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Fong FJY, Wong BWZ, Ong JSP, Tan BWZ, Seng MSF, Tan AM, Tanugroho RR. Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:530-538. [PMID: 39373372 DOI: 10.47102/annals-acadmedsg.202445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Introduction Childhood cancer survivors (CCS) are at risk of experiencing psychological distress years after completing cancer treatments. We aimed to assess the prevalence and associated risk factors affecting psychological distress and health-related quality of life (HRQOL) among CCS in Singapore, and compare with their siblings without a history of or existing cancer as control. Method We recruited 143 young adult CCS aged ≥18 years attending survivorship clinics at KK Women's and Children's Hospital in Singapore who were in remission for ≥5 years and treatment-free for ≥2 years, and 57 siblings. CCS and siblings were matched at a 1:1 ratio based on sociodemographic factors yielding 46 pairs for comparison. Among CCS participants, 79 (55.2%) were male, 86 (60.1%) had leukaemia, 29 (20.3%) had solid tumours, 15 (10.5%) had lymphoma and 13 (9.1%) had brain tumours. All participants completed the Brief Symptom Inventory-18 (BSI-18) and Medical Outcomes Short Form-36 (MOS SF-36) questionnaires from August 2021 to July 2022. Results There were 35 (24.5%) CCS who reported psychological distress in the BSI-18 Global Severity Index. Five (3.5%) and 31 (21.7%) CCS reported low HRQOL in the physical and mental composite scores, respectively. Mean scores between CCS and their siblings were not statistically significant across all domains of the BSI-18 and MOS SF-36. Associated risk factors for psychological distress and low HRQOL among CCS were history of psychiatric illness after cancer diagnosis and mood affected by the COVID-19 pandemic. Conclusion CCS reported significant psychological distress and low HRQOL although they were not statistically different from their siblings. A holistic and risk factor-centric follow-up programme can aid early detection and mitigation of psychological late effects for CCS and their families.
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Affiliation(s)
- Francis Jia Yi Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Wei Zhi Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jamie Si Pin Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beron Wei Zhong Tan
- Psychology Service, KK Women's and Children's Hospital; Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore
| | - Michaela Su-Fern Seng
- Haematology Oncology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Ah Moy Tan
- Haematology Oncology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Baron Nelson M, O'Neil SH, Cho SJ, Dhanani S, Tanedo J, Shin BJ, Rodman J, Olch A, Wong K, Nelson MD, Finlay J, Lepore N. Dose-dependent cranial irradiation associations with brain structures and neuropsychological outcomes in children with posterior fossa brain tumors. Brain Behav 2024; 14:e70019. [PMID: 39295085 PMCID: PMC11410875 DOI: 10.1002/brb3.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Posterior fossa irradiation with or without whole brain irradiation results in high doses of radiation to the thalamus, hippocampus, and putamen, structures critical to cognitive functioning. As a result, children with brain tumors treated with cranial irradiation (CRT) may experience significant cognitive late effects. We sought to determine the effect of radiation to those structures on neuropsychological outcome. METHODS Forty-seven children with a history of posterior fossa tumor (17 treated with surgery; 11 with surgery and chemotherapy; and 19 with surgery, chemotherapy, and CRT) underwent neuroimaging and neuropsychological assessment at a mean of 4.8 years after treatment, along with 17 healthy sibling controls. The putamen, thalamus, and hippocampus were segmented on each participant's magnetic resonance imaging for diffusion indices and volumes, and in the radiation treatment group, radiation dose to each structure was calculated. RESULTS Performance on visuoconstruction and spatial learning and memory was lower in patient groups than controls. Volume of the thalamus, when controlling for age, was smaller in the patient group treated with CRT than other groups. Higher radiation doses to the putamen correlated with higher fractional anisotropy in that structure. Higher radiation dose to the hippocampus correlated with lower spatial learning, and higher dose to thalami and putamina to lower verbal and nonverbal reasoning. CONCLUSIONS All children with posterior fossa tumors, regardless of treatment modality, had cognitive deficits compared to their sibling controls. Posterior fossa irradiation may affect thalamic volume and aspects of verbal and nonverbal cognitive functioning.
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Affiliation(s)
- Mary Baron Nelson
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Sharon H O'Neil
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, California, USA
- Neuropsychology Core, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Scarlet J Cho
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, California, USA
| | - Sofia Dhanani
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Division of Child Neurology, Department of Neurology, Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Tanedo
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Brandon J Shin
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
- Kansas City University, College of Osteopathic Medicine, Joplin, Missouri, USA
| | - Jack Rodman
- Biostatistics, Epidemiology, and Research Design (BERD), Southern California Translational Science Institute, Los Angeles, California, USA
| | - Arthur Olch
- Department of Radiation Oncology, Keck School of Medicine of USC and Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kenneth Wong
- Department of Radiation Oncology, Keck School of Medicine of USC and Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Marvin D Nelson
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Natasha Lepore
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, California, USA
- CIBORG Laboratory, Children's Hospital Los Angeles, Los Angeles, California, USA
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Kubinec N, Heinrich KP, Richard AE, Hodges EK, Oswald-McCloskey KA. Association between visual attention and parent-reported social problems in pediatric cancer survivors. Child Neuropsychol 2024:1-13. [PMID: 39206856 DOI: 10.1080/09297049.2024.2397950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Social deficits in pediatric cancer survivors have been well documented and have been linked to neurocognitive late effects, particularly attention deficits. The purpose of this study was to examine the association between components of attention, both parent-report and a performance-based measure, with parent-reported social functioning in survivors of pediatric cancer. The study included data from outpatient neuropsychological evaluations of 76 survivors of pediatric cancer. The Integrated Visual and Auditory (IVA) continuous performance test was used to evaluate the components of attention with variables corresponding to Posner's model of attention. Assessment of inattention and peer problems were derived from the Conner's Parent Rating Scale, third edition. Parent-reported attention symptoms were significantly associated with worse auditory prudence (r = -0.382, p < .001) and visual consistency (r = -0.234, p = .046) and higher parent-reported peer problems (r = 0.302, p = .008). Auditory attention domains were not significantly predictive of peer problems (p > .05). When controlling for FSIQ and type of cancer, worse visual consistency (p = .029) and visual speed (p = .036) were significantly associated with more peer problems. Parent-reported inattention was associated with only some domains of performance-based attention, highlighting the importance of using multi-modal assessments of attention. This study also revealed an important relationship between visual attention and peer problems.
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Affiliation(s)
- Nicole Kubinec
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kimberley P Heinrich
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Annette E Richard
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Elise K Hodges
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Raguindin PF, Rueegg CS, Kälin S, Bergstraesser E, von der Weid NX, Tinner EM, Kuehni CE, Michel G. Longitudinal changes of psychological distress among childhood cancer survivors: The Swiss Childhood Cancer Survivor Study. Pediatr Blood Cancer 2024; 71:e31095. [PMID: 38825751 DOI: 10.1002/pbc.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Childhood cancer survivors may experience psychological distress due to the disease, cancer treatments, and potential late effects. Limited knowledge exists regarding longitudinal changes in psychological distress after childhood cancer. We aimed to determine changes in psychological distress over time and explore determinants of changes. METHODS The Swiss Childhood Cancer Survivor Study collected data at baseline (2007-2009) and follow-up (2010-2012). Psychological distress was measured using the Brief Symptom Inventory 18 (BSI-18), including three symptom scales (somatization, depression, anxiety) and an overall distress index (Global Severity Index, GSI). Sum-scores were T-standardized (mean = 50; standard deviation [SD] = 10). Survivors with a score ≥57 on the GSI or two symptom scales were classified as cases with distress. We used linear mixed effects regression to identify potential sociodemographic and clinical determinants of change in psychological distress. RESULTS We analyzed 696 survivors at baseline (mean age = 24 years [SD = 4], 49% females, mean time since diagnosis = 16 years [SD = 4]). On follow-up (2.4 years, SD = 1), 317 survivors were analyzed, including 302 participants with repeated measures. We found that 13% (39/302) were cases at baseline, and 25% (76/302) were cases on follow-up. Those older at study and longer since diagnosis, females, diagnosed with central nervous system (CNS) tumors, and those reporting late effects were more likely to experience higher levels of distress. Females and unemployed are at higher risk for developing or persisting psychological distress than males and those who are employed or in training. CONCLUSION We observed an increase in psychological distress score over time, with higher proportion of psychological distress on follow-up. Anticipatory guidance and screening should be implemented in regular follow-up care.
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Affiliation(s)
| | - Corina S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Sonja Kälin
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Eva Bergstraesser
- Department of Pediatrics, Pediatric Palliative Care, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Eva Maria Tinner
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Campens S, Claes L, Vanderhaegen J, Van Laere E, Prikken S, Lemiere J, Uyttebroeck A, Luyckx K. Nonsuicidal Self-Injury in Adolescent and Emerging Adult Childhood Cancer Survivors: A First Exploration. J Adolesc Young Adult Oncol 2024. [PMID: 38963773 DOI: 10.1089/jayao.2024.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Purpose: This study examines nonsuicidal self-injury (NSSI) in adolescent and emerging adult survivors of childhood cancer, aiming to gain a first understanding of the phenomenon, its relation to general and cancer-specific functioning, and the stability of NSSI engagement over time. Methods: Dutch-speaking survivors (n = 125, age range = 14-25 years) participated in the first three annual waves of the Longitudinal Identity Study of Childhood Cancer Survivors study. Descriptive characteristics of lifetime NSSI were calculated. Multivariate analysis of variance (MANOVA) and χ2-analyses were performed to examine differences in demographic and clinical characteristics between survivors with and without lifetime NSSI. To assess differences in general and cancer-specific functioning between survivors with and without lifetime NSSI, two MANOVA analyses were performed. Finally, prevalence rates of current NSSI across the three waves were calculated, followed by χ2-analyses to explore differences in current NSSI over time. Results: The prevalence and characteristics of lifetime NSSI engagement resembled those in the general population. Although demographic and clinical characteristics were unrelated to NSSI engagement, several meaningful differences were found in both general and cancer-specific functioning between survivors with and without NSSI. Survivors with lifetime NSSI experienced more depressive symptoms and difficulties with identity formation (i.e., lower levels of identity synthesis and higher levels of identity confusion). In addition, they experienced more post-traumatic stress symptoms and cancer-related worries, and identified less as a "cancer patient." Conclusions: This study provides a first understanding of NSSI engagement in survivors of childhood cancer, mapping the characteristics of NSSI and its associations with both general and cancer-specific functioning.
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Affiliation(s)
- Sara Campens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Janne Vanderhaegen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Elise Van Laere
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Sofie Prikken
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Pediatric Oncology, KU Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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Zahid N, Enam SA, Mårtensson T, Azam I, Mushtaq N, Moochhala M, Kausar F, Hassan A, Kamran Bakhshi S, Javed F, Rehman L, Mughal MN, Altaf S, Kirmani S, Brown N. Factors associated with changes in the quality of life and family functioning scores of primary caregivers of children and young people with primary brain tumors in Karachi, Pakistan: a prospective cohort study. BMC Pediatr 2024; 24:389. [PMID: 38851708 PMCID: PMC11161978 DOI: 10.1186/s12887-024-04867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND There are limited data available, particularly in low- and middle-income countries (LMICs), on the long-term quality of life (QoL) and family functioning of primary caregivers of children and young people (CYPs) affected by primary brain tumors (PBTs). This study aimed to assess the factors associated with the mean change in QoL and family functioning scores of primary caregivers of CYP patients with PBTs 12 months posttreatment. METHODS This prospective cohort study enrolled CYPs aged 5-21 years with newly diagnosed PBTs and their primary caregivers. The study was carried out between November 2020 and July 2023. The primary caregivers of CYPs were recruited from two major tertiary care centers in Karachi, Pakistan. The primary caregivers QoL were assessed by the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module. The assessment was undertaken by a psychologist at the time of diagnosis and 12 months posttreatment. The data were analyzed with STATA version 12. RESULTS Forty-eight CYPs with newly diagnosed PBTs and their primary caregivers (46 mothers and 2 fathers) were enrolled. At 12 months posttreatment, 25 (52%) CYPs and their primary caregivers (mothers) were reassessed, and 23 (48%) were lost to follow-up. On multivariable analysis, a significant decrease in mothers' mean 12-month posttreatment QoL and family functioning scores was associated with CYP having posttreatment seizures (beta= -10.2; 95% CI: -18.4 to -2.0) and with the financial burden associated with the CYP's illness (beta= -0.3; 95% CI: -0.4 to -0.1). However, in those cases where CYP had higher posttreatment quality of life scores (beta = 0.4; 95% CI = 0.1, 0.6) and posttreatment higher verbal intelligence scores (beta = 0.1; 95% CI = 0.01, 0.3), the mothers' QoL and family functioning scores were significantly greater. CONCLUSION We found a significant decrease in QoL of mothers who had a high financial burden and whose CYP had posttreatment seizures. However, those whose CYPs had higher posttreatment verbal intelligence scores and quality of life scores had significantly greater QoL scores. Identification of the factors that influence primary caregivers QoL has the potential to aid in the development of targeted strategies to alleviate stressors and improve the overall quality of life for primary caregivers and their children who are at high risk.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden.
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Thomas Mårtensson
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Mariya Moochhala
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Faiza Kausar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Farrukh Javed
- Department of Neurosurgery, Jinnah Post graduate Medical Centre, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Jinnah Post graduate Medical Centre, Karachi, Pakistan
| | | | - Sadaf Altaf
- Department of Pediatric Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Nick Brown
- Global Health and Migration Unit Department of Women's and Children's Health, Uppsala University, Box 256, Uppsala, 751 05, Sweden.
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan.
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7
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Fantozzi PM, Anil A, McHugh S, Srsich AR, Zope M, Parish-Morris J, Schultz RT, Herrington J, Hocking MC. Social impairment in survivors of pediatric brain tumors via reduced social attention and emotion-specific facial expression recognition. Pediatr Blood Cancer 2024; 71:e30943. [PMID: 38470289 PMCID: PMC11039359 DOI: 10.1002/pbc.30943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND/OBJECTIVES Survivors of pediatric brain tumors (SPBT) experience significant social challenges, including fewer friends and greater isolation than peers. Difficulties in face processing and visual social attention have been implicated in these outcomes. This study evaluated facial expression recognition (FER), social attention, and their associations with social impairments in SPBT. METHODS SPBT (N = 54; ages 7-16) at least 2 years post treatment completed a measure of FER, while parents completed measures of social impairment. A subset (N = 30) completed a social attention assessment that recorded eye gaze patterns while watching videos depicting pairs of children engaged in joint play. Social Prioritization scores were calculated, with higher scores indicating more face looking. Correlations and regression analyses evaluated associations between variables, while a path analysis modeling tool (PROCESS) evaluated the indirect effects of Social Prioritization on social impairments through emotion-specific FER. RESULTS Poorer recognition of angry and sad facial expressions was significantly correlated with greater social impairment. Social Prioritization was positively correlated with angry FER but no other emotions. Social Prioritization had significant indirect effects on social impairments through angry FER. CONCLUSION Findings suggest interventions aimed at improving recognition of specific emotions may mitigate social impairments in SPBT. Further, reduced social attention (i.e., diminished face looking) could be a factor in reduced face processing ability, which may result in social impairments. Longitudinal research is needed to elucidate temporal associations between social attention, face processing, and social impairments.
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Affiliation(s)
| | - Ashley Anil
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sean McHugh
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Manali Zope
- The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Julia Parish-Morris
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert T. Schultz
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - John Herrington
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew C. Hocking
- The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Lam KKW, Ho KY, Liu APK, Liu CQ, Ng MH, Lam TC, Belay GM, Hammoda AO, Yang F, Yuen WM, Chan GCF. Effectiveness of Computerized Cognitive Training on Working Memory in Pediatric Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00234. [PMID: 38527112 DOI: 10.1097/ncc.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Interactive features of computerized cognitive training (CCT) may enhance adherence to training, providing a relatively low-cost intervention. A robust systematic review on the effectiveness of CCT for improving working memory (WM) among pediatric survivors with cancer is lacking. OBJECTIVE To summarize the available evidence and determine the effectiveness of CCT for WM among pediatric survivors with cancer. INTERVENTIONS/METHODS Five databases were searched. The Effective Public Health Practice Project was used to assess the study quality. ReviewerManager was used. The primary outcome was WM performance. Secondary outcomes included processing speed, attention, intervention adherence, and number of adverse events. RESULTS Six studies were included. Regarding overall quality, 1 study was weak, and 5 studies were moderate. Five studies reported a significant improvement of WM postintervention (P < .05). The meta-analysis of Cogmed interventions on symbolic WM revealed a significant difference between groups (vs placebo), with an overall pooled effect size of 0.71 (95% confidence interval, 0.02-1.41; P = .04). Two and 4 studies investigated the effects of CCT on processing speed and attention, respectively, with conflicting results. Four studies reported adherence of 80% or greater. Two studies reported no adverse events. CONCLUSIONS Computerized cognitive training using Cogmed has a significant positive effect on WM. The effects of CCT on processing speed and attention remain inconclusive. IMPLICATIONS FOR PRACTICE More rigorous trials should be conducted to elucidate the cognitive effects of CCT, particularly processing speed and attention, in the pediatric population with cancer. Further studies should consider combining CCT with other existing interventions to strengthen their effectiveness.
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Affiliation(s)
- Katherine K W Lam
- Author Affiliations: School of Nursing, Hong Kong Polytechnic University (Drs Lam, Ho, Hammoda, and Yuen; Mss Liu and Yang; and Messrs Ng, Lam, and Belay); and Hong Kong Children's Hospital (Drs Liu and Chan)
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9
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Winzig J, Inhestern L, Sigmund D, Paul V, Hail LA, Rutkowski S, Escherich G, Bergelt C. And what about today? Burden and support needs of adolescent childhood cancer survivors in long-term follow-up care-A qualitative content analysis. Child Care Health Dev 2024; 50:e13207. [PMID: 38083813 DOI: 10.1111/cch.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 11/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Childhood cancer affects approximately 2000 children annually in Germany, and there is an increasing number of long-term childhood cancer survivors. Due to developmental tasks, adolescent survivors in long-term follow-up (LTFU) care may face specific challenges and perceive different burden due to their disease. The current study explored (a) the impact of cancer and burden regarding survivorship and (b) supportive needs of adolescent childhood cancer survivors in LTFU care. METHODS Semistructured qualitative interviews were conducted with 18 adolescent childhood cancer survivors in LTFU care aged 14-18 years (average age 16.4 years). Interviews were transcribed verbatim and analysed using content analysis. RESULTS Based on the exploratory research questions, two key categories were generated: (1) The impact and burden on survivors' lives during LTFU care and (2) support needs of adolescent childhood cancer survivors in LTFU care. The four subcategories that emerged regarding the impact and burden on survivors' lives during LTFU care were (1) physical consequences, (2) cognitive impairments, (3) difficulties in social interactions, and (4) psychosocial burden. Additionally, two subcategories, (1) practical and (2) emotional support needs of adolescent childhood cancer survivors were identified. CONCLUSIONS Our results indicate that childhood cancer influences adolescent survivors' life in a negative way even many years after the end of treatment. Furthermore, parents seem to play a crucial role in the survivorship experience of childhood cancer survivors, as they remain keep responsible for most cancer-related concerns even during LTFU care, causing adolescents to persist in the child role. A family systemic approach to care is suggested to facilitate development-specific tasks and to enable adolescents to become autonomous adults. Still, the question remains as to who in the health care system could take over the family systemic tasks.
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Affiliation(s)
- Jana Winzig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Désirée Sigmund
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Verena Paul
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lesley-Ann Hail
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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10
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Kim Y, Ritt-Olson A, Tobin J, Haydon M, Milam J. Beyond depression: correlates of well-being in young adult survivors of childhood cancers. J Cancer Surviv 2023; 17:1397-1404. [PMID: 35187609 DOI: 10.1007/s11764-022-01186-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study investigated the correlates of well-being with psychosocial and clinical factors in young adult childhood cancer survivors (YACCS) above and beyond depressive symptoms. METHODS Participants were from the Project Forward Cohort, a population-based study of young adult survivors of childhood cancers. Participants (n = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County). A majority received a diagnosis of leukemia (36.1%) or lymphoma (21.7%). Participants completed self-reported questionnaires at one timepoint. Multiple regression analyses were performed with well-being as the outcome variable and psychosocial and clinical variables (social support, sense of adulthood, posttraumatic growth, treatment intensity, and self-rated health) as the independent variables. Covariates included demographics (age, gender, relationship status, race/ethnicity) and depressive symptoms. RESULTS In the multivariable model, posttraumatic growth, social support, sense of adulthood, and self-rated health were significantly associated with well-being (all ps < .05), when controlling for depressive symptoms. Treatment intensity and years since diagnosis were not significantly associated with well-being, when controlling for depressive symptoms. CONCLUSIONS There are unique correlates of well-being above and beyond depressive symptoms among YACCS. This finding illuminates individual differences that may be associated with well-being and provides targets for intervention. IMPLICATIONS FOR CANCER SURVIVORS Psychosocial interventions and survivorship care for YACCS should consider the broad aspects of well-being, independent of depressive symptoms.
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Affiliation(s)
- Yoonji Kim
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
| | | | - Jessica Tobin
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Marcie Haydon
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
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11
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Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
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Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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12
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L’Hotta AJ, Randolph SB, Reader B, Lipsey K, King AA. Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review. CA Cancer J Clin 2023; 73:524-545. [PMID: 37158423 PMCID: PMC10524286 DOI: 10.3322/caac.21783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Increased attention to the rehabilitation needs of children with cancer is vital to enhance health, quality-of-life, and productivity outcomes. Among adults with cancer, rehabilitation recommendations are frequently incorporated into guidelines, but the extent to which recommendations exist for children is unknown. Reports included in this systematic review are guideline or expert consensus reports containing recommendations related to rehabilitation referral, evaluation, and/or intervention for individuals diagnosed with cancer during childhood (younger than 18 years). Eligible reports were published in English from January 2000 to August 2022. Through database searches, 42,982 records were identified; 62 records were identified through citation and website searching. Twenty-eight reports were included in the review: 18 guidelines and 10 expert consensus reports. Rehabilitation recommendations were identified in disease-specific (e.g., acute lymphoblastic leukemia), impairment-specific (e.g., fatigue, neurocognition, pain), adolescent and young adult, and long-term follow-up reports. Example recommendations included physical activity and energy-conservation techniques to address fatigue, referral to physical therapy for chronic pain management, ongoing psychosocial surveillance, and referral to speech-language pathology for those with hearing loss. High-level evidence supported rehabilitation recommendations for long-term follow-up care, fatigue, and psychosocial/mental health screening. Few intervention recommendations were included in guideline and consensus reports. In this developing field, it is critical to include pediatric oncology rehabilitation providers in guideline and consensus development initiatives. This review enhances the availability and clarity of rehabilitation-relevant guidelines that can help prevent and mitigate cancer-related disability among children by supporting access to rehabilitation services.
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Affiliation(s)
| | | | - Ben Reader
- Nationwide Children’s Hospital, Columbus, OH
| | - Kim Lipsey
- Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Allison A. King
- Washington University in St. Louis School of Medicine, St. Louis, MO
- St. Louis Children’s Hospital, St. Louis, MO
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13
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Lee ARYB, Low CE, Yau CE, Li J, Ho R, Ho CSH. Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:790-799. [PMID: 37345504 PMCID: PMC10288378 DOI: 10.1001/jamapediatrics.2023.2168] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023]
Abstract
Importance A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide. Objective To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators. Data Sources Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022. Study Selection Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration. Main Outcomes and Measures Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses. Results From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.
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Affiliation(s)
- Ainsley Ryan Yan Bin Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Ee Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiaqi Li
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
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14
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Thierheimer M, Cioffi G, Waite KA, Kruchko C, Ostrom QT, Barnholtz-Sloan JS. Mortality trends in primary malignant brain and central nervous system tumors vary by histopathology, age, race, and sex. J Neurooncol 2023; 162:167-177. [PMID: 36928698 PMCID: PMC10050015 DOI: 10.1007/s11060-023-04279-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Primary malignant brain and other central nervous system tumors are rare cancers that have shown rising mortality rates in recent years. To elucidate potential factors involved in this rising death rate, we examined mortality trends for primary malignant BT in the United States stratified by histopathology groupings, age, race, and sex. METHODS Mortality rates for demographic factors within primary malignant BT were generated using the National Center for Health Statistics' National Vital Statistics Systems data from 2004 to 2018. Additionally, histopathology-specific incidence-based mortality rates were calculated using the National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) 18 data from 2004 to 2018. Joinpoint modeling was used to estimate mortality trends and annual percent changes with corresponding 95% confidence intervals. RESULTS Overall, there was a very small increase in mortality from 2004 to 2018. Individuals > 65 years saw a small increase in mortality, while changes in individuals of other ages were non-significant. Asian/Pacific Islander or American Indian/Alaskan Native had the largest increase in mortality. Among histopathology groupings, there was a small mortality increase in adults ages > 65 years with glioblastoma, while the mortality rate of other malignant gliomas declined in the same age group. CNS lymphoma mortality rates in patients ages 15-39 and 40-64 years declined significantly while rising significantly in the > 65 age group. In pediatric patients, embryonal tumor mortality had a non-significant increase between 2004 and 2007 but declined significantly between 2007 and 2018. CONCLUSION Examining age, race, sex, and histopathology-specific mortality trends at the population level can provide important information for clinicians, researchers, and aid in public health planning.
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Affiliation(s)
| | - Gino Cioffi
- Division of Cancer Epidemiology and Genetics, Trans Divisional Research Program, National Cancer Institute, Bethesda, MD, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Kristin A Waite
- Division of Cancer Epidemiology and Genetics, Trans Divisional Research Program, National Cancer Institute, Bethesda, MD, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Jill S Barnholtz-Sloan
- Division of Cancer Epidemiology and Genetics, Trans Divisional Research Program, National Cancer Institute, Bethesda, MD, USA.
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA.
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, USA.
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15
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Van Zyl A, Kruger M, Ndlovu S, Meehan SA, Rogers PC. Psychological distress of adolescent and young adult childhood cancer survivors in a South African cohort. Pediatr Blood Cancer 2023; 70:e30088. [PMID: 36440682 DOI: 10.1002/pbc.30088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated psychological distress in a South African childhood cancer survivor (CCS) cohort. METHODS Adult CCSs treated at Tygerberg Hospital, Cape Town, completed the Brief Symptom Inventory-18. Internal consistency was acceptable: Cronbach's alpha values were 0.91 (Global Severity Index (GSI)), 0.85 (depression), 0.83 (somatization), and 0.75 (anxiety). We compared results utilizing different case rules (GSI T scores of ≥50, ≥57, and ≥63) for the identification of psychological distress. RESULTS Forty CCSs (median age 24 years; median follow-up period 16 years) participated. Most (58%; 23 out of 40) completed school or tertiary education, were unmarried (90%; 36 out of 40), and unemployed (59.5%; 22 out of 37). The diagnoses included hematological malignancies (65%; 26 out of 40) and solid tumors (35%; 14 out of 40). The GSI T scores of ≥63, ≥57, and ≥50 identified 10% (four out of 40), 32.5% (13 out of 40), and 45% (18 out of 40) of survivors with psychological distress, respectively. Radiotherapy (odds ratio (OR) 4.6; p = .035), presence of ≥six late effects (OR 7.5; p = .026), and severe late effects (OR 6.6; p = .024) were significant risk factors (GSI T score ≥57). Follow-up period of 11-20 years (OR 7.3; p = .034) was significant for a GSI T score ≥50. CONCLUSION This South African CCS cohort had higher levels of psychological distress utilizing the GSI T score ≥50 and ≥57 case rules than reported in the literature. Most were unmarried or unemployed. Significant contributing factors were radiotherapy, number and severity of late effects, and follow-up period. CCSs must be screened for psychological distress.
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Affiliation(s)
- Anel Van Zyl
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,Discipline of Psychology, School of Applied Human Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - Sandile Ndlovu
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Sue-Ann Meehan
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Paul C Rogers
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
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16
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Pletschko T, Krottendorfer K, Schlifelner J, Schwarzinger A, Fohn-Erhold V, Weiler-Wichtl L, Kienesberger A, Leiss U. A Psychosocial Support Program for Young Adult Childhood Cancer Survivors in Austria: a Qualitative Evaluation Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:96-105. [PMID: 34519981 PMCID: PMC9852182 DOI: 10.1007/s13187-021-02083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
Many adolescents and young adult (AYAs) childhood cancer survivors face disease- or therapy-related late-effects, which limit their participation in various areas of daily life. AYAs are often left alone in our health care system, and many worry about their ability to cope with long-term sequelae, and some are even lost to follow-up. Therefore, in the present study, a targeted aftercare program was developed and evaluated with the goal of facilitating three important "life skills": (1) self-perception, (2) social interaction and conflict management, and (3) self-conscious communication of support needs. A total of n = 13 participants (19.2-30.2 years, mean age 22.8 years) completed a 3-day aftercare seminar, at the end of which each participant wrote a reflection letter ("letter to my future self"), elaborating on observed effects of the seminar, applicability of the given information in daily life, and the direct impact of the seminar on their individual circumstances. The reflection letters were analyzed using qualitative content analysis. All target life skills were mentioned in the reflection letters. The participants reported individual benefits from the program especially with respect to self-perception and self-confidence, giving and taking feedback, and acceptance of personal strengths and weaknesses. Moreover, the feeling of "not being alone" was associated with the survivors' experience of emotional and social support. This evaluation highlights the potential of a one weekend aftercare seminar to address important life skills that are known to positively influence health behavior in AYAs. The detailed description of the seminar can serve as a basis for making this kind of aftercare accessible for other people in similar circumstances.
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Affiliation(s)
- Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
| | - Kerstin Krottendorfer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Juliana Schlifelner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Agathe Schwarzinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Austrian Childhood Cancer Organization, Vienna, Austria
| | - Verena Fohn-Erhold
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Liesa Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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17
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Witcraft SM, Wickenhauser ME, Russell KM, Mandrell BN, Conklin HM, Merchant TE, Crabtree VM. A Latent Profile Analysis of Sleep, Anxiety, and Mood in Youth with Craniopharyngioma. Behav Sleep Med 2022; 20:762-773. [PMID: 34719997 DOI: 10.1080/15402002.2021.1996363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness (EDS) which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. METHOD Actigraphs recorded nightly sleep data, including measures of sleep onset latency (SOL) and wake after sleep onset (WASO), in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. RESULTS The latent profile analysis revealed three sleep profiles: "healthy sleepers" (68.8%), "night wakers" (21.3%), and "prolonged onset sleepers" (10.0%). Contrary to expectations, sleep profiles were not associated with daytime anxiety (β = 2.26-4.30, p > .05) or depression (β = -5.87-4.74, p > .05). CONCLUSIONS Youth with craniopharyngioma demonstrate poor sleep and EDS. Those with delayed SOL and prolonged WASO are particularly vulnerable to disrupted nighttime sleep, which may significantly compound EDS. Disrupted sleep was not associated with anxiety or depression, which may be related to the overall poor sleep and daytime sleepiness or to timing, as patients were early in their treatment course. Further study should evaluate the factors underlying sleepiness and daytime function in patients with craniopharyngioma.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, The University of Mississippi, University, Mississippi, USA
| | - Molly E Wickenhauser
- Department of Psychology, The University of Mississippi, University, Mississippi, USA
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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18
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Albee M, Allende S, Cosgrove V, Hocking MC. A prospective study of social competence in survivors of pediatric brain and solid tumors. Pediatr Blood Cancer 2022; 69:e29670. [PMID: 35312152 DOI: 10.1002/pbc.29670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND/OBJECTIVES Survivors of pediatric brain tumors are at increased risk for difficulties with social competence, including poor social information processing (SIP) and peer relationships. Improved survival rates heighten the need to better understand these challenges and if they are specific to survivors of pediatric brain tumors versus survivors of other childhood cancers. METHODS Fifty-one survivors of pediatric brain tumors and 34 survivors of pediatric solid tumors completed evaluations of SIP and peer relationship quality within six months of completing treatment and one year later. Caregivers completed a measure of social skills. Linear mixed models evaluated differences between survivors of pediatric brain and solid tumors on SIP and social skills and how indices of SIP were associated with peer relationships over time. RESULTS The two groups did not differ on indices of SIP or social skills over time. A three-way interaction between measures of SIP, group, and time predicted peer relationships. Survivors of pediatric solid tumors showed a positive association between baseline social skills and theory of mind and peer relationships over time, whereas survivors of pediatric brain tumors showed an inverse association between baseline social skills and theory of mind and peer relationships over time. CONCLUSION Findings revealed unanticipated associations between baseline SIP and social skills and peer relationships over time among survivors of pediatric brain tumors. Additional research is needed to elucidate the factors most influential on peer relationships in this group to inform interventions.
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Affiliation(s)
- May Albee
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Matthew C Hocking
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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19
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McCurdy MD, Raghubar KP, Christopher K, Okcu MF, Wilde E, Desai N, Chu ZD, Gragert M, Stancel H, Warren EH, Whitehead WE, Grosshans D, Paulino AC, Chintagumpala M, Kahalley LS. Predicting neurocognitive function in pediatric brain tumor early survivorship: The neurological predictor scale and the incremental validity of tumor size. Pediatr Blood Cancer 2022; 69:e29803. [PMID: 35709014 PMCID: PMC10265925 DOI: 10.1002/pbc.29803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Neurological Predictor Scale (NPS) quantifies cumulative exposure to conventional treatment-related neurological risks but does not capture potential risks posed by tumors themselves. This study evaluated the predictive validity of the NPS, and the incremental value of tumor location and size, for neurocognitive outcomes in early survivorship following contemporary therapies for pediatric brain tumors. PROCEDURE Survivors (N = 69) diagnosed from 2010 to 2016 were administered age-appropriate versions of the Wechsler Intelligence Scales. Hierarchical multiple regressions examined the predictive and incremental validity of NPS score, tumor location, and tumor size. RESULTS Participants (51% female) aged 6-20 years (M = 13.22, SD = 4.09) completed neurocognitive evaluations 5.16 years (SD = 1.29) postdiagnosis. The NPS significantly predicted Full-Scale Intelligence Quotient (FSIQ; ΔR2 = .079), Verbal Comprehension Index (VCI; ΔR2 = 0.051), Perceptual Reasoning Index (PRI; ΔR2 = 0.065), and Processing Speed Index (PSI; ΔR2 = 0.049) performance after controlling for sex, age at diagnosis, and maternal education. Tumor size alone accounted for a significant amount of unique variance in FSIQ (ΔR2 = 0.065), PRI (ΔR2 = 0.076), and PSI (ΔR2 = 0.080), beyond that captured by the NPS and relevant covariates. Within the full model, the NPS remained a significant independent predictor of FSIQ (β = -0.249, P = 0.016), VCI (β = -0.223, P = 0.048), and PRI (β = -0.229, P = 0.037). CONCLUSIONS Tumor size emerged as an independent predictor of neurocognitive functioning and added incrementally to the predictive utility of the NPS. Pretreatment disease burden may provide one of the earliest markers of neurocognitive risk following contemporary treatments. With perpetual treatment advances, measures quantifying treatment-related risk may need to be updated and revalidated to maintain their clinical utility.
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Affiliation(s)
- Mark D. McCurdy
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - Kimberly P. Raghubar
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | | | - M. Fatih Okcu
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - Elisabeth Wilde
- Baylor College of Medicine, Houston, TX, US
- University of Utah, Salt Lake City, UT, US
| | - Nilesh Desai
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - Zili D. Chu
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - Marsha Gragert
- The University of Texas MD Anderson Cancer Center, Houston, TX US
| | | | - Emily H. Warren
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - William E. Whitehead
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - David Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, TX US
| | | | - Murali Chintagumpala
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
| | - Lisa S. Kahalley
- Baylor College of Medicine, Houston, TX, US
- Texas Children’s Hospital, Houston, TX, US
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20
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Alchin JE, Signorelli C, McLoone JK, Wakefield CE, Fardell JE, Johnston K, Cohn RJ. Childhood Cancer Survivors' Adherence to Healthcare Recommendations Made Through a Distance-Delivered Survivorship Program. J Multidiscip Healthc 2022; 15:1719-1734. [PMID: 35983228 PMCID: PMC9380825 DOI: 10.2147/jmdh.s363653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Ongoing survivorship care allows childhood cancer survivors the opportunity to address treatment-related health problems and improve their quality of life. However, many survivors do not adhere to their healthcare professionals’ recommendations and the factors supporting their adherence remain unclear. Patients and Methods Long-term childhood cancer survivors completed the “Re-engage” program, which assessed survivors’ heath needs and provided individualised recommendations for health interventions and surveillance developed by an expert multi-disciplinary team (MDT). We measured survivors’ recall of, and adherence to, their individualised healthcare recommendations at one and six months post-intervention. We conducted a series of univariate negative binomial regressions to investigate factors associated with the total number of recommendations that were correctly recalled and adhered to. Results We analysed the data of 25 childhood cancer survivors who participated in Re-engage (mean age = 31.9 years). On average, survivors were provided with 6.6 recommendations (range = 1–11). Survivors accurately recalled receiving 3.0 recommendations at one month post-intervention and 1.9 at six months. Survivors had adhered to an average of 1.3 recommendations by six-month follow-up. In total, 56% of participants reported that they did not adhere to any recommendations. By six-month follow-up, greater adherence to MDT recommendations was associated with having a history of a second cancer (B = 1.391; 95% confidence interval [CI], 0.686 to 2.097; p < 0.001) and reporting a greater level of worry about late effects (B = 1.381; 95% CI, 0.494 to 2.269; p = 0.002). Conclusion Survivors reported sub-optimal levels of adherence and demonstrated limited recall of their healthcare recommendations. Effective communication of recommendations and clear discussion of barriers limiting adherence, coupled with late effects education, may be critical to ensure that survivors engage with their recommendations, to improve their quality of life and health outcomes. Trial Registration Number ACTRN12618000194268.
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Affiliation(s)
- Joseph Elliot Alchin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jordana Kathleen McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Claire Elizabeth Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Elizabeth Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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21
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Grenawalt TA, Tansey TN, Phillips BN, Strauser DR, Rosenthal DA, Wagner S. Effectiveness of internet-based behavioral activation on quality of life among young adult survivors of childhood brain tumor: a randomized controlled trial. Disabil Rehabil 2022:1-8. [PMID: 35798680 DOI: 10.1080/09638288.2022.2094478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Diagnosis and treatment of childhood brain tumor have detrimental effects on physical, neurocognitive, psychological, and social functioning that lasts into adulthood and effects quality of life (QOL). To address diminished QOL, an Internet-based behavioral activation (BA) intervention was developed. Behavioral activation aims to increase activities and behaviors likely to improve thoughts, mood, and QOL. METHODS Participants included 127 young adult survivors of childhood brain tumor (SCBT) randomized into the experimental group (n= 64) or the waitlist control group (n= 63). The dependent variables included: life satisfaction, stress, and activation and were assessed with a two-way mixed analysis of variance (ANOVA). RESULTS Results revealed a significant interaction between the intervention and time on life satisfaction, F(1, 125)=4.793, p = 0.03. There were no significant main effects over time for perceived stress and activation. CONCLUSIONS Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult SCBT. Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.Implications for rehabilitationBehavioral activation (BA) is aimed at increasing positively reinforcing overt behaviors that are likely to promote improved thoughts, mood, and quality of life (QOL).Results indicated study participants in the experimental group demonstrated a significant gain in life satisfaction compared to the control group after receiving the Internet-based BA intervention; and provides support that the intervention was associated with positive changes across time.Findings offer initial evidence that BA can be delivered over the internet and that Internet-delivered BA can have a positive effect on the QOL of young adult survivors of childhood brain tumor (SCBT).Internet-based BA interventions can serve as a resource for young adult SCBT who desire to boost their mood and QOL.
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Affiliation(s)
- Teresa Ann Grenawalt
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, Tuscaloosa, AL, USA
| | - Timothy N Tansey
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Brian N Phillips
- Department of Special Education and Rehabilitation Counseling, Utah State University, Logan, UT, USA
| | - David R Strauser
- Department of Kinesiology and Community Health, Work and Disability Lab, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - David A Rosenthal
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Stacia Wagner
- Children's Brain Tumor Foundation, New York, NY, USA
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22
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The Influence of Socioeconomic Status (SES) and Processing Speed on the Psychological Adjustment and Wellbeing of Pediatric Brain Tumor Survivors. Cancers (Basel) 2022; 14:cancers14133075. [PMID: 35804846 PMCID: PMC9264789 DOI: 10.3390/cancers14133075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Processing speed (PS) is one of the most impaired functions in pediatric brain tumor survivors (PBTSs) and it has been linked to difficulties in their psychological functioning, together with other non-insult-related risk factors, such as socio-economic status (SES). Given the psychological adjustment difficulties observed in PBTS, the aim of the current study was to explore the relationship between SES and psychological functioning, measured with the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire, and considering the contribution of PS as a mediator. The results demonstrated that the influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the SES–internalizing problems relationship but not on the SES–externalizing problems relationship. These findings suggest that PS may be a rehabilitation target to prevent psychological distress and should be addressed, especially for PBTSs who live in a disadvantaged situation. Abstract (1) Background: The relationship between processing speed (PS) and psychological adjustment in the healthy population is well established, as is that between low socio-economic status (SES) and psychological distress. While PS is one of the most impaired functions in pediatric brain tumor survivors (PBTSs), previous research has demonstrated that low SES may be a predictor of increased psychosocial risk in PBTSs. Given the psychological adjustment difficulties observed in PBTS, in the current study we aimed to explore the relationship between SES and psychological functioning, considering the contribution of PS as a mediator. (2) Methods: demographic and clinical data of 80 children (age range: 4–17 y.o.) were retrospectively collected. Psychological measures were the parent-compiled versions of the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Mediation analysis models were performed on psychological measures with and without the inclusion of covariates. (3) Results: The influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the relationship between SES and internalizing problems but not on the relationship between SES and externalizing problems. (4) Conclusions: The results suggest that PS may be a rehabilitation target for the prevention of psychological distress and should be addressed especially for PBTSs who live in a disadvantaged situation.
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23
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Janah A, Haddy N, Demoor-Goldschmidt C, Bougas N, Clavel J, Poulalhon C, Lacour B, Souchard V, Jackson A, Casagranda L, Berger C, Allodji R, El Fayech C, Fresneau B, De Vathaire F, Dumas A. The Psychological Consequences of the COVID-19 Pandemic in Adults Treated for Childhood Cancer. Curr Oncol 2022; 29:4104-4116. [PMID: 35735436 PMCID: PMC9221954 DOI: 10.3390/curroncol29060327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Compared with the general population, childhood cancer survivors (CCS) could be at greater risk of psychological distress following the emergence of the COVID-19 pandemic. Purpose: This cross-sectional study assessed the psychological consequences of COVID-19 on the mental health of CCS. Design and participants: In December 2020, we interviewed through an online self-report questionnaire, 580 5-year CCS participating in the French Childhood Cancer Survivor Study (FCCSS) cohort. Methods: We first compared the mental health score of CCS with that observed in the French general population of the same age and gender. Subsequently, we studied predictors of the mental health score of CCS. Results: External comparisons revealed that the mental health score of CCS was similar to that of the general population. Among CCS, almost 42% stated that their psychological state had been worse during the lockdown. Predictors of poorer mental health included, among others, female gender, reporting a change in the occupational situation, having a relative who had been hospitalized or had died following COVID-19, and a greater perceived infection risk. Interpretation and Implications: Given the pre-existing vulnerability of some CCS to mental distress, the additional psychological consequences of COVID-19 in vulnerable survivors should receive attention from health care providers.
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Affiliation(s)
- Asmaa Janah
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Nadia Haddy
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- CHU Angers, Paediatric Oncology Department, F-49100 Angers, France
- François Baclesse Centre, Radiotherapy Department, F-14000 Caen, France
| | - Nicolas Bougas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Jacqueline Clavel
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Brigitte Lacour
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Vincent Souchard
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Angela Jackson
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Leonie Casagranda
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Claire Berger
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Rodrigue Allodji
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Chiraz El Fayech
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Florent De Vathaire
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Correspondence:
| | - Agnes Dumas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
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24
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Tremolada M, Taverna L, Bonichini S, Pillon M, Biffi A. Psychological Well-Being, Cognitive Functioning, and Quality of Life in 205 Adolescent and Young Adult Childhood Cancer Survivors Compared to Healthy Peers. Front Psychol 2022; 13:860729. [PMID: 35651574 PMCID: PMC9149561 DOI: 10.3389/fpsyg.2022.860729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
The majority of the studies underlined how adolescent and young adult (AYA) Cancer Survivors had no significant differences in their well-being and quality of life compared with a control group of healthy counterparts, although French et al. (2013) found less years of education among cancer survivors. The present study aimed at comparing AYA cancer survivors and a control group of peers who had no history of serious illness, in terms of well-being, cognitive functioning, and perceptions of life. Participants in this study were 205 AYA cancer survivors, 126 males, off therapy from a mean of 10.87 years (SD = 4.91), with a mean age of 18.96 (SD = 3.08), recruited during follow-up visits and healthy counterparts (n = 205), matched for age and gender. They all completed self-report questionnaires: Ladder of Life, BSI-18 and Cognitive problems. Paired t test evidenced significant differences between survivors (Mean = 6.19; SD = 2.07) and controls (Mean = 6.88; SD = 2.02) in perceptions of quality of life regarding 5 years before the current time [t(204) = −3.39; p = 0.001], with a lower level for childhood cancer survivors. Specifically, Hierarchical regression (R2 = 0.05, p = 0.04) identified a shorter time since the completion of treatment (β = 0.18, p = 0.03) and a trend of stem cell transplantation experience (β = −0.11, p = 0.06) as factors associated with negative perception of precedent quality of life. The AYA cancer survivors reported lower cognitive difficulties (Mean = 1.46) than controls (Mean = 1.56) [t(204) = −3.41; p = 0.001]: in memory (Meanclinical = 1.32 vs Meancontrol = 1.50) [t(204) = −4.52; p = 0.001], in concentration (Meanclinical = 1.36 vs Meancontrol = 1.54) [t(204) = −4.66; p = 0.001] and in mental organization skills (Meanclinical = 1.47 vs Meancontrol = 1.56) [t(204) = −2.56; p = 0.01], even if they had a lower educational attainment [X(9)2 = 131.28; p = 0.001]. They showed similar satisfaction with their psychological well-being and their lives as healthy counterparts, except for past life perceptions associated with the cancer period. Important recommendations for future research and clinical suggestions could be given.
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Affiliation(s)
- Marta Tremolada
- Department of Development and Social Psychology, University of Padua, Padua, Italy.,Department of Woman's and Child's Health, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padua, Padua, Italy
| | - Livia Taverna
- Department of Development and Social Psychology, University of Padua, Padua, Italy.,Faculty of Education, Free University of Bozen-Bolzano, Bolzano, Italy
| | - Sabrina Bonichini
- Department of Development and Social Psychology, University of Padua, Padua, Italy
| | - Marta Pillon
- Department of Woman's and Child's Health, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padua, Padua, Italy
| | - Alessandra Biffi
- Department of Woman's and Child's Health, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padua, Padua, Italy
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25
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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: 27] [Impact Index Per Article: 13.5] [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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26
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Bates CR, Fairclough D, Noll RB, Barrera ME, Kupst MJ, Egan AM, Gartstein MA, Ach EL, Gerhardt CA, Vannatta KA. Psychosocial functioning of caregivers of pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29565. [PMID: 35044078 PMCID: PMC8860870 DOI: 10.1002/pbc.29565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.
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Affiliation(s)
- Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maru E. Barrera
- Division of Hematology/Oncology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna M. Egan
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Emily L. Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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27
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Marchak JG, Christen S, Mulder RL, Baust K, Blom JMC, Brinkman TM, Elens I, Harju E, Kadan-Lottick NS, Khor JWT, Lemiere J, Recklitis CJ, Wakefield CE, Wiener L, Constine LS, Hudson MM, Kremer LCM, Skinner R, Vetsch J, Lee JL, Michel G. Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2022; 23:e184-e196. [PMID: 35358467 PMCID: PMC9639707 DOI: 10.1016/s1470-2045(21)00750-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022]
Abstract
Survivors of childhood, adolescent, and young adult (diagnosed when <25 years of age) cancer are at risk of mental health problems. The aim of this clinical practice guideline is to harmonise international recommendations for mental health surveillance in survivors of childhood, adolescent, and young adult cancer. This guideline was developed by a multidisciplinary panel of experts under the sponsorship of the International Guideline Harmonization Group. We evaluated concordance among existing survivorship clinical practice guidelines and conducted a systematic review following evidence-based methods. Of 7249 studies identified, 76 articles from 12 countries met the inclusion criteria. Recommendations were formulated on the basis of identified evidence in combination with clinical considerations. This international clinical practice guideline strongly recommends mental health surveillance for all survivors of childhood, adolescent, and young adult cancers at every follow-up visit and prompt referral to mental health specialists when problems are identified. Overall, the recommendations reflect the necessity of mental health surveillance as part of comprehensive survivor-focused health care.
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Yamaji N, Suzuki D, Suto M, Sasayama K, Ota E. Communication tools used in cancer communication with children: a scoping review protocol. BMJ Open 2022; 12:e056403. [PMID: 35197351 PMCID: PMC8867319 DOI: 10.1136/bmjopen-2021-056403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Despite the potential benefits of effective communication, telling children about cancer, unpredictable and life-threatening conditions is challenging. This study aimed to summarise the communication tools used in cancer communication among children with cancer, caregivers and healthcare professionals. METHODS AND ANALYSIS We will conduct a scoping review following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist. We will search PubMed (including MEDLINE), Embase, CENTRAL, PsycINFO and CINAHL. We will include the qualitative and quantitative studies that reported the communication tools that tell a child diagnosed with cancer about the cancer-related information. We will summarise the communication tools and the impacts of the tools. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data will not be collected in this study. The findings of this study will be disseminated through the presentation at the conference and publication in a peer-reviewed journal.
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Affiliation(s)
- Noyuri Yamaji
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
| | - Daichi Suzuki
- Department of Nursing, Kanagawa Institute of Technology, Atsugi, Japan
| | - Maiko Suto
- Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Kiriko Sasayama
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Japan
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Witcraft SM, Wickenhauser ME, Russell KM, Mandrell BN, Conklin HM, Merchant TE, Crabtree VM. Do Anxiety and Mood Vary among Disparate Sleep Profiles in Youth with Craniopharyngioma? A Latent Profile Analysis. Behav Sleep Med 2022; 20:100-111. [PMID: 33661060 DOI: 10.1080/15402002.2021.1892679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. Method: Actigraphs recorded nightly sleep data, including measures of sleep onset latency and wake after sleep onset, in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. Results: The latent profile analysis revealed three sleep profiles: "variable sleepers" (48.3%), "consistently poor sleepers" (45.4%), and "night wakers" (6.4%). Consistently poor sleepers had lower rates of anxiety (g = .76; p = .009) and depression (g = .81; p = .003) than variable sleepers and had significantly lower rates of anxiety than night wakers (g = .52; p = .05); all other differences were nonsignificant (ps > .05). Discussion: Youth with craniopharyngioma who have nightly variations in sleep may have worse psychological functioning than those with more consistent, albeit poor, sleep patterns. Patients with craniopharyngioma who report variable sleep should be assessed for anxiety and depression to prevent and intervene on emotional difficulties that may be reciprocally related to sleep.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, The University of Mississippi, University, Mississippi
| | - Molly E Wickenhauser
- Department of Psychology, The University of Mississippi, University, Mississippi
| | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennesse
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Sylvest R, Vassard D, Schmidt L, Schmiegelow K, Macklon KT, Forman JL, Pinborg A. Family Formation and Socio-Economic Status among 35-Year-Old Men Who Have Survived Cancer in Childhood and Early Adulthood: A Register-Based Cohort Study. Oncol Res Treat 2021; 45:102-111. [PMID: 34823245 DOI: 10.1159/000520365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The number of children and young adults who survive cancer has steadily increased over the past decades. Consequently, life circumstances after cancer have gained increasing importance. The aim of this study was to explore family formation and socio-economic status among 35-year-old men having survived cancer in childhood or early adulthood compared to an age-matched comparison group. METHODS This study is a national, register-based cohort study among 35-year-old men. Men diagnosed with cancer in childhood and early adulthood were registered between 1978 and 2016. At the time of diagnosis, each patient was randomly matched with 150 men without cancer from the background population within the same birth year. Those still alive at the age of 35 years were included in the study population. RESULTS The study population consisted of 4,222 men diagnosed with cancer in childhood or early adulthood and 794,589 men in the age-matched comparison group. Men who have survived cancer during childhood or early adulthood have a reduced probability of having children, and lower probability of getting married or of cohabitation than those from an age-matched comparison group. Men who have survived CNS cancer also have a lower probability of having a higher education than high school and a higher probability of being outside the workforce than those from an age-matched comparison group. DISCUSSION/CONCLUSION Many men who have survived cancer during childhood or early adulthood are influenced by their cancer later in life, which was apparent in family formation, educational achievements, and labour market attachment. Continued focus on rehabilitation and needs for support among the male survivors of childhood and youth cancer is warranted.
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Affiliation(s)
- Randi Sylvest
- Department of Obstetrics and Gynaecology, Fertility Clinic Section 455, Hvidovre University Hospital, Hvidovre, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Tryde Macklon
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julie Lyng Forman
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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31
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White GE, Caterini JE, McCann V, Rendall K, Nathan PC, Rhind SG, Jones H, Wells GD. The Psychoneuroimmunology of Stress Regulation in Pediatric Cancer Patients. Cancers (Basel) 2021; 13:4684. [PMID: 34572911 PMCID: PMC8468382 DOI: 10.3390/cancers13184684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Stress is a ubiquitous experience that can be adaptive or maladaptive. Physiological stress regulation, or allostasis, can be disrupted at any point along the regulatory pathway resulting in adverse effects for the individual. Children with cancer exhibit significant changes to these pathways in line with stress dysregulation and long-term effects similar to those observed in other early-life stress populations, which are thought to be, in part, a result of cytotoxic cancer treatments. Children with cancer may have disruption to several steps in the stress-regulatory pathway including cognitive-affective function, neurological disruption to stress regulatory brain regions, altered adrenal and endocrine function, and disrupted tissue integrity, as well as lower engagement in positive coping behaviours such as physical activity and pro-social habits. To date, there has been minimal study of stress reactivity patterns in childhood illness populations. Nor has the role of stress regulation in long-term health and function been elucidated. We conclude that consideration of stress regulation in childhood cancer may be crucial in understanding and treating the disease.
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Affiliation(s)
- Gillian E. White
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Jessica E. Caterini
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Victoria McCann
- School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Kate Rendall
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Paul C. Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.N.); (H.J.)
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada;
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Heather Jones
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.N.); (H.J.)
| | - Greg D. Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
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Miller KD, Ostrom QT, Kruchko C, Patil N, Tihan T, Cioffi G, Fuchs HE, Waite KA, Jemal A, Siegel RL, Barnholtz-Sloan JS. Brain and other central nervous system tumor statistics, 2021. CA Cancer J Clin 2021; 71:381-406. [PMID: 34427324 DOI: 10.3322/caac.21693] [Citation(s) in RCA: 388] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
Brain and other central nervous system (CNS) tumors are among the most fatal cancers and account for substantial morbidity and mortality in the United States. Population-based data from the Central Brain Tumor Registry of the United States (a combined data set of the National Program of Cancer Registries [NPCR] and Surveillance, Epidemiology, and End Results [SEER] registries), NPCR, National Vital Statistics System and SEER program were analyzed to assess the contemporary burden of malignant and nonmalignant brain and other CNS tumors (hereafter brain) by histology, anatomic site, age, sex, and race/ethnicity. Malignant brain tumor incidence rates declined by 0.8% annually from 2008 to 2017 for all ages combined but increased 0.5% to 0.7% per year among children and adolescents. Malignant brain tumor incidence is highest in males and non-Hispanic White individuals, whereas the rates for nonmalignant tumors are highest in females and non-Hispanic Black individuals. Five-year relative survival for all malignant brain tumors combined increased between 1975 to 1977 and 2009 to 2015 from 23% to 36%, with larger gains among younger age groups. Less improvement among older age groups largely reflects a higher burden of glioblastoma, for which there have been few major advances in prevention, early detection, and treatment the past 4 decades. Specifically, 5-year glioblastoma survival only increased from 4% to 7% during the same time period. In addition, important survival disparities by race/ethnicity remain for childhood tumors, with the largest Black-White disparities for diffuse astrocytomas (75% vs 86% for patients diagnosed during 2009-2015) and embryonal tumors (59% vs 67%). Increased resources for the collection and reporting of timely consistent data are critical for advancing research to elucidate the causes of sex, age, and racial/ethnic differences in brain tumor occurrence, especially for rarer subtypes and among understudied populations.
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Affiliation(s)
- Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Nirav Patil
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- University Hospitals, Cleveland, Ohio
| | - Tarik Tihan
- Neuropathology Division, University of California, San Francisco, California
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
| | - Hannah E Fuchs
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland
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Hong HC, Kim YM, Min A. Factors influencing quality of life among childhood cancer survivors in Korea: A quantile regression approach. Res Nurs Health 2021; 45:108-122. [PMID: 34322889 DOI: 10.1002/nur.22170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
Cancer treatment in childhood may negatively affect survivors' quality of life. In this study, we aimed to determine the contributing factors for health-related quality of life (HRQOL) in survivors of childhood cancer in Korea using quantile regression analysis. This study was a secondary analysis. Data were collected from 130 childhood cancer survivors (CCS) from November 2018 to July 2019. Participants completed the Memorial Symptom Assessment Scale, Depression Anxiety Stress Scale, Health-Promoting Lifestyle Profile-II, and 36-Item Short Form Health Survey (physical component summary [PCS] and mental component summary [MCS]). Quantile and multiple linear regressions were used to analyze the factors contributing to HRQOL. The quantile and linear regression models revealed different results on the contributing factors to HRQOL in CCS. Mean PCS and MCS scores were 78.55 (SD = 15.08) and 64.02 (SD = 18.00), respectively. Symptoms (e.g., difficulty concentrating, worrying, pain, and lack of energy), physical activity, spiritual growth, interpersonal relationships, stress management, depression, and anxiety were significant influencing factors in some PCS quantiles, while symptoms, spiritual growth, interpersonal relationships, depression, and stress were significant influencing factors in some MCS quantiles. The findings of this study showed specific contributing factors in CCS with different levels of HRQOL. There is a need for targeted interventions related to risk reduction and stratification for CCS with different HRQOL levels. Symptom management strategies, early detection programs for CCS with psychological distress, and clinical and counseling interventions for CCS with poor HRQOL need to be developed.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Young Man Kim
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Jeollabuk-do, South Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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Grenawalt TA, Umucu E, Reyes A, Baylin A, Strauser DR, Tansey TN, Wagner S. Psychometric Validation of the PERMA-Profiler as a Well-Being Measure for Young Adult Survivors of Pediatric Central Nervous System Tumor. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/00343552211025509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to validate a measure of well-being, the PERMA-Profiler, among a sample of young adult survivors of pediatric central nervous system (CNS) tumor. Measurement structure of the PERMA-Profiler was evaluated using exploratory factor analysis and confirmatory factor analysis using pretest–posttest data. Reliability and concurrent validity of the PERMA-Profiler were examined. This study included 127 young adult survivors of pediatric CNS tumor between the ages of 18 and 30 ( M = 23.83, SD = 3.00) years. The results of factor analyses yielded a single-factor solution for well-being. Significant relationships between well-being and happiness, life satisfaction, perceived stress, and physical health were observed, providing support for the concurrent validity of the PERMA-Profiler. The PERMA-Profiler displayed good internal consistency and test–retest reliability. The PERMA-Profiler can help rehabilitation researchers and counselors better evaluate well-being in young adult survivors of pediatric CNS tumor, which provides opportunity for more targeted psychosocial interventions.
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Affiliation(s)
| | | | | | | | | | | | - Stacia Wagner
- Children’s Brain Tumor Foundation, New York, NY, USA
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Plant-Fox AS, O'Halloran K, Goldman S. Pediatric brain tumors: the era of molecular diagnostics, targeted and immune-based therapeutics, and a focus on long term neurologic sequelae. Curr Probl Cancer 2021; 45:100777. [PMID: 34303558 DOI: 10.1016/j.currproblcancer.2021.100777] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
Pediatric brain tumors are the second most common malignancy of childhood after acute leukemia and the number one cause of cancer-related mortality1. Over the past decade, advanced molecular diagnostics have led to the discovery of new molecularly-defined tumor types with prognostic and therapeutic implications. Methylation profiles, whole genome sequencing, and transcriptomics have defined subgroups and revealed heterogeneity within commonly defined tumor entities2,3. These findings have also revealed important differences between adult and pediatric brain tumors of similar histology. The majority of pediatric low grade gliomas (pLGG) are defined by alterations in the mitogen-activated protein kinase (MAPK) pathway including BRAFV600E point mutation, K1AA1549-BRAF fusion, and FGFR1 alterations as opposed to IDH1/2 mutations and 1p/19q co-deletion seen more frequently in adult low grade gliomas4. These findings have led to targeted therapies, namely BRAF and MEK inhibitors, which are currently being evaluated in phase III clinical trials and may soon supplant chemotherapy as standard of care for pLGG's. While targeted therapy trials for pediatric brain tumors have had significant success, immunotherapy remains a challenge in a group of tumors with generally lower mutational burden compared to adult tumors and relatively "cold" immune microenvironment. Despite this, a wide array of immunotherapy trials including vaccine therapies, immune checkpoint blockade, chimeric antigen receptor (CAR) T cells, and viral therapies are on-going. Unique to pediatrics, multiple clinical trials have sought to answer the question of whether the most malignant pediatric brain tumors in the youngest patients can be successfully treated with high dose chemotherapy in lieu of radiation to avoid devastating long-term neurocognitive deficits. Due to the collaborative work of multiple pediatric neuro-oncology consortiums, the recent history of pediatric brain tumor research is one of efficient translation from bench to bedside in a rare group of tumors resulting in significant progress in the field. Here, advances in the areas of molecular characterization, targeted and immune-based therapies, and reduction in long term co-morbidities will be reviewed.
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Affiliation(s)
- Ashley S Plant-Fox
- Ann and Robert H. Lurie Children's Hospital of Chicago. Division of Hematology/Oncology/Stem Cell Transplantation/Neuro-Oncology. Chicago, Illinois.
| | - Katrina O'Halloran
- Children's Hospital of Los Angeles. Division of Hematology/Oncology, Los Angeles, California
| | - Stewart Goldman
- Ann and Robert H. Lurie Children's Hospital of Chicago. Division of Hematology/Oncology/Stem Cell Transplantation/Neuro-Oncology. Chicago, Illinois
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Keng A, Stewart DE, Sheehan KA. Neuropsychiatric Symptoms After Brain Tumor Resection in Children and Adolescents: A Scoping Review. J Acad Consult Liaison Psychiatry 2021; 63:110-118. [PMID: 34229094 DOI: 10.1016/j.jaclp.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain tumors are one of the most common solid tumors in pediatric populations, with their treatments having significant neuropsychiatric impact. OBJECTIVE The objective of this study was to review the literature on neuropsychiatric sequelae after surgical resection of brain tumors in children and adolescents. METHODS Using a scoping method, we reviewed empirical articles describing pediatric patients with brain tumors who underwent partial or total resection and examined major neuropsychiatric domains postoperatively over time. RESULTS The initial search yielded 15,543 articles. After duplicate removal, abstract screening, and review, 44 articles were included. Cognitive deficits were the most widely studied outcomes and found to be associated with tumor location, operative variables, perioperative complications, treatment types, and psychosocial factors. Cerebellar mutism, or posterior fossa syndrome, commonly co-occurred with emotional and behavioral dysregulation after posterior fossa resections. Depression, anxiety, and somatization were frequently grouped together as "distress," with higher rates among pediatric patients with brain tumor than among healthy peers. Problematic school behaviors, antisocial, and attention-deficit traits were increased; however, several other behaviors (e.g., risky sexual behaviors, substance use) were equal or lower when compared to peers. Posttraumatic stress disorder was highly prevalent and often interfered with social functioning. Delirium, eating disorders, and longer-term outcomes received inadequate attention. CONCLUSION Identifying risk factors of neuropsychiatric sequelae and their impact after pediatric brain tumor resection is important for prognostication and the development of tailored management strategies for these children and adolescents.
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Affiliation(s)
- Alvin Keng
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathleen Ann Sheehan
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
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Brown JL, Lawrence MM, Borowik A, Oliver L, Peelor FF, Van Remmen H, Miller BF. Tumor burden negatively impacts protein turnover as a proteostatic process in noncancerous liver, heart, and muscle, but not brain. J Appl Physiol (1985) 2021; 131:72-82. [PMID: 34013745 PMCID: PMC8325617 DOI: 10.1152/japplphysiol.01026.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
Cancer survivors are more susceptible to pathologies such as hypertension, liver disease, depression, and coronary artery disease when compared with individuals who have never been diagnosed with cancer. Therefore, it is important to understand how tumor burden negatively impacts nontumor-bearing tissues that may impact future disease susceptibility. We hypothesized that the energetic costs of a tumor would compromise proteostatic maintenance in other tissues. Therefore, the purpose of this study was to determine if tumor burden changes protein synthesis and proliferation rates in heart, brain, and liver. One million Lewis lung carcinoma (LLC) cells or phosphate-buffered saline (PBS, sham) were injected into the hind flank of female mice at ∼4.5 mo of age, and the tumor developed for 3 wk. Rates of proliferation and protein synthesis were measured in heart, brain, liver, and tumor tissue. Compared with sham, rates of protein synthesis (structural/nuclear, cytosolic, mitochondrial, and collagen) relative to proliferation were lower in the heart and liver of LLC mice, but higher in the brain of LLC mice. In the tumor tissue, the ratio of protein synthesis to DNA synthesis was approximately 1.0 showing that protein synthesis in the tumor was used for proliferation with little proteostatic maintenance. We further provide evidence that the differences in tissue responses may be due to energetic stress. We concluded that the decrease in proteostatic maintenance in liver, heart, and muscle might contribute to the increased risk of disease in cancer survivors.NEW & NOTEWORTHY We present data showing that simultaneously measuring protein synthesis and cell proliferation can help in the understanding of protein turnover as a proteostatic process in response to tumor burden. In some tissues, like hepatic, cardiac, and skeletal muscle, there was a decrease in the protein to DNA synthesis ratio indicating less proteostatic maintenance. In contrast, the brain maintained or even increased this protein to DNA synthesis ratio indicating more proteostatic maintenance.
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Affiliation(s)
- Jacob L Brown
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | - Marcus M Lawrence
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
- Department of Kinesiology and Outdoor Recreation, Southern Utah University, Cedar City, Utah
| | - Agnieszka Borowik
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | - Lauren Oliver
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
- Oklahoma University Health Science Center, Oklahoma City, Oklahoma
| | - Fredrick F Peelor
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | - Holly Van Remmen
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma
| | - Benjamin F Miller
- Aging and Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
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Difficulties encountered by physicians and mental health professionals in evaluating and caring for affective and behavioral problems in pediatric brain tumor survivors. Support Care Cancer 2021; 29:6771-6780. [PMID: 33990882 DOI: 10.1007/s00520-021-06250-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTS) present a high risk for emotional and behavioral disorders. When addressing these difficulties, differences in study designs; variety of and disagreement about diagnoses; and intricate links of emotional, behavioral, and cognitive issues may complicate the interpretation of studies and probably also the work of clinicians. We aimed to survey the difficulties perceived by physicians and mental health professionals in their practice and their interest in developing a new evaluative tool. METHODOLOGY We surveyed 29 health professionals involved in the follow-up of this population. They completed questionnaires about their clinical practice (difficulties, needs, activities) and indicated diagnosis hypotheses and treatment plans on a clinical case developed for this study. RESULTS Emotional and behavioral disorders were reported as difficult to assess for 93% of participants. The overlap of symptoms (90%) and the lack of an adapted diagnostic framework (90%) were the main reasons mentioned. Respectively 93%, 90%, and 65% of participants would at least "often" make referrals to psychological (93%), neuropsychological (90%), and psychiatric (65%) assessments and care. Family and group therapy were less common as was drug management. All participants were in favor of creating a tool to help with diagnosis and treatment. When responding to a clinical case, the heterogeneity of participants' responses highlighted their issues in diagnosing and managing these patients. CONCLUSION This survey exemplifies the difficulties of health professionals related to the evaluation and management of affective and behavioral disorders experienced by PBTS. It underlines the need to help professionals by initiating systematic assessment strategies with this vulnerable population.
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Dattilo TM, Olshefski RS, Nahata L, Hansen-Moore JA, Gerhardt CA, Lehmann V. Growing up after childhood cancer: maturity and life satisfaction in young adulthood. Support Care Cancer 2021; 29:6661-6668. [PMID: 33961121 PMCID: PMC8464568 DOI: 10.1007/s00520-021-06260-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/28/2021] [Indexed: 01/07/2023]
Abstract
Purpose Young individuals face a variety of developmental tasks as they mature into adulthood. For survivors of childhood cancer, growing up may be more difficult due to their illness and late effects from treatment. This study is the first to quantitatively examine perceptions of maturity and how these perceptions contribute to satisfaction with life among young adult survivors of childhood cancer. Methods Ninety survivors of childhood cancer (Mage = 29.8; 7–37 years post-diagnosis) were recruited to complete online surveys on how mature they felt relative to peers, their perceived maturity on three domains (financial, personal, social), and life satisfaction. Results Most survivors (62%; n = 56) felt they grew up faster than their peers, and over half (56%; n = 50) felt more mature. Perceived maturity was high on all three domains, but brain tumor survivors reported significantly lower maturity than other survivors (d = 0.76–1.11). All maturity domains were positively associated with life satisfaction (r = .49–.56). Hierarchical linear regressions indicated that 44% of the variance in life satisfaction was explained by perceptions of growing up slower (β = − 1.08, p = .004) and marginally by greater perceived personal maturity (β = 0.45, p = .061). Conclusions Childhood cancer can influence development, with most survivors feeling that they grew up faster and were more mature than peers. Personal maturity was related to life satisfaction, with survivors of brain tumors or those who felt they grew up slower at greatest risk for lower life satisfaction. Future research and clinical practice should consider survivors’ development and maturation across the life span to promote overall well-being.
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Affiliation(s)
- Taylor M Dattilo
- Center for Biobehavioral Health, The Abigail Wexner Research Institute At Nationwide Children's Hospital, Columbus, OH, USA
| | - Randal S Olshefski
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute At Nationwide Children's Hospital, Columbus, OH, USA.,Divison of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer A Hansen-Moore
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute At Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vicky Lehmann
- Center for Biobehavioral Health, The Abigail Wexner Research Institute At Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Medical Psychology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
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40
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Wibroe M, Ingersgaard MV, Larsen HB, Juhler M, Piil K. Living with the cerebellar mutism syndrome: long-term challenges of the diagnosis. Acta Neurochir (Wien) 2021; 163:1291-1298. [PMID: 32621064 DOI: 10.1007/s00701-020-04479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND After posterior fossa tumour surgery, up to 39% of children experience postoperative cerebellar mutism syndrome (CMS) characterized by mutism and other motor and cognitive impairments. There is a lack of knowledge on the patient-reported challenges and long-term needs. Consequently, no specific recommendations exist for rehabilitative and supportive interventions for patients with CMS. The aims of this study were to explore the patients' experiences related to the sequelae of CMS, to identify challenges and needs regarding support and rehabilitation in the period of growing from child to adult and to add perspectives for future developments of supportive care and rehabilitative guidelines. METHODS Ten semi-structured interviews were conducted with young adults diagnosed with CMS as children. A thematic analysis identified four themes describing challenges impacting aspects of the participants' lives. RESULTS Four main themes were identified and highlight the rehabilitative need for focus on verbal and non-verbal communication skills in addition to the physical impairments. We found that brain tumour survivors with CMS can benefit from social and educational rehabilitation, straightforward and truthful information, support in structuring their everyday lives and increased public knowledge of CMS. CONCLUSION Children with CMS face a variety of challenges affecting many aspects of their everyday lives. They should be entitled to the elements of a current rehabilitation initiative for childhood cancer to support patients' social disability and educational decline. Finally, we identified a need for an official information publication.
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Affiliation(s)
- Morten Wibroe
- Department of Neurosurgery and Paediatric Department, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Bonkolab 5704, Blegdamsvej 9, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, 2092, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Karin Piil
- Department of Oncology, Center for Cancer and Organ diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
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Scholtes C, Baust K, Weinhold L, Creutzig U, Gnekow A, Hinz A, Kaatsch P, Kreitz K, Langer T, Rutkowski S, Singer S, Spix C, Teske C, Schmid M, Dilloo D, Calaminus G. Health status, health-related quality of life, and socioeconomic outcome in childhood brain tumor survivors: a German cohort study. Neuro Oncol 2021; 21:1069-1081. [PMID: 30793186 DOI: 10.1093/neuonc/noz044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With rising numbers of childhood cancer survivors, somatic and socioeconomic outcome as well as health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health, and Quality of Life of Childhood Cancer Survivors, the VIVE survey, we report the outcome of survivors of childhood brain tumors localized in the posterior fossa. METHODS Two hundred seventy participants with a median follow-up period of 21.9 years completed a questionnaire on socioeconomic and somatic late effects as well as a standardized QoL questionnaire (European Organisation for Research and Treatment of Cancer QLQ-C30). Comparisons were performed between World Health Organization (WHO) grades I-II, WHO grades III-IV brain tumor survivors (BTS), and the general population adjusting for potential confounders. RESULTS The socioeconomic and QoL results of WHO grades I-II BTS were largely comparable to the general population, while grades III-IV BTS were at higher risk for significantly worse outcomes. Of WHO grades III-IV BTS, 36.8% were still living with their parents or in assisted living facilities compared with 16.1% of grades I-II BTS and 7.8% of the age-adjusted general population. Of grades III-IV BTS, 60.8% achieved at least an intermediate school degree in comparison to 80.5% of grades I-II BTS and 75.6% of the general population. Grades III-IV BTS developed up to 2 times more somatic late effects than survivors of grades I-II tumors. CONCLUSION Derived from a large and homogeneous cohort, these results stress the importance of an appropriate follow-up period focusing not only on physical aspects but encompassing the entire living situation to allow patient-tailored support.
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Affiliation(s)
- Cathy Scholtes
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Ursula Creutzig
- Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Astrid Gnekow
- Pediatric Hematology/Oncology, Children's Hospital Augsburg, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Kiana Kreitz
- Institute for Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Thorsten Langer
- Pediatric Hematology/Oncology, University Children's Hospital Lübeck, Germany
| | - Stefan Rutkowski
- Pediatric Hematology/Oncology, University Children's Hospital Hamburg, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Mainz, Germany
| | - Carmen Teske
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Dagmar Dilloo
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
| | - Gabriele Calaminus
- Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany
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Sharkey CM, Mullins LL, Clawson AH, Gioia A, Hawkins MAW, Chaney JM, Walsh KS, Hardy KK. Assessing neuropsychological phenotypes of pediatric brain tumor survivors. Psychooncology 2021; 30:1366-1374. [PMID: 33823083 DOI: 10.1002/pon.5692] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Pediatric brain tumor survivors (PBTS) are at risk for both neurocognitive impairments and psychological difficulties, yet these two domains have historically been discretely examined, with assessment of psychosocial outcomes rarely included in studies of cognitive outcomes. Taking a person-centered approach, the current study aimed to more comprehensively evaluate PBTS late effect profiles, including both neurocognitive and psychological sequelae, and predictors of these profiles. METHOD PBTS (N = 89) were assessed in a pediatric neuropsychological clinic between May 2009 and May 2018, diagnosed at least 1 year prior, and off-treatment for at least 3 months (Mage = 6.57 years, SD = 4.53; 46.1% female). Parent- and teacher-report of psychological symptoms, and performance-based measures of neurocognitive functioning were examined using latent profile analysis. The R3STEP procedure identified predictors of class membership. RESULTS The optimal model identified four classes characterized by: (1) average functioning across all measures ("Average," n = 47), (2) average psychosocial functioning and impaired neurocognitive functioning ("Cognitive Deficit," n = 25), (3) elevated social problems and significant neurocognitive impairments ("Social/Cognitive Deficit," n = 9), and (4) impaired visual planning and problem-solving and elevated parent-reported psychosocial problems, but average processing speed, working memory, and teacher-reported psychosocial outcomes ("Discrepant," n = 8). Ethnicity, race, radiation treatment, and diagnoses of neurofibromatosis 1, hydrocephalus, and cerebellar mutism syndrome were significant predictors of class membership (ps < 0.05). CONCLUSION The present study identified distinct phenotypes with unique patterns of relations among neurocognitive and psychological domains. These findings are a vital first step toward identifying those at highest risk for poor outcomes and informing interventions that effectively address interrelated treatment targets for specific groups.
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Affiliation(s)
- Christina M Sharkey
- Children's National Hospital, Division of Pediatric Neuropsychology, Washington DC, USA
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Ashley H Clawson
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Anthony Gioia
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Misty A W Hawkins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Karin S Walsh
- Children's National Hospital, Division of Pediatric Neuropsychology, Washington DC, USA
| | - Kristina K Hardy
- Children's National Hospital, Division of Pediatric Neuropsychology, Washington DC, USA
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Miroshnychenko A, Rae C, Tsangaris E, Breakey VR, D'Agostino N, Klassen AF. Clinical and Demographic Factors Associated with Distress in Adolescent and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:682-689. [PMID: 33844943 DOI: 10.1089/jayao.2020.0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Distress in cancer is defined as multifactorial unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with ones' ability to cope with cancer and its symptoms and treatment. The aim of this study was to determine clinical and demographic factors associated with the presence of distress in adolescent and young adults (AYAs) with cancer. Methods: Data were collected as part of a field-test study conducted between August 2016 and November 2017 in Canada (Toronto, Edmonton, and Vancouver) to determine the reliability and validity of CDS-AYA (Cancer Distress Scales for Adolescent and Young Adults). The CDS-AYA consist of five independently functioning scales including impact of cancer, physical, emotional, cognitive, and cancer worry. Multivariate logistic regression analyses, using established CDS-AYA cut points, were performed to identify clinical and demographic factors associated with the presence of distress in AYAs of ages 15-39 years with cancer. Results: Across all scales, increased distress was associated with female gender (p < 0.05), on-treatment status (p < 0.05), and reported poor overall health (p < 0.001). For the emotional scale, distress was also associated with being of age 15-19 years (p = 0.01). The greatest effect size for all scales was associated with treatment status [exp(β) = 1.78-4.6], except for the cognitive scale where gender had a slightly greater effect size. Conclusion: Factors associated with distress in AYA patients with cancer were similar across five CDS-AYA scales. Although it is important to screen all patients for distress, our findings reveal that patients who are female, on treatment, or who report having poorer health may be at a greater risk.
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Affiliation(s)
- Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicky R Breakey
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Desjardins L, Lai MC, Vorstman J, Bartels U, Barrera M. A Novel Approach to Understanding Social Behaviors in Pediatric Brain Tumor Survivors: A Pilot Study. J Pediatr Psychol 2021; 46:80-90. [PMID: 33377489 DOI: 10.1093/jpepsy/jsaa090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Pediatric brain tumor survivors (PBTS) are at risk of experiencing challenges in social adjustment. However, the specific social behaviors of PBTS have rarely been directly assessed. This pilot study explores the first novel use of the Autism Diagnostic Observation Schedule, second edition (ADOS-2), to evaluate the social behaviors of PBTS. METHODS Twenty-six PBTS (ages 9-17 years; M = 7.8 years from diagnosis; 52% male; 41% received radiation treatment) completed the ADOS-2. The proportion of the sample experiencing impairment was examined descriptively across all items of the ADOS-2, as well as by a summary "overall score" created for this study, and using the ADOS-2 "diagnostic algorithm" scores for autism. Social adjustment, cognitive, medical, and demographic variables were explored as correlates of the ADOS-2 "overall score". RESULTS Study recruitment was 34%, impeded by distance from the tertiary-care center. The percentage of PBTS experiencing detectable impairments ranged from 0% to 50% across ADOS-2 items. Cranial radiation treatment, lower IQ, and slower cognitive processing were associated with higher impairment on the ADOS-2 "overall score". CONCLUSION The ADOS-2 can be used to assess the discrete social behaviors of PBTS. This study provides a foundation for future investigations using the ADOS-2 to assess social behaviors in this population. Identifying specific social behavior difficulties in PBTS is key to refining much needed targeted social skills interventions for this population.
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Affiliation(s)
- Leandra Desjardins
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jacob Vorstman
- Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Ontario Institute of Studies in Education and Institute of Medical Sciences, University of Toronto, Toronto, Canada
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Sharkey CM, Espeleta HC, Traino KA, Roberts CM, Perez MN, Bakula DM, Chaney JM, Alderson RM, Mullins LL. Psychological adjustment outcomes among pediatric brain tumor survivors: A meta-analysis. Pediatr Blood Cancer 2020; 67:e28644. [PMID: 32761992 DOI: 10.1002/pbc.28644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTS) are at significant risk for psychological adjustment difficulties, including greater depressive and anxious symptomology. Systematic reviews have identified this heightened risk among youth with medical conditions, but these reviews have not been specific to PBTS. Therefore, the current study aimed to directly examine the psychological adjustment of PBTS as compared to healthy peers. PROCEDURE A systematic review and meta-analysis was conducted using PubMed, PsychInfo, and Academic Search Premier databases. The search yielded 2833 articles, with 22 articles meeting inclusion criteria. RESULTS A statistically significant overall medium effect size (Hedge's g = 0.32) indicated that PBTS exhibited poorer overall psychological adjustment relative to healthy comparison groups. Studies that included younger children were associated with larger between-group differences. When evaluating specific outcomes, PBTS had relatively higher levels of depressive symptoms (Hedge's g = 0.36), anxious symptoms (Hedge's g = 0.11), and general distress (Hedge's g = 0.22), but not more externalizing problems. CONCLUSIONS The present study confirmed that PBTS are indeed at greater risk for psychological adjustment difficulties relative to healthy comparison groups. These findings highlight the importance of psychosocial screening among this population. Given that depressive symptoms were the most elevated relative to healthy peers, investigation of such symptomatology among PBTS is particularly important.
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Affiliation(s)
| | - Hannah C Espeleta
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Katherine A Traino
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Caroline M Roberts
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
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Dumont É, Bourque CJ, Duval M, Payot A, Sultan S. A Portrait of Self-Reported Health and Distress in Parents Whose Child Died of Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:958-973. [DOI: 10.1177/0030222820959943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Grieving a child following cancer is a substantially difficult task. The objectives of this research were: 1) to describe current quality of life (QoL), psychological distress and symptoms of grief of bereaved parents, and 2) to explore the role of possible contributors of QoL and psychological distress. Forty-six parents (32 mothers) of children who died of cancer were surveyed on their QoL, distress, and complicated grief. Data were analyzed using multiple linear regression. Parents had a high frequency of grieving symptoms (58%). Mothers reported more retrospective grief symptoms than fathers when describing the year after child death. Current lower mental well-being was associated with experiencing higher retrospective grief symptoms, a shorter period since child death, and being a father. Hence, parents experienced disturbances even long after child death. Mothers and fathers may present specificities that should be considered when developing supportive activities for this vulnerable population.
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Affiliation(s)
- Émilie Dumont
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Claude Julie Bourque
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Michel Duval
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Antoine Payot
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
- Sainte-Justine University Health Center, Montréal, Québec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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Hayek S, Brinkman TM, Plana JC, Joshi VM, Leupker RV, Durand JB, Green DM, Partin RE, Santucci AK, Howell RM, Srivastava DK, Hudson MM, Robison LL, Armstrong GT, Ness KK. Association of Exercise Intolerance With Emotional Distress, Attainment of Social Roles, and Health-Related Quality of Life Among Adult Survivors of Childhood Cancer. JAMA Oncol 2020; 6:1194-1202. [PMID: 32584369 PMCID: PMC7317652 DOI: 10.1001/jamaoncol.2020.2054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
Importance Exercise intolerance is associated with increased risk for morbidity and mortality in childhood cancer survivors. However, an association between exercise intolerance and psychosocial outcomes has not been fully explored. Objective To examine the associations between exercise intolerance and emotional distress, attainment of social roles, and health-related quality of life in childhood cancer survivors. Design, Setting, and Participants A cross-sectional study including 1041 adult survivors of childhood cancer and 286 community controls in the St Jude Lifetime Cohort was conducted at St Jude Children's Research Hospital. The study was performed from April 1, 2012, to March 15, 2020. Exposures Exercise intolerance was defined as relative peak oxygen uptake less than 85% of age- and sex-estimated levels from maximal cardiopulmonary exercise testing. Main Outcomes and Measures Emotional distress was measured with the 18-item Brief Symptom Inventory-18, which includes overall Global Severity Index and depression, anxiety, and somatization subscales. Participants with T scores greater than or equal to 63 were classified as having elevated levels of distress. Social attainment was evaluated using patient-reported educational, employment, and marital status. Health-related quality of life was examined with the Medical Outcomes Survey Short Form-36. Participants with T scores less than or equal to 40 were classified as reporting poor health-related quality of life. Results Of the 1041 participants, 528 were women (50.7%). The prevalence of exercise intolerance among survivors (mean [SD] age, 35.5 [9.2] years) was higher than that among controls (age, 34.5 [10.0] years) (survivors: 634 [60.9%] vs controls: 75 [26.2%], P < .001). After adjusting for age at diagnosis and cardiopulmonary exercise testing, sex, race/ethnicity, smoking, physical activity, and exercise intolerance were associated with an increased risk for anxiety (prevalence rate ratio [PRR], 1.95; 95% CI, 1.20-3.16), somatization (PRR, 1.86; 95% CI, 1.23-2.80), and unemployment (PRR, 1.76; 95% CI, 1.23-2.52); an inverse association was noted with having a college degree (PRR, 0.67; 95% CI, 0.50-0.88). Exercise intolerance was associated with an increased the risk for scoring less than or equal to 40 on the physical component summary of the Medical Outcomes Survey Short Form-36 (PRR, 3.69; 95% CI, 2.34-5.84). These associations persisted when either cancer treatment exposures or chronic health conditions were added to the model. Conclusions and Relevance The findings of this study suggest that exercise intolerance is independently associated with emotional distress, attainment of social roles, and health-related quality of life of long-term survivors of childhood cancer. The results also suggest that improving physiologic capacity may benefit general health and wellness, as well as emotional health, ability to participate in social roles, and health-related quality of life.
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Affiliation(s)
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Juan C. Plana
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Vijaya M. Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis
| | - Russell V. Leupker
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Jean B. Durand
- Division of Cardiology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Daniel M. Green
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Robyn E. Partin
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Aimee K. Santucci
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rebecca M. Howell
- Division of Radiology Oncology, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston
| | - Deo Kumar Srivastava
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
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Uche EO, Eke CB, Okafor OC, Uche NJ, Ajuzieogu OV, Amuta DS, Onyia EE, Guga DA, Okpara S, Mezue WC, Tisell M, Ryttlefors M. Pediatric brain tumor care in a Sub-Saharan setting: current poise of a precariously loaded dice. Br J Neurosurg 2020; 35:174-180. [PMID: 32657167 DOI: 10.1080/02688697.2020.1777259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the current status of pediatric brain tumor (PBT) care and identify determinants and profiles of survival and school attendance. METHODS An 8-year institution-based prospective longitudinal study. All cases investigated with neuroimaging and treated were enrolled. Data was analyzed with SPSS (Inc) Chicago IL, USA version 23. Chi Square test, One-way ANOVA and confidence limits were used to evaluate associations at the 95% level of significance. Ethical approval for our study was obtained Health Research Ethics Committee of our hospital. RESULTS Among 103 patients enrolled, 92 satisfied our study criteria. There were 45 males and 39 females, M: F = 0.8. The mean age was 9.5 ± 2.1 years 95%CI with a range of 7 months to 16 years. The most common symptom was headache for supratentorial lesions (73%) and gait disturbance (80.2%) for infratentorial lesions. More tumors were supratentorial in location 51 (55.4%), 35 (38.1%) were infratentorial and 6 (6.5%) were transtentorial. Craniopharyngiomas (n = 23), medulloblastomas (n = 22) and astrocytomas (n = 15) were the most common tumors. Hemoglobin genotype (AA and AS) had some influence on tumor phenotype FT, P = 0.033. 76 cases were microsurgically resected while 16 patients were treated with radiotherapy alone. The 30-day mortality for operated cases is 7.2 ± 0.7%. Overall 1-year and 5-year survival was 66.7 and 52.3%, respectively. School attendance, performance and outcome varied among treatment subgroups. CONCLUSION Survival profile in this series suggests some improvement in comparison to previous studies from our region, Hemoglobin genotype profiles may signature paediatric brain tumor phenotypes in our setting.
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Affiliation(s)
- Enoch Ogbonnaya Uche
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Christopher B Eke
- Department of Pediatrics, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid and Anatomic Pathology, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | | | - Obinna V Ajuzieogu
- Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dubem S Amuta
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ephraim E Onyia
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dung A Guga
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Samuel Okpara
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Wilfred C Mezue
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Magnus Tisell
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
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49
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Ji X, Cummings JR, Gilleland Marchak J, Han X, Mertens AC. Mental health among nonelderly adult cancer survivors: A national estimate. Cancer 2020; 126:3768-3776. [PMID: 32538481 DOI: 10.1002/cncr.32988] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study assessed mental health (MH) outcomes across age groups in a nationally representative US sample of adult cancer survivors. METHODS The 2015 to 2017 National Survey on Drug Use and Health was used to identify respondents aged 18 to 64 years. The authors compared MH outcomes between respondents with a cancer history and respondents without a cancer history in adjusted analyses controlling for demographics and socioeconomic status. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. All analyses were stratified by age group (18-34, 35-49, or 50-64 years). RESULTS In a comparison of 2656 survivors and 112,952 individuals without cancer, within each age group, survivors had an elevated prevalence of MH problems in 5 of the 7 outcome measures. Among young adults (aged 18-34 years), survivors were more likely than noncancer counterparts to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P values <.05). These differences persisted in adjusted analyses (P values <.01). Similar survivor-comparison differences were observed among older groups but with a smaller magnitude. Among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all outcomes (P values <.05). CONCLUSIONS This population-based study shows an elevated prevalence of MH problems among adult cancer survivors in comparison with the general population. This finding highlights the importance of developing strategies to ensure the early detection of mental illness and to improve access to MH treatment for cancer survivors.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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50
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Hocking MC, Parish-Morris J, Schultz RT, Minturn JE, Brodsky C, Shabason EK, Herrington JD. Diminished social attention in pediatric brain tumor survivors: Using eye tracking technology during naturalistic social perception. Neuropsychology 2020; 34:350-358. [PMID: 31999166 DOI: 10.1037/neu0000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The etiology of pediatric brain tumor survivor (PBTSs) social difficulties is not well understood. A model of social competence for youth with brain disorder and evidence from youth with autism spectrum disorder (ASD) suggests that diminished social attention may underlie social deficits in PBTSs. This study used eye tracking technology to compare visual social attention in PBTSs, youth with ASD, and typically developing (TD) youth. METHODS Participants included 90 age-, gender-, and IQ-matched youth (N = 30 per group). PBTSs were at least 5 years from diagnosis and 2 years from the completion of tumor-directed therapy. Participants' eye gaze patterns were recorded while watching an established social play paradigm that presented videos of children engaging in either interactive or parallel play. Group differences in proportional gaze duration toward social versus nonsocial areas of interest were compared. Medical correlates of social attention in PBTSs were evaluated. RESULTS Groups significantly differed in gaze preference across conditions, with PBTSs looking less at social areas of interest than TD youth and in a manner comparable to youth with ASD. Among PBTSs, multimodal tumor-directed therapy was associated with reduced gaze preference for faces. CONCLUSIONS This study provides the first evidence of disrupted social attention in PBTSs, with parallels to the social attention deficits observed in ASD. Findings offer a new way to conceptualize the social difficulties of PBTSs and could guide interventions aimed at improving PBTS social adjustment by increasing visual attention to socially relevant information during social interactions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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