Mader
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Adrienne S Viola
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | | | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.,Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle Upon Tyne, United Kingdom.,Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Gisela Michel
- Health Science and Health Policy, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Fiona S M Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Alexander TC, Krull KR. Effects of chemotherapy for acute lymphoblastic leukemia on cognitive function in animal models of contemporary protocols: A systematic literature review. Neurosci Biobehav Rev 2021; 129:206-217. [PMID: 34352229 DOI: 10.1016/j.neubiorev.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 10/29/2020] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
Survival rates of childhood acute lymphoblastic leukemia (ALL) have improved greatly due to advanced therapies and supportive care. Intrathecal chemotherapy replaced cranial radiation due to radiation-induced neurotoxicity and late-effects. Survivors treated with chemotherapy-only experience neurologic and cognitive problems following cessation of treatment. Very long-term cognitive outcomes remain unclear. Animal models are being generated to assess late-effects of chemotherapy on cognitive function. Although, few address juvenile models of chemotherapy-induced cognitive impairment (CICI) and developing brain, results of this review outline neurocognitive effects of chemotherapy consistent with childhood ALL therapy. Studies demonstrate deficits across cognitive domains including spatial memory, executive function, short-term memory, anxiety and depression. Inflammation, oxidative stress, excitotoxity, and other metabolic disruptions may lead to neurodegeneration associated with cognitive impairment observed in ALL survivors. Interventions directly targeting these mechanisms may prevent and/or promote recovery of cognitive function and improve long-term outcomes. Evidence suggests success of anti-inflammatory and antioxidant treatments in reducing cognitive decline. Animal models provide basis for assessing effects of chemotherapy on neurologic processes to guide future clinical investigations.
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Affiliation(s)
- Tyler C Alexander
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States.
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Olivo EL, Woolverton K. Surviving Childhood Cancer: Disruptions in the Developmental Building Blocks of Sexuality. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/01614576.2001.11074411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Henderson PA. Psychosocial Adjustment of Adult Cancer Survivors: Their Needs and Counselor Interventions. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6676.1997.tb02332.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yonemoto T, Ishii T, Takeuchi Y, Kimura K, Hagiwara Y, Tatezaki S. Education and Employment in Long-Term Survivors of High-Grade Osteosarcoma: A Japanese Single-Center Experience. Oncology 2008; 72:274-8. [DOI: 10.1159/000113038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 07/20/2007] [Indexed: 12/18/2022]
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9
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Pang JWY, Friedman DL, Whitton JA, Stovall M, Mertens AC, Robison LL, Weiss NS. Employment status among adult survivors in the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2008; 50:104-10. [PMID: 17554791 DOI: 10.1002/pbc.21226] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND With increased cure, childhood cancer survivors are reaching adulthood and seeking employment. Host, disease and treatment risk factors may contribute to inability to attain or maintain employment. PROCEDURE The prevalence and risk factors for unemployment were evaluated using self-reported employment history in 10,399 childhood cancer survivors and 3,083 siblings >/= age 18 in the Childhood Cancer Survivor Study (CCSS). RESULTS Among survivors, 5.6% reported unemployment, compared with 1.2% of siblings (odds ratio [OR] 3.7; 95% confidence interval [CI] 2.6, 5.1). Increased risks were observed within all cancer diagnoses. In multivariate analysis, diagnosis of central nervous system (CNS) tumor (OR 1.5; 95% CI 1.1, 2.1), bone cancer (OR 1.5; 95% CI 1.0, 2.1), treatment with >/=30 Gy cranial radiotherapy (OR 4.0; 95% CI 2.9, 5.5), female gender (OR 1.4; 95% CI 1.2, 1.7) and age < 4 years at diagnosis (OR 1.4; 95% CI 1.1, 1.8) increased risk. Diagnosis of CNS or bone tumor or cranial radiotherapy >/=30 Gy remained significant after adjusting for treatment, medical late effects, age and gender. Risk of unemployment decreased with attained age (OR((year)) 0.89; 95% CI 0.87, 0.91). CONCLUSIONS Compared to siblings, adult childhood cancer survivors are at increased risk for unemployment with highest risk defined by diagnosis, treatment and demographic factors.
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Affiliation(s)
- Jenny W Y Pang
- University of Washington School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington, USA
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Miedema B, Hamilton R, Easley J. From "invincibility" to "normalcy": coping strategies of young adults during the cancer journey. Palliat Support Care 2007; 5:41-9. [PMID: 17461370 DOI: 10.1017/s147895150707006x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little research has been undertaken regarding the psychological impact of cancer on those stricken during the young adult years. Specifically, research on the coping strategies of young adults with cancer is limited. METHOD In this qualitative, Grounded Theory study, we did not set out to examine coping; rather, it emerged as a major phenomenon in the analysis of interview data from 15 young adults with cancer. RESULTS These young adults used various coping strategies to come to terms with the cancer diagnosis, management of the illness, its treatment, and treatment sequelae. The coping strategies varied considerably from person to person, depended on the stage(s) of the illness, and were rooted in their precancer lives. We were able to discern a pattern of coping strategies used by most participants. The prevailing goal for all participants was to achieve what they called "normalcy." For some, this meant major changes in their lives; for others it meant to "pick up" where they had left off before the cancer diagnosis. SIGNIFICANCE OF RESULTS To aid the understanding of the issues that influence coping, we have developed a model to illustrate the bidirectional nature and the complexities of the coping strategies as they relate to the phases of the disease and the disease treatment. The model also affirms Folkman and Lazarus' coping theory.
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Affiliation(s)
- Baukje Miedema
- Dalhousie University Family Medicine Teaching Unit, Fredericton, New Brunswick, Canada.
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Gerber LH, Hoffman K, Chaudhry U, Augustine E, Parks R, Bernad M, Mackall C, Steinberg S, Mansky P. Functional outcomes and life satisfaction in long-term survivors of pediatric sarcomas. Arch Phys Med Rehabil 2007; 87:1611-7. [PMID: 17141641 DOI: 10.1016/j.apmr.2006.08.341] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/28/2006] [Accepted: 08/30/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe the inter-relationships among impairments, performance, and disabilities in survivors of pediatric sarcoma and to identify measurements that profile survivors at risk for functional loss. DESIGN Prospective, cross-sectional. SETTING Research facility. PARTICIPANTS Thirty-two participants in National Cancer Institute clinical trials. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Range of motion (ROM), strength, limb volume, grip strength, walk velocity, Assessment of Motor and Process Skills (AMPS); Human Activity Profile (HAP), Sickness Impact Profile (SIP), standard form of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36); and vocational attitudes and leisure satisfaction. RESULTS Twenty of 30 survivors tested had moderate or severe loss of ROM; 13 of 31 tested had 90% or less of predicted walk velocity; all of whom had trunk or lower-extremity lesions. Women with decreased ROM (r=.50, P=.06) or strength (r=.74, P=.002) had slow gait velocity. Sixteen of 31 tested were more than 1 standard deviation below normal grip strength. Eighteen had increased limb volume. These 18 had low physical competence (SF-36) (r=-.70, P=.001) and high SIP scores (r=.73, P=.005). AMPS scores were lower than those of the matched normed sample (P<.001). HAP identified 15 of 30 who had moderately or severely reduced activity. Leisure satisfaction was higher in the subjects (P<.001). Eight reported cancer had negatively impacted work and 17 reported that it negatively impacted vocational plans. CONCLUSIONS Survivors with lower-extremity or truncal lesions and women with decreased ROM and strength likely have slow walk velocity, low exercise tolerance, and high risk for functional loss. They should be identified using ROM, strength, limb volume, and walk time measures.
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Affiliation(s)
- Lynn H Gerber
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA. ngerber1@gmu
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Punyko JA, Gurney JG, Scott Baker K, Hayashi RJ, Hudson MM, Liu Y, Robison LL, Mertens AC. Physical impairment and social adaptation in adult survivors of childhood and adolescent rhabdomyosarcoma: a report from the Childhood Cancer Survivors Study. Psychooncology 2006; 16:26-37. [PMID: 16921476 DOI: 10.1002/pon.1072] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite interest in the well-being of adult survivors of childhood rhabdomyosarcoma (RMS), few studies have examined their health-related quality of life (HRQOL). This study evaluated physical and social aspects of HRQOL among long-term childhood RMS survivors relative to a sibling comparison group, and assessed whether physical impairment among RMS survivors adversely affected their ability to achieve adult life goals. METHODS Using baseline data from the Childhood Cancer Survivor Study, we evaluated self-reported physical impairment and social adaptation among 417 survivors of childhood RMS and 2685 siblings > or =18 years of age at survey completion. RESULTS Survivors were more likely than siblings to report physical impairment, characterized by: at least one medically diagnosed condition, limitations in the performance of routine activities, a health-related inability to work or attend school, cancer-related pain. Survivors were less likely than siblings to have completed high school, ever worked a job, or ever been married. The odds of completing high school were lower among survivors with performance limitations, a health-related inability to work or attend school, or moderate to high levels of cancer-related pain. Survivors who reported cancer-related pain had an increased likelihood of ever being married. CONCLUSIONS The majority of adult survivors of pediatric RMS are successful in attaining adult life goals despite higher reported occurrence of physical impairment than their sibling counterparts. Additional studies are needed to advance our understanding of other aspects of HRQOL in this population of pediatric cancer survivors.
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Affiliation(s)
- Judith A Punyko
- Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA
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de Boer AGEM, Verbeek JHAM, van Dijk FJH. Adult survivors of childhood cancer and unemployment: A metaanalysis. Cancer 2006; 107:1-11. [PMID: 16718655 DOI: 10.1002/cncr.21974] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A range of late effects is associated with the survival of childhood cancer, including problems with employment. The purpose of this metaanalysis was to assess the risk of unemployment of adult survivors of childhood cancer compared with healthy controls and to explore prognostic factors. A literature search of studies published between 1966 and January 2006 was conducted using the databases of MedLine, CINAHL, EMBASE, ClinPSYCH, PsycINFO, and OSHROM. The authors synthesized data using a random effects model. A total of 34 articles was found, in which 40 original empirical studies were reported, 24 of which were controlled studies. Survivors of childhood cancer were nearly twice as likely to be unemployed than healthy controls (odds ratio [OR] 1.85, 95% confidence interval [95% CI], 1.27-2.69). Survivors of central nervous system (CNS) and brain tumors were nearly 5 times more likely to be unemployed (OR 4.74, 95% CI, 1.21-18.65), whereas the risks for survivors of blood or bone cancers were elevated but not found to be statistically significant (OR 1.42, 95% CI, 0.79-2.55; OR 1.97, 95% CI, 0.88-4.40, respectively). No increased risk was found for survivors of other or mixed diagnoses (OR 0.97, 95% CI, 0.27-3.53). Furthermore, survivors in the U.S. had an overall 3-fold risk (OR 3.24, 95% CI, 2.16-4.86) of becoming unemployed, whereas no such risk was found for European survivors (OR 1.00, 95% CI, 0.58-1.70). Apart from type of diagnosis and country, predictors of unemployment were younger age, lower education or intelligence quotient, female gender, motor impairment or epilepsy, and radiotherapy. Adult survivors of childhood cancer are at risk of unemployment, especially the subgroup of survivors of CNS and brain tumors. Interventions to enhance participation in work life should be developed and evaluated.
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Affiliation(s)
- Anna G E M de Boer
- Coronel Institute for Occupational Heath, Research Institute AmCOGG, Academic Medical Center, Amsterdam, the Netherlands.
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Park ER, Li FP, Liu Y, Emmons KM, Ablin A, Robison LL, Mertens AC. Health Insurance Coverage in Survivors of Childhood Cancer: The Childhood Cancer Survivor Study. J Clin Oncol 2005; 23:9187-97. [PMID: 16361621 DOI: 10.1200/jco.2005.01.7418] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine the prevalence and predictors of health insurance coverage and the difficulties obtaining coverage in a large cohort of childhood cancer survivors. Patients and Methods This study included 12,358 5-year survivors of childhood cancer and 3,553 sibling controls participating in the Childhood Cancer Survivor Study. Data were collected by surveys distributed in 1994 (baseline) and 2000 (follow-up). Results At baseline, 83.9% of adult survivors, compared with 88.3% of siblings, had health insurance coverage (P < .01); 6 years later, small but significant survivor-sibling differences remained (88% v 91%; P < .01). Twenty-nine percent of survivors reported having had difficulties obtaining coverage, compared with only 3% of siblings (P < .01). In multivariate analysis of survivors 18 years of age or older, factors associated with being uninsured included younger age at diagnosis (diagnosis age of 0 to 4 years; odds ratio [OR] = 1.7; 95% CI, 1.3 to 2.2), male sex (OR = 1.3; 95% CI, 1.2 to 1.5), age at baseline survey (age 22 to 24 years; OR = 1.6; 95% CI, 1.2 to 2.1), lower level of attained education (less than high school, OR = 2.6, 95% CI, 2.1 to 3.3; high school graduate, OR = 2.1, 95% CI, 1.8 to 2.5), income less than $20,000 (OR = 5.6, 95% CI, 4.5 to 7.1), marital status (widowed/divorced/separated; OR = 1.3; 95% CI, 1.1 to 1.6), smoking status (current smoker, OR = 2.0, 95% CI, 1.7 to 2.3; former smoker, OR = 1.4, 95% CI, 1.2 to 1.8), and treatment that included cranial radiation (OR = 1.3, 95% CI, 1.0 to 1.6). Conclusion Compared with siblings, adult survivors of childhood cancer had significantly lower rates of health insurance coverage and more difficulties obtaining coverage. Since lack of coverage likely has serious health and financial implications for this at-risk population, any disparity in availability and quality of coverage is of great concern.
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Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA.
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Langeveld NE, Grootenhuis MA, Voûte PA, de Haan RJ, van den Bos C. Quality of life, self-esteem and worries in young adult survivors of childhood cancer. Psychooncology 2005; 13:867-81. [PMID: 15386796 DOI: 10.1002/pon.800] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study assessed quality of life, self-esteem and worries in young adult survivors of childhood cancer compared to a group of young adults with no history of cancer. The impact of demographic, medical and treatment factors and self-esteem on survivors' quality of life and worries was studied. Participants were 400 long-term survivors (LTS) of childhood cancer (age range 16-49 years, 45% female) who had completed treatment an average of 16 years previously and 560 persons (age range 16-53 years, 55% female) with no history of cancer. All participants completed the MOS-24 (Medical Outcome Study Scale), a Worry questionnaire consisting of three scales (cancer-specific concerns, general health concerns, present and future concerns), and the Rosenberg Self-Esteem Scale. Small to moderate differences were found in mean MOS-24 scores between the LTS group and controls (range effect sizes -0.36-0.22). No significant difference was found in the mean self-esteem scores between LTS and controls. Female LTS had more cancer-specific concerns than male LTS. In several related areas of general health, self-image and dying, the LTS group reported less worries than controls, but LTS worried significantly more about their fertility, getting/changing a job and obtaining insurance's. Multiple linear regression analysis revealed that female gender, unemployment, severe late effects/health problems and a low self-esteem were predictors of worse quality of life in survivors. In addition, age at follow-up, unemployment, years since completion of therapy and a low self-esteem were associated with a higher degree of survivors' worries. Quality of life and the level of self-esteem in LTS of childhood cancer is not different from their peers. Although many LTS worried not more or even less about health issues than their peers, they often are concerned about some present and future concerns. The investigated factors could explain poor quality of life and worries only to a limited extent. Further research exploring determinants and indices of quality of life and worries in LTS is warranted.
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Affiliation(s)
- N E Langeveld
- Department of Paediatric Oncology, Emma Kinderziekenhuis, Academic Medical Center, University of Amsterdam, Netherlands.
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Demark-Wahnefried W, Werner C, Clipp EC, Guill AB, Bonner M, Jones LW, Rosoff PM. Survivors of childhood cancer and their guardians. Cancer 2005; 103:2171-80. [PMID: 15812823 DOI: 10.1002/cncr.21009] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Survivors of childhood cancer are at increased risk for osteoporosis, cardiovascular disease, and second malignancies-conditions for which modifiable risk factors are recognized and lifestyle interventions have shown benefit. Although some data regarding health behaviors of this population exist, receptivity to health promotion is largely unknown. METHODS A survey was mailed to 380 survivors (age range, 11-33 years) of childhood leukemia, lymphoma, or central nervous system carcinomas (and guardians of survivors < 18 years old) to elicit data on exercise, dietary intake of calcium, fat, and fruits and vegetables, smoking status, readiness to pursue lifestyle change, quality of life, and interest in various health interventions. RESULTS Responses from 209 survivors (a 55% response rate) suggested that most did not meet guidelines for fruit and vegetable consumption (79%), calcium intake (68%), or exercise (52%), 42% were overweight/obese, and 84% consumed > 30% of calories from fat. Older (> 18 years) compared with younger (< 18 years) survivors were more likely to smoke (17% vs. 1%), to be obese (21.6% vs. 14.6%), and to have suboptimal calcium intakes (75.6% vs. 57.6%). No differences in lifestyle behaviors were observed between cancer groups. Compared with interventions aimed at weight control, improving self-esteem, or smoking cessation, the highest levels of interest were found consistently for interventions aimed at getting in shape and eating healthy. Survivors preferred mailed interventions to those delivered in-person, by telephone counselors, or via computers. CONCLUSIONS Survivors of childhood cancer practiced several suboptimal health behaviors. Health promotion interventions aimed at areas of interest and delivered through acceptable channels have the potential to improve long-term health and function of this vulnerable population.
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Affiliation(s)
- Wendy Demark-Wahnefried
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. demar001mc.duke.edu
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Langeveld NE, Grootenhuis MA, Voûte PA, de Haan RJ. Posttraumatic stress symptoms in adult survivors of childhood cancer. Pediatr Blood Cancer 2004; 42:604-10. [PMID: 15127415 DOI: 10.1002/pbc.20024] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous research suggests that posttraumatic stress disorder (PTSD) is present in survivors of childhood cancer. The aim of the current study was to explore posttraumatic stress symptoms in a sample of young adult survivors of childhood cancer. In addition, the impact of demographic, medical and treatment factors on survivors' posttraumatic stress symptoms was studied. PROCEDURE Participants were 500 long-term survivors of childhood cancer. The median age at follow-up was 24 years (age range, 16- 49 years, 47% female). To assess symptoms of posttraumatic stress, all participants completed the Impact of Event Scale (IES), a self-report instrument consisting of two subscales, intrusion and avoidance. RESULTS Twelve percent of this sample of adult survivors of childhood cancer had scores in the severe range, indicating they are unable to cope with the impact of their disease and need professional help. Twenty percent of the female survivors had scores in the severe range as compared with 6% of the male survivors. Linear regression models revealed that being female, unemployed, a lower educational level, type of diagnosis and severe late effects/health problems were associated with posttraumatic stress symptoms. CONCLUSIONS The results indicate that, although the proportion of survivors reporting symptoms is well within the proportions found in the general population, a substantial subset of survivors report symptoms of posttraumatic stress. This finding supports the outcomes reported previously that diagnosis and treatment for childhood cancer may have significant long-term effects, which are manifested in symptoms of posttraumatic stress. The investigated factors could explain posttraumatic stress symptoms only to a limited extent. Further research exploring symptoms of posttraumatic stress in childhood cancer survivors in more detail is clearly warranted. From a clinical perspective, health care providers must pay attention to these symptoms during evaluations in the follow-up clinic. Early identification and treatment of PTSD symptoms can enhance the quality of life for survivors of childhood cancer.
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Affiliation(s)
- N E Langeveld
- Department of Paediatric Oncology (From the Late Effects Study Group), Emma Kinderziekenhuis, Academic Medical Center, University of Amsterdam, The Netherlands.
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18
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Boman KK, Bodegård G. Life after cancer in childhood: social adjustment and educational and vocational status of young-adult survivors. J Pediatr Hematol Oncol 2004; 26:354-62. [PMID: 15167348 DOI: 10.1097/00043426-200406000-00005] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term social effect of illness and its treatment on young-adult survivors of pediatric cancer by addressing a selection of general social adjustment criteria. METHODS In a cross-sectional case-control study, 30 young-adult survivors of childhood cancer were compared with (1). controls with no history of serious illness, matched by sex, age, and geographic area of residence, and (2). general population norms on the subject of educational and vocational factors, habitation, family/partner relationships, parenthood, and leisure activities. RESULTS The educational status of survivors was similar to that of controls, although a smaller proportion of the patients expressed concrete plans for future vocational or educational advancement. Survivors had less frequently entered higher education compared with general population norms. A longer duration of treatment was related to a lower estimated socioeconomic level, and poor psychological coping with the illness experience was associated with the fact that they were still living with their parents, a shorter education, and a lower socioeconomic level. CONCLUSIONS The social, vocational, and educational adjustment of relapse-free survivors from childhood cancer appears as only moderately, if at all, negatively affected by the illness and treatment history. However, the treatment intensity and particularly the survivors' coping with their illness experience may influence their ability to achieve long-term social goals. These findings suggest that special attention should be given to matters concerning education and partner relationships at long-term follow-up of pediatric cancer patients.
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Affiliation(s)
- Krister K Boman
- Department of Woman and Child Health, Karolinska Institutet, Stockolm, Sweden.
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Abstract
The present study focuses on the parents of the first group of children in Sweden to receive a bone marrow transplant and survive. Its aim was to get in-depth knowledge of the parents' situation during this critical time. The result of 10 years of research (1988-98), the study deals with the situation to which the parents had to adapt and the strategies that they used to handle their situation within a long-term perspective. Two series of qualitative interviews with the parents of 20 children who had undergone bone marrow transplantation were carried out. A self-report questionnaire for coping was also used. The result shows that the child's illness and treatment played an important role in the parents' lives for many years. Those parents who managed to put reason before emotion rated their coping as better. A sense of participation was also a useful coping strategy.
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Affiliation(s)
- Ulla Forinder
- Ersta Sköndal University College and Department of Social Work, Huddinge University Hospital, Sweden.
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20
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Nagarajan R, Neglia JP, Clohisy DR, Yasui Y, Greenberg M, Hudson M, Zevon MA, Tersak JM, Ablin A, Robison LL. Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study. Cancer 2003; 97:2554-64. [PMID: 12733155 DOI: 10.1002/cncr.11363] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND With increasing numbers of childhood cancer survivors, direct sequelae of cancer therapy and psychosocial outcomes are becoming more important. The authors described psychosocial outcomes (education, employment, health insurance, and marriage) for survivors of pediatric lower extremity bone tumors. METHODS The long-term follow-up study of the Childhood Cancer Survivor Study is a multiinstitutional cohort study comprising 14,054 individuals who have survived for 5 or more years after treatment for cancer diagnosed during childhood or adolescence. Baseline demographic and medical information were obtained. Six hundred ninety-four survivors had osteosarcoma or Ewing sarcoma of the lower extremity or pelvis and were classified by amputation status and by age at diagnosis. The median age at diagnosis was 14 years old with a median of 16 years of follow up since diagnosis. Demographic characteristics were used to analyze the rates of psychosocial outcomes. RESULTS Amputation status and age at diagnosis did not significantly influence any of the measured psychosocial outcomes. Education was a significant positive predictor of employment, having health insurance, and being currently in their first marriage. Male gender predicted ever being employed and female gender predicted having health insurance and marriage. When compared with siblings, amputees had significant deficits in education, employment, and health insurance. CONCLUSIONS Overall, no differences between amputees and nonamputees were found. However, gender and education play a prominent role. When compared with siblings, amputees in this cohort may benefit from additional supports.
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Affiliation(s)
- Rajaram Nagarajan
- Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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21
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Langeveld NE, Ubbink MC, Last BF, Grootenhuis MA, Voûte PA, De Haan RJ. Educational achievement, employment and living situation in long-term young adult survivors of childhood cancer in the Netherlands. Psychooncology 2003; 12:213-25. [PMID: 12673806 DOI: 10.1002/pon.628] [Citation(s) in RCA: 181] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper investigated educational achievement, employment status, living situation, marital status and offspring in 500 Dutch long-term young adults survivors of childhood cancer (age range, 16-49 years, 47% female). The results were compared with a reference group of 1092 persons with no history of cancer (age range, 15-33 years, 55% female). The impact of demographic and medical characteristics on psychosocial adjustment was studied. All participants completed a self-report questionnaire. The results showed that, although many survivors are functioning well and leading normal lives, a subgroup of survivors were less likely to complete high-school, to attain an advanced graduate degree, to follow normal elementary or secondary school and had to be enrolled more often on learning disabled programs. The percentage of employed survivors was lower than the percentage of employed controls in the comparison group, but more survivors were student or homemaker. Survivors had lower rates of marriage and parenthood, and worried more about their fertility and the risk of their children having cancer. Survivors, especially males, lived more often with their parents. Cranial irradiation dose <or=25 Gy was an important independent prognostic factor of lower educational achievement. Survivors with a history of brain/CNS tumours had a higher risk of being single than survivors with a diagnosis of leukaemia/non-Hodgkin lymphoma. These results indicate that important aspects of life are affected in a substantial number of persons who have been diagnosed with cancer during childhood or adolescence.
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Affiliation(s)
- N E Langeveld
- Department of Paediatric Oncology, Emma Kinderziekenhuis, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Elad P, Yagil Y, Cohen L, Meller I. A jeep trip with young adult cancer survivors: lessons to be learned. Support Care Cancer 2003; 11:201-6. [PMID: 12673458 DOI: 10.1007/s00520-002-0426-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The paper describes major areas of concern and preferred coping mechanisms among 17 young survivors of childhood cancer who participated in an 8-day adventure jeep trip in Greece. The paper also deals with various aspects of "adventure therapeutic activity." The participants were videotaped and interviewed during and after the trip. The data gathered were studied through a process of content analysis. Survivors' main areas of concern included: coping with uncertainty, dependency versus autonomy, social exclusion, separation processes, body image, intimacy, sexuality and fertility, and occupation. Preferred coping styles included use of humor, religious beliefs, cognitive reframing, and use of imagination. The trip provided the young adults with an opportunity for physical challenges, and they reported improvements in self-confidence, independence, and social contacts. The trip served as a catalyst for further group activities and group support. An adventure trip seems to be a suitable therapeutic milieu for young adult cancer survivors, where they can profit from a nurturing setting in which rehabilitation-promoting resources are available. It still remains to be seen which components of such an activity are more health promoting, what contraindications there could be, if any, for participation in such a trip, and what role health professionals should play in this kind of activity.
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Affiliation(s)
- P Elad
- Department of Social Services, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.
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Affiliation(s)
- K Woolverton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Rauck AM, Green DM, Yasui Y, Mertens A, Robison LL. Marriage in the survivors of childhood cancer: a preliminary description from the Childhood Cancer Survivor Study. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 33:60-3. [PMID: 10401499 DOI: 10.1002/(sici)1096-911x(199907)33:1<60::aid-mpo11>3.0.co;2-h] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The goal of this paper is to provide a preliminary description of the marital status for a large number of childhood cancer survivors participating in the Childhood Cancer Survivor Study (CCSS). PROCEDURE This report includes children and adolescents (< 21 years of age) diagnosed with cancer between 1970 and 1986 at 25 oncology centers in the United States and Canada who survived at least 5 years from diagnosis. Self-reported data from 10,425 survivors are used in this preliminary descriptive summary. The proportion of survivors ever married and divorced/separated is compared to the U.S. population according to age-specific groups. The median age of the survivor population at diagnosis was 7 years and 26 years at the time martial status was ascertained. Excluded from this assessment are children < 15 years of age at the time of study, those whose martial status was unknown, and those married prior to diagnosis. Data for marital status of the U.S. population, as tabulated in the Bureau of Census 1995 Update, is used as a general comparison to the survivor population. RESULTS Overall, 32% of the survivors reported being married or living as married, 6% being divorced or separated, 0% being widowed, and 62% having never been married. In general, compared to the U.S. population, survivors were less likely to have ever married, particularly females and whites, but, once married, were less likely to divorce/separate, again particularly females and whites. Black survivors were generally found to be more likely to have married, with males and blacks more likely to divorce/separate once married. Comparison of childhood tumor types suggested that survivors of CNS tumors, particularly males, were less likely to have ever married and more likely to divorce/separate compared to those with other cancer diagnoses and the general U.S. population. CONCLUSIONS This interim evaluation of the CCSS cohort provided preliminary data describing a suggested decreased likelihood of marriage, which may be influenced by gender and/or race. These patterns must be confirmed within the entire CCSS cohort and comparisons made with an appropriate sibling comparison group before making final conclusions.
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Affiliation(s)
- A M Rauck
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, USA.
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Schwartz CE, Feinberg RG, Jilinskaia E, Applegate JC. An evaluation of a psychosocial intervention for survivors of childhood cancer: paradoxical effects of response shift over time. Psychooncology 1999; 8:344-54. [PMID: 10474852 DOI: 10.1002/(sici)1099-1611(199907/08)8:4<344::aid-pon399>3.0.co;2-t] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study examined the impact of response shift on a psychosocial treatment evaluation of 22 young adult cancer survivors. An age-matched cohort of 54 healthy controls were included in the study to provide a comparison for normative levels and structure of quality-of-life (QOL). It was found that this evaluation of a psychosocial intervention for young adult cancer survivors was notably influenced by response shift phenomenon. Standard analyses suggested that the intervention had no impact on measured aspects of well-being. It did appear to yield an immediate gain in reported global QOL, but seemed to cause a significant decline over time. By considering response shift, it was highlighted that an apparently deleterious effect on QOL was largely a function of response shift. This response shift effect was reflected not only in changes in internal standards, but also in values and in conceptualization of QOL. The intervention seemed to have normalized survivors' conceptualization of QOL so that it was increasingly similar to their age-matched cohort. Future psychosocial intervention research should explicitly consider response shift in a randomized treatment evaluation.
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Affiliation(s)
- C E Schwartz
- Behavioral Science Research Program, Frontier Science & Technology Research Foundation, Inc., Chestnut Hill, MA 02467, USA.
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Lähteenmäki PM, Salmi HA, Salmi TT, Helenius H, Mäkipernaa A, Lanning M, Perkkiö M, Siimes MA. Military service of male survivors of childhood malignancies. Cancer 1999; 85:732-40. [PMID: 10091747 DOI: 10.1002/(sici)1097-0142(19990201)85:3<732::aid-cncr24>3.0.co;2-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this study was to assess the eligibility for and the course of compulsory military service of childhood cancer survivors. METHODS The medical, military recruitment, conscription, and military service data of male Finnish childhood cancer survivors were collected from manually filed records. Inclusion criteria were: survivors born 1977 or earlier, treated for a malignancy between birth and age 15 years, and followed by a pediatrician until at least age 18 years. The documents of 207 survivors from the Pediatric Clinics of Finnish University Hospitals were examined, and 130 of these survivors were considered eligible for military service. Demographic factors, the predictors of fitness for military service, factors associated with service interruption, the attained level of military training, and the health status of conscripts during service were evaluated. Comparisons were made with the Finnish male population of the same age and with conscripts serving at the corresponding time. RESULTS Approximately 60% of studied survivors were enlisted. Positive predictors of fitness for service were year of birth of 1973 or later (odds ratio [OR], 3.2), height at call-up age of 170-174.9 cm (OR, 3.6), and the man's own positive opinion of his fitness for service (OR, 62.3). Negative predictors were age at diagnosis > or = 11 years (OR, 0.5), central nervous system radiotherapy (OR, 0.3), limb defects (OR, 0.02), and the group of sequelae concerning neurologic, cardiopulmonary, and gastrointestinal systems, or secondary malignancies (OR, 0.3). Survivors interrupted their service more often (20%) (P < 0.001). Leukemia survivors were less likely to interrupt their service (7%) compared with other survivors (P = 0.04). Factors associated with service interruption were: diagnosis (P = 0.04), the man's own opinion of his fitness for service (P = 0.013), surgery (P = 0.003), and height (P = 0.049), weight (P = 0.019), and body mass index (P = 0.035) at the beginning of military service. The attained level of military training was equal to that of controls. The survivors visited the garrison physician less frequently in total (mean, 5.9 times) (P < 0.001), visited because of infections as much as controls, and were off duty more (mean, 11.9 days) (P = 0.012) than controls. CONCLUSIONS The current study found that childhood cancer survivors were less likely to meet the requirements set for military service in Finland. The causes of rejection usually were obvious, but approximately 30% were rejected merely on the basis of a former cancer diagnosis. However, enlisted survivors coped well with military service if their treatment sequelae were taken into consideration carefully at the time of enlistment. Vocational opportunities within the armed forces might be an appropriate career option even for survivors of childhood malignancies.
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Karian VE, Jankowski SM, Beal JA. Exploring the lived-experience of childhood cancer survivors. J Pediatr Oncol Nurs 1998; 15:153-62. [PMID: 9699452 DOI: 10.1177/104345429801500304] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this qualitative phenomenological study was to explore the lived-experience of childhood cancer survivors with regard to their patterns of interaction with family and the environment using Newman's theory of Health as Expanding Consciousness, which proposes that experiencing a devastating event promotes an expanded consciousness. The sample consisted of five young adults, ages 23 to 26 years, who had experienced childhood cancer and now are considered to be cured of their initial cancer. A hermeneutic dialectic approach was used, with each subject being asked to respond to one open-ended question, "What are the most meaningful events in your life?" The interviews were analyzed for evidence of expanded consciousness, changing relatedness, and other universal themes. Individual patterns emerged and themes were identified that supported Newman's theory, such as optimism and hope, stronger bonds to family and friends, increased capacity for empathy, a desire to help others, and deeper feelings for the value of life. The intensely personal and professional relationship that develops between pediatric oncology nurses and their patients can only be strengthened by the knowledge that these patients generally grew up to be caring and empathetic individuals, perhaps as a result of the nurses' loving care for them. This research also provided support for Newman's theory as a sound paradigm for nursing practice.
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Affiliation(s)
- V E Karian
- Division of Cardiovascular and Interventional Radiology, Children's Hospital Medical Center, Boston, MA, USA
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Abstract
Going through a life-threatening illness as a child or adolescent is a tremendously stressful experience for the entire family. Although the majority of survivors do go on to adjust and function well, some have ongoing problems. These problems include evidence of posttraumatic stress, learning difficulties, depression, and anxiety. Their parents appear to be even more severely affected, possibly because they had a better appreciation at the time of the true dangers posed by the illness and the treatment. Little is yet known about their siblings, although it is clear that the acute stage of illness and treatment effects the entire family. Areas needing study include the long-term sequelae on siblings of survivors, as well as a better understanding of the precipitants and mediators of the problems noted in survivors and parents. Only then can interventions and preventative measures be undertaken and tested. Also needed is a better understanding of the impact of cultural differences on precipitants, mediators, and symptoms.
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Affiliation(s)
- M L Stuber
- Division of Child and Adolescent Psychiatry, University of California Los Angeles School of Medicine, USA
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Banner LM, Mackie EJ, Hill JW. Family relationships in survivors of childhood cancer: resource or restraint? PATIENT EDUCATION AND COUNSELING 1996; 28:191-199. [PMID: 8852094 DOI: 10.1016/0738-3991(96)00901-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Family relationships may be an important mediator between childhood cancer and psychosocial adjustment in adult life. This paper focuses on the developmental task of the transition from adolescence to adulthood, with regard to the cancer survivor's family relationships. Theories, concepts and findings relevant to this specific focus are considered in relation to whether these relationships may prove a resource or a restraint in this process. Potential aspects of family relationships that may be of interest to research are discussed, and clinical implications drawn.
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Bhatia S, Robison LL, Oberlin O, Greenberg M, Bunin G, Fossati-Bellani F, Meadows AT. Breast cancer and other second neoplasms after childhood Hodgkin's disease. N Engl J Med 1996; 334:745-51. [PMID: 8592547 DOI: 10.1056/nejm199603213341201] [Citation(s) in RCA: 604] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients who survive Hodgkin's disease are at increased risk for second neoplasms. As survival times increase, solid tumors are emerging as a serious long-term complication. METHODS The Late Effects Study Group followed a cohort of 1380 children with Hodgkin's disease to determine the incidence of second neoplasms and the risk factors associated with them. RESULTS In this cohort, there were 88 second neoplasms as compared with 4.4 expected in the general population (standardized incidence ratio, 18.1; 95 percent confidence interval, 14.3 to 22.3). The estimated actuarial incidence of any second neoplasm 15 years after the diagnosis of Hodgkin's disease was 7.0 percent (95 percent confidence interval, 5.2 to 8.8 percent); the incidence of solid tumors was 3.9 percent (95 percent confidence interval, 2.3 to 5.5 percent). Breast cancer was the most common solid tumor (standardized incidence ratio 75.3; 95 percent confidence interval, 44.9 to 118.4), with an estimated actuarial incidence in women that approached 35 percent (95 percent confidence interval, 17.4 to 52.6 percent) by 40 years of age. Older age (10 to 16 vs. <10 years) at the time of radiation treatment (relative risk, 1.9) and a higher dose (2000 to 4000 vs. <2000 cGy) of radiation (relative risk, 5.9) were associated with significantly increased risk of breast cancer. The estimated actuarial incidence of leukemia reached a plateau of 2.8 percent (95 percent confidence interval, 0.8 to 4.8 percent) 14 years after diagnosis. Treatment with alkylating agents, older age at the diagnosis of Hodgkin's disease, recurrence of Hodgkin's disease, and a late stage of disease at diagnosis were risk factors for leukemia. CONCLUSIONS The risk of solid tumors, especially breast cancer, is high among women who were treated with radiation for childhood Hodgkin's disease. Systematic screening for breast cancer could be important in the health care of such women.
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Affiliation(s)
- S Bhatia
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Abstract
The aim of this study was to look at the current lifestyle of young adult survivors of childhood cancer between the ages of 16 and 30 years to document their achievements and expose any psychosocial problems. Sixty six young adult survivors were contacted and asked if they and their siblings (16-30 years) would take part in a lifestyle study; 48 patients and 38 sibling controls were interviewed. This took the form of a structured lifestyle questionnaire, a self esteem questionnaire (Oxford Psychologists Press), and an unstructured interview. Fifty five per cent of patients achieved five or more A-C grades at 'O' level/GCSE compared with 62% of siblings and a national average of 30%. Despite that these patients were significantly less likely to go on to higher education than their siblings. The two groups were equally employable and earning similar salaries. There were three cases of known employer prejudice. A slightly higher percentage of patients than siblings had their driving licence. Seventeen patients felt their appearance had changed and eight felt that they had a residual physical mobility problem. Both groups were socially active and equally likely to partake in competitive sports. There was no overall difference in the self esteem of the two groups. In general the survivors of childhood cancer were coping well in their young adult life and achieving the same lifestyle goals as their siblings. However, significant problems have been identified.
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Affiliation(s)
- S E Evans
- Department of Child Health, University of Southampton, Southampton General Hospital
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32
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Jenney ME, Kane RL, Lurie N. Developing a measure of health outcomes in survivors of childhood cancer: a review of the issues. MEDICAL AND PEDIATRIC ONCOLOGY 1995; 24:145-53. [PMID: 7838035 DOI: 10.1002/mpo.2950240302] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The success of treatment for childhood cancer has prompted greater attention to issues of quality of life for the survivors. Work on health-related quality of life has proceeded faster for adults than for children. This paper reviews the results of such work for adults and points to the potential for applications in children. Specific problems in adapting measures and in interpreting the results in the context of a child's development are discussed. An approach to the assessment of the health-related quality of life for survivors of childhood cancer is proposed.
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Affiliation(s)
- M E Jenney
- Institute for Health Services Research, School of Public Health, University of Minneapolis, MN
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33
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Affiliation(s)
- C Eiser
- Department of Psychology, University of Exeter, Devon
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34
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Abstract
Survivors of adult forms of cancer have noted discrimination in obtaining employment appropriate to their abilities/training and in securing comprehensive, affordable health and life insurance. Among survivors of childhood cancer, these problems are complicated, because most survivors of childhood cancer have no employment record and only family-related insurance before the onset of cancer. Relative to these issues, adults who are survivors of childhood cancer can be divided into two groups, i.e., those who are younger and those older than 30 years of age. In the older age group (30-50 years), the general indicators of economic achievement and insurability are similar to those of control subjects. Exceptions in this age group include denial of entry into the uniformed services and rejection of applications for life insurance. Survivors who are 20-29 years of age have a wider range of areas in which there is variance from control subjects, including educational achievement, employment, workplace relationships, and the ability to obtain health and life insurance.
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Affiliation(s)
- D M Hays
- Childrens Hospital Los Angeles, CA 90054-0700
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35
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Abstract
Survivors of cancer diagnosed during adolescence and young adulthood have had to muster the resources to cope with cancer treatment while accomplishing the tasks unique to this developmental period, tasks such as the accomplishment of economic and emotional independence, capacity for intimacy, solidification of career goals, and formation of a comfortable identity. Studies of survivors of childhood cancer have not found major psychiatric disorders but have pointed out some adjustment difficulties, such as increased health concerns, worries about the development of second neoplasms, increased somatic complaints, and academic problems. Marriage may be delayed, and women, unlike men, worry about their fertility and the health of their future offspring. Survivors of both genders do not appear to be troubled by obvious-to-the-observer physical sequelae. Future studies should examine the quality of life issues pertinent to the successful accomplishment of adult tasks and should include assessment of the facilitators and impediments to carrying out these tasks, particularly during the transition from adolescence into young adulthood. The ultimate goal of the above assessments is to permit not only survival but quality survival.
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Affiliation(s)
- L K Zeltzer
- Department of Pediatrics, UCLA School of Medicine 90024-1752
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36
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Meister LA, Meadows AT. Late effects of childhood cancer therapy. CURRENT PROBLEMS IN PEDIATRICS 1993; 23:102-31. [PMID: 8513680 DOI: 10.1016/0045-9380(93)90019-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- L A Meister
- Joe DiMaggio Children's Hospital at Memorial, Hollywood, Florida
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37
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Zülfikar B, Gedikoğlu G. Ewing's sarcoma: experience with 12 cases. J Chemother 1992; 4:50-5. [PMID: 1403071 DOI: 10.1080/1120009x.1992.11739139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Twelve patients with localized Ewing's sarcoma were treated between 1980-1990 at the Istanbul School of Medicine, Department of Pediatric Oncology-Hematology, Oncology Research and Treatment Center and Our Children Leukemia Foundation. There were 8 boys and 4 girls, with a mean age of 8.1 (range 3-17) years. The tumors were in the femur in 3 patients, in the humerus and rib in 2 patients each and in the tibia, radius, vertebra, clavicula and pelvis in 1 patient each. Chemotherapy alone was applied in 2 patients, 1 patient had chemotherapy and radiotherapy. The remaining 9 cases were treated with Chemotherapy and radiotherapy (during the chemotherapy). The chemotherapy protocols were: VAC (n = 5), VACA (n = 3), IVAD (n = 3) and T.9 (n = 1). One patient died from the disease itself. Remissions were achieved in the other 11 patients. After 5 to 95 months (mean: 22 months) 7 patients had relapsed (4 had local and 3 had distant metastases). Three patients were not able to be followed, 3 died due to additional problems (infection, cardiotoxicity). The best prognosis was achieved when Ewing's sarcoma initiated in the long bones, with less than 100 ml tumor volumes and patients were under 5 years old. There were no significant differences among chemotherapy protocols.
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Affiliation(s)
- B Zülfikar
- Istanbul University, Istanbul Medical School, Turkey
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Overbaugh KA, Sawin K. Future life expectations and self-esteem of the adolescent survivor of childhood cancer. J Pediatr Oncol Nurs 1992; 9:8-16. [PMID: 1596388 DOI: 10.1177/104345429200900103] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The number of adolescent cancer survivors has increased dramatically over the past decade as the result of improved treatment and diagnostic techniques. This population brings with them unique characteristics and concerns. The present study consisted of interviews with 10 adolescent survivors of childhood cancer and their parents. It investigated the adolescent's present self-esteem, the future life expectations held by both the teenagers and parents, and the relationship between the variables. Results indicated that the adolescents felt moderately competent in their lives (measures of self-esteem) and the parents felt more certain than their children that the teenagers would accomplish the tasks deemed appropriate for entry into a healthy adulthood. Pearson correlations showed a strong relationship between parents' future life expectations and adolescents' self-esteem (r = .82; P = .002), but not between parents' and adolescents' future life expectations or between the adolescents' future life expectations and self-esteem. The results are significant in addressing the impact parents can have on their child's self-esteem.
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39
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Abstract
To assess the impact of the diagnosis and modern treatment of childhood cancer on achievement of adult goals, the authors evaluated employment, health and life insurance coverage, marriage, divorce, and reproduction in 227 former pediatric cancer patients. Each area was evaluated in relation to a common set of disease and demographic factors that included age at follow-up, age at diagnosis, gender, marital status, history of disease recurrence, and diagnosis. Patients were younger than 20 years of age at diagnosis, and their diagnoses were made between January 1, 1960, and December 31, 1984. The median age at diagnosis was 11.4 years, and the median age at follow-up was 26.6 years. The percentage of unemployed male respondents did not differ from population norms. The percentage of unemployed female respondents, however, was slightly higher than that of the United States population. Approximately 11% of the survivors reported some form of employment-related discrimination, a level significantly lower than that of prior reports. Company-offered health insurance was provided to 92.4% of full-time and 90.0% of part-time employed respondents. Life insurance was purchased by 60% of full-time employed men and 55% of women. These percentages were lower than those reported for the United States population. Twenty-four percent of those with life insurance had difficulty obtaining it. Fifty-eight percent of the subjects were married or lived as married. The percentages of married men and women were significantly lower than United States norms. Twenty percent of those who were married or lived as married have divorced or separated or no longer live as married. Women aged 20 to 24 years were less likely to marry, and women aged 35 to 44 years had a significantly higher frequency of divorce than similarly aged United States women. In general, the history of childhood cancer did not influence the decision to marry or live as married but was occasionally (20%) important in the decision to dissolve a marital relationship. Many former patients indicated that their diagnosis and treatment for childhood cancer influenced their decision to have children. The current study suggests that most former pediatric cancer patients achieve adult life goals. Additional research is necessary to define those populations at greatest risk of failure to achieve these goals.
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Affiliation(s)
- D M Green
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York
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41
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Literature Review: References of Interest for the Pediatric Oncology Nurse. J Pediatr Oncol Nurs 1990. [DOI: 10.1177/104345429000700229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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