1
|
Janssen LE, Laarman ARC, van Dijk-Lokkart EM, Bröring-Starre T, Oudijk MA, de Groot CJM, de Boer MA. Long-Term Maternal Mental Health after Spontaneous Preterm Birth. Am J Perinatol 2023. [PMID: 37758204 DOI: 10.1055/a-2182-4131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The aim of this study is to investigate whether a history of spontaneous preterm birth (SPTB) is associated with maternal depressive and anxiety symptoms, or psychosocial distress in the fifth decade of life. STUDY DESIGN This is a secondary analysis of the PreCaris-study, a prospective observational study in which we included 350 women with a history of SPTB between 220/7 and 366/7 weeks of gestation and compared them to 115 women who had a term birth. Primary outcomes were the Depression and Anxiety scores measured using the Hospital Anxiety Depression Scale and Psychosocial distress assessed with the Distress Thermometer for Parents. Secondary outcomes were self-reported impact of the birth in daily life and psychosocial support after delivery. RESULTS After a median of 13 years after delivery, no significant differences were found in primary outcomes. Significantly more women with a history of SPTB reported that the birth still had impact in daily life; adjusted odds ratio: 2.46 (95% confidence interval: 1.35-4.48). A total of 57 (16.3%) women after SPTB reported to have needed professional psychosocial support after delivery but did not receive it. These women more often had a high Anxiety score (p = 0.030), psychosocial distress (p = 0.001), and influence of birth in daily life (p = 0.000). CONCLUSION There are no long-term effects on depressive and anxiety symptoms and psychosocial distress in women who experienced SPTB compared with women who had a full-term pregnancy. A significant part of the women who delivered preterm needed psychosocial support but did not receive it and were at higher risk of anxiety, psychosocial distress, and impact in daily life. We therefore recommend offering all women after SPTB psychosocial support after delivery. KEY POINTS · No long-term effects on depressive and anxiety symptoms and psychosocial distress after SPTB.. · A total of 16.3% of the cases needed professional psychosocial support after delivery but did not receive it.. · This subgroup was at higher risk of anxiety symptoms, psychosocial distress, and impact on daily life..
Collapse
Affiliation(s)
- Laura E Janssen
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Aranka R C Laarman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Tinka Bröring-Starre
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Emma Childrens' Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Marjon A de Boer
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Obstetrics, Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Jagt JZ, van Rheenen PF, Thoma SMA, Gower J, Reimering-Hartgerink PB, van der Wielen HJHL, van Steenbergen EJ, Goutbeek AM, van Dijk-Lokkart EM, Vlietstra S, Reinders D, den Otter Y, Schoonderwoert I, Schoonderwoert B, Schoonderwoert H, van der Weide G, van Harten S, Mouthaan K, Benninga MA, de Boer NKH, van der Horst D, Scherpenzeel M, de Meij TGJ. The top 10 research priorities for inflammatory bowel disease in children and young adults: results of a James Lind Alliance Priority Setting Partnership. Lancet Gastroenterol Hepatol 2023:S2468-1253(23)00140-1. [PMID: 37230110 DOI: 10.1016/s2468-1253(23)00140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Jasmijn Z Jagt
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands; Paediatric Gastroenterology, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands.
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Sophia M A Thoma
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, and Faculty of Medicine, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Esther J van Steenbergen
- Department of Paediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anne-Marije Goutbeek
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | | | | | | | | | | | | | | | | | | | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, VU University Amsterdam, Amsterdam, Netherlands
| | | | | | - Tim G J de Meij
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105, Netherlands
| |
Collapse
|
3
|
Van Assche IA, Huis In 't Veld EA, Van Calsteren K, van Gerwen M, Blommaert J, Cardonick E, Halaska MJ, Fruscio R, Fumagalli M, Lemiere J, van Dijk-Lokkart EM, Fontana C, van Tinteren H, De Ridder J, van Grotel M, van den Heuvel-Eibrink MM, Lagae L, Amant F. Cognitive and Behavioral Development of 9-Year-Old Children After Maternal Cancer During Pregnancy: A Prospective Multicenter Cohort Study. J Clin Oncol 2023; 41:1527-1532. [PMID: 36634293 PMCID: PMC10022854 DOI: 10.1200/jco.22.02005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.This multicenter cohort study reports on the long-term effects of prenatal exposure to maternal cancer and its treatment on cognitive and behavioral outcomes in 9-year-old children. In total, 151 children (mean age, 9.3 years; range, 7.8-10.6 years) were assessed using a neurocognitive test battery and parent-report behavioral questionnaires. During pregnancy, 109 children (72.2%) were exposed to chemotherapy (only or in combination with other treatment modalities), 18 (11.9%) to surgery only, 16 (10.6%) to radiotherapy, one to trastuzumab, and 16 (10.6%) were not exposed to oncologic treatment. Mean cognitive and behavioral outcomes were within normal ranges. Gestational age at birth showed a positive association with Full Scale Intelligence Quotient (FSIQ), with the average FSIQ score increasing by 1.6 points for each week increase in gestational age (95% CI, 0.7 to 2.5; P < .001). No difference in FSIQ was found between treatment types (F[4,140] = 0.45, P = .776). In children prenatally exposed to chemotherapy, no associations were found between FSIQ and chemotherapeutic agent, exposure level, or timing during pregnancy. These results indicate a reassuring follow-up during the critical maturational period of late childhood, when complex functions develop and rely on the integrity of early brain development. However, associations were observed with preterm birth, maternal death, and maternal education.
Collapse
Affiliation(s)
- Indra A Van Assche
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium
| | - Evangeline A Huis In 't Veld
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Kristel Van Calsteren
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium.,Division of Foetomaternal Medicine, Department of Obstetrics and Gynaecology, UZ Leuven, Belgium
| | - Mathilde van Gerwen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen Blommaert
- Department of Oncology, Unit of Pediatric Oncology, KU Leuven, Belgium.,Department of Oncology, Unit of Gynaecological Oncology, KU Leuven, Belgium.,Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Belgium
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ
| | - Michael J Halaska
- Department of Obstetric Gynecology, University Hospital Kralovske Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Robert Fruscio
- Department of Medicine and Surgery, Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milano, Italy
| | - Jurgen Lemiere
- Department of Oncology, Unit of Pediatric Oncology, KU Leuven, Belgium.,Division of Pediatric Hemato-Oncology, Department of Pediatrics, UZ Leuven, Belgium
| | - Elisabeth M van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, the Netherlands.,Amsterdam Reproduction and Development, Child Development, Amsterdam, the Netherlands
| | - Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milano, Italy
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jessie De Ridder
- Division of Pediatric Neurology, Department of Pediatrics, UZ Leuven, Belgium.,Department of Development and Regeneration, Unit Locomotor and Neurological Disorders, KU Leuven, Belgium
| | | | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,UMCU-Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Lieven Lagae
- Department of Development and Regeneration, Unit of Woman and Child, KU Leuven, Belgium.,Division of Pediatric Neurology, Department of Pediatrics, UZ Leuven, Belgium
| | - Frédéric Amant
- Center for Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oncology, Unit of Gynaecological Oncology, KU Leuven, Belgium.,Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, UZ Leuven, Belgium
| |
Collapse
|
4
|
van Gerwen M, Maggen C, Cardonick E, Verwaaijen EJ, van den Heuvel-Eibrink M, Shmakov RG, Boere I, Gziri MM, Ottevanger PB, Lok CAR, Halaska M, Shao LT, Struys I, van Dijk-Lokkart EM, Van Calsteren K, Fruscio R, Zola P, Scarfone G, Amant F. Association of Chemotherapy Timing in Pregnancy With Congenital Malformation. JAMA Netw Open 2021; 4:e2113180. [PMID: 34106263 PMCID: PMC8190627 DOI: 10.1001/jamanetworkopen.2021.13180] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Chemotherapy during the first trimester of pregnancy should be avoided owing to the risk of congenital malformations. However, the precise gestational age at which chemotherapy can be initiated safely remains unclear. OBJECTIVE To assess congenital malformation rates associated with gestational age at initiation of chemotherapy among pregnant women with cancer. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study evaluated all pregnant women who received chemotherapy between 1977 and 2019 registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database. Data were analyzed from February 15 to June 2, 2020. EXPOSURES Cancer treatment with chemotherapy during pregnancy. MAIN OUTCOMES AND MEASURES Analysis was focused on major and minor structural malformations in offspring, defined by EUROCAT, detected during pregnancy or at birth. RESULTS A total of 755 women in the INCIP database who underwent cancer treatment with chemotherapy during pregnancy were included in analysis. The median (range) age at cancer diagnosis was 33 (14-48) years. Among offspring, the major congenital malformation rate was 3.6% (95% CI, 2.4%-5.2%), and the minor congenital malformation rate was 1.9% (95% CI, 1.0%-3.1%). Chemotherapy exposure prior to 12 weeks gestational age was associated with a high rate of major congenital malformations, at 21.7% (95% CI, 7.5%-43.7%; odds ratio, 9.24 [95% CI, 3.13-27.30]). When chemotherapy was initiated after gestational age 12 weeks, the frequency of major congenital malformations was 3.0% (95% CI, 1.9%-4.6%), which was similar to the expected rates in the general population. Minor malformations were comparable when exposure occurred before or after gestational age 12 weeks (4.3% [95% CI, 0.1%-21.9%] vs 1.8% [95% CI, 1.0-3.0]; odds ratio, 3.13 [95% CI, 0.39-25.28]). Of 29 women who received chemotherapy prior to 12 weeks gestation, 17 (58.6%) were not aware of pregnancy, and 6 (20.7%) experienced a miscarriage (3 women [10.3%]) or decided to terminate their pregnancy (3 women [10.3%]). CONCLUSIONS AND RELEVANCE This cohort study found that chemotherapy was associated with an increased risk of major congenital malformations only in the first 12 weeks of pregnancy. The risk of congenital malformations when chemotherapy was administered during the first trimester and the high number of incidental pregnancies during cancer treatment in the INCIP registry underscore the importance of contraceptive advice and pregnancy testing at the start of chemotherapeutic treatment in young women with cancer.
Collapse
Affiliation(s)
- Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, New Jersey
| | | | | | - Roman G. Shmakov
- National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mina M. Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, Université Catholique de Louvain, Sint-Lambrechts-Woluwe, Belgium
| | - Petronella B. Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Christianne A. R. Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michael Halaska
- University Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Long Ting Shao
- Cooper Medical School, Rowan University, Camden, New Jersey
| | - Ilana Struys
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Elisabeth M. van Dijk-Lokkart
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Robert Fruscio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milan, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giovanna Scarfone
- Gynecological Oncology Unit, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Frédéric Amant
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek–Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| |
Collapse
|
5
|
van Gerwen M, Huis In 't Veld E, van Grotel M, van den Heuvel-Eibrink MM, Van Calsteren K, Maggen C, Drochytek V, Scarfone G, Fontana C, Fruscio R, Cardonick E, van Dijk-Lokkart EM, Amant F. [Formula: see text]Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment. Child Neuropsychol 2021; 27:822-833. [PMID: 33876721 DOI: 10.1080/09297049.2021.1902489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18 months, 36 months, 6, 9, 12, 15 and 18 years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child's general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7 years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7 years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did not affect the neurodevelopment of the child in the long term. Yet, caution is indicated and surveillance of the emotional development of the child is needed, especially when the mother is deceased to cancer.
Collapse
Affiliation(s)
- Mathilde van Gerwen
- Center for Gynecologic Oncology Amsterdam, the Netherlands Cancer Institute, Amsterdam, The Netherlands.,Pediatric Oncology , Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Evangeline Huis In 't Veld
- Center for Gynecologic Oncology Amsterdam, the Netherlands Cancer Institute, Amsterdam, The Netherlands.,Pediatric Oncology , Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martine van Grotel
- Pediatric Oncology , Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven and Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Vit Drochytek
- Department of Obstetrics and Gynecology, 3rd Medical Faculty Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Giovanna Scarfone
- Gynecological Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, NJ, USA
| | - Elisabeth M van Dijk-Lokkart
- Department of Child & Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frédéric Amant
- Center for Gynecologic Oncology Amsterdam, the Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
6
|
van Gerwen M, Vandenbroucke T, Gorissen AS, van Grotel M, van den Heuvel-Eibrink M, Verwaaijen E, van der Perk M, Van Calsteren K, van Dijk-Lokkart EM, Amant F. Executive functioning in 6 year old children exposed to chemotherapy in utero. Early Hum Dev 2020; 151:105198. [PMID: 32980625 DOI: 10.1016/j.earlhumdev.2020.105198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Cancer treatment during pregnancy imposes a dilemma. Maternal advantage should be weighed against the potential impact of chemotherapy on child development. Recent studies in cancer survivors have shown that exposure to chemotherapeutic agents can have late adverse effects on cognitive functioning and executive functioning (EF). It is still unclear whether these late adverse effects also arise if a child is exposed to chemotherapy in utero. AIM To compare the development of executive functioning in 6 year old children prenatally exposed to chemotherapy (study group) and children born to healthy women after an uncomplicated pregnancy (control group). METHODS AND STUDY DESIGN In a multicenter cohort study, the outcome on a measure of EF was compared. Study and control children were prospectively examined by means of the Behavior Rating Inventory of Executive Function (BRIEF), a health questionnaire and an intelligence test. RESULTS In total 37 study children and 37 matched controls were included. In the study group, 11 children (29.7%) were exposed to chemotherapy alone, 22 children (59.5%) were exposed to chemotherapy and surgery and 4 children (10.8%) were exposed to chemotherapy, surgery and radiotherapy during pregnancy. All outcome scales of the BRIEF were within normal ranges. However, a significant between-group difference in emotional control was found. CONCLUSION Overall outcomes of EF were reassuring. However, children prenatally exposed to chemotherapy have weaker emotion regulation skills compared to their matched controls. The results underscore the need for long-term follow-up of these children.
Collapse
Affiliation(s)
- Mathilde van Gerwen
- Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands, Cancer Institute, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tineke Vandenbroucke
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | - An-Sofie Gorissen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | - Emma Verwaaijen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Elisabeth M van Dijk-Lokkart
- Department of Child & Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Frédéric Amant
- Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands, Cancer Institute, Amsterdam, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, the Netherlands.
| |
Collapse
|
7
|
Ouwendijk-Andréa M, Bröring-Starre T, Molderink AC, Laarman CARC, Oostrom KJ, van Dijk-Lokkart EM. Parental emotional distress after discharge from the neonatal intensive care unit: A pilot study. Early Hum Dev 2019; 140:104892. [PMID: 31715521 DOI: 10.1016/j.earlhumdev.2019.104892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mieke Ouwendijk-Andréa
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands.
| | - Tinka Bröring-Starre
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands
| | - Alice C Molderink
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands; Psychosocial Department, Emma Children's Hospital/Amsterdam University Medical Centers, the Netherlands
| | - Céleste A R C Laarman
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands; Department of Neonatology, Amsterdam University Medical Centers, the Netherlands
| | - Kim J Oostrom
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands; Psychosocial Department, Emma Children's Hospital/Amsterdam University Medical Centers, the Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Departments of Medical Psychology, Amsterdam University Medical Centers, the Netherlands; Psychosocial Department, Emma Children's Hospital/Amsterdam University Medical Centers, the Netherlands
| |
Collapse
|
8
|
Braam KI, van Dijk-Lokkart EM, Kaspers GJL, Takken T, Huisman J, Buffart LM, Bierings MB, Merks JHM, van den Heuvel-Eibrink MM, Veening MA, van Dulmen-den Broeder E. Effects of a combined physical and psychosocial training for children with cancer: a randomized controlled trial. BMC Cancer 2018; 18:1289. [PMID: 30587148 PMCID: PMC6307314 DOI: 10.1186/s12885-018-5181-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background Physical fitness and psychosocial function is often reduced in children during or shortly after cancer treatment. This study evaluates the effect of a combined physical exercise and psychosocial intervention on cardiorespiratory fitness, muscle strength, body composition, psychosocial function and health-related quality of life (HrQoL). In addition, intervention mediators, applicability and adherence were examined. Methods This multicenter randomized controlled trial included 68 children with cancer [mean age 13.2 (SD: 3.1) years; 54% male] during treatment or within 12-months post-treatment. The 12-week intervention consisted of 24 individual physical exercise sessions supervised by a physiotherapist, and 6 psychosocial training sessions for children and 2 for parents. Physical fitness and psychosocial function were assessed at baseline, directly post-intervention and at 12 months’ post-baseline. Generalized estimating equations were used to simultaneously assess intervention effects at short and long-term. Additionally, we evaluated within-group differences over time. Potential physical and psychosocial mediators in the intervention effect on HrQoL were examined using the product-of-coefficient test. Applicability and adherence were assessed by trainer-report. Results This study was able to compare 26 children who received the study intervention, with 33 children who received usual care. No significant differences in the effects of the intervention were found on physical fitness and psychosocial function at short-term. At 12-months follow-up, significantly larger improvements in lower body muscle strength (β = 56.5 Newton; 95% CI: 8.5; 104.5) were found in the intervention group when compared to the control group. Within-group changes showed significant improvements over time in HrQoL and bone density in both groups. Intervention effects on HrQoL were not significantly mediated by physical fitness and psychological function. Intervention applicability was satisfactory with an average session attendance of 67% and 22% dropout (mainly due to disease recurrence). Conclusions This 12-week physical exercise and psychosocial training intervention for children with cancer was applicable and showed satisfactory adherence. We found no significant between-group differences in effect, except for a significant improvement in lower body muscle strength at long-term in the intervention group compared to the control group. Yet, both the intervention and the control group showed improvements in bone mineral density and HrQoL over time. Trial registration The trial was registered at the Dutch Trial Registry (NTR1531). Registered 12 November 2008.
Collapse
Affiliation(s)
- Katja I Braam
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Center for Innovative Health Practice, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Medical Psychology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap Huisman
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Medical Oncology, VU University Medical Center and the Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marc B Bierings
- Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Margreet A Veening
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | |
Collapse
|
9
|
Bröring T, Oostrom KJ, van Dijk-Lokkart EM, Lafeber HN, Brugman A, Oosterlaan J. Attention deficit hyperactivity disorder and autism spectrum disorder symptoms in school-age children born very preterm. Res Dev Disabil 2018; 74:103-112. [PMID: 29413425 DOI: 10.1016/j.ridd.2018.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/21/2017] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Very preterm (VP) children face a broad range of neurodevelopmental sequelae, including behavioral problems. AIM To investigate prevalence, pervasiveness and co-occurrence of symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-age children born very preterm. METHODS Using questionnaire and diagnostic interview data, parent and teacher reported symptoms of ADHD and ASD of 57 VP-children (mean age = 9.2 years) were compared with 57 gender and age matched full-term children using t-tests. Intra-class correlation coefficients quantified parent-teacher agreement. Correlation analysis investigated co-occurrence of ADHD/ASD symptoms. ADHD/ASD measures were aggregated using principal component analysis. Regression analyses investigated the contribution of perinatal risk factors, sex and SES to ADHD/ASD symptoms. RESULTS VP-children showed higher levels of parent and teacher reported attention problems, social impairment and compromised communication skills. Fair to strong agreement was found between parent and teacher reported ADHD and ASD symptoms, indicating pervasiveness of observed difficulties. Co-occurrence of ADHD and ASD symptoms in VP-children was found. Lower gestational age was associated with higher ADHD and ASD symptom levels, male sex with higher ADHD symptom levels and lower SES with higher ASD symptom levels. CONCLUSION School-age VP-children show higher levels of ADHD and ASD symptoms, and attention, socialization and communication difficulties in particular. Routinely screening for these problems is recommended in follow-up care.
Collapse
Affiliation(s)
- Tinka Bröring
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Kim J Oostrom
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands; Psychosocial Department, Emma Children's Hospital/Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Elisabeth M van Dijk-Lokkart
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Harrie N Lafeber
- Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Anniek Brugman
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands; Clinical Neuropsychology section, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
10
|
Schepers SA, Sint Nicolaas SM, Maurice-Stam H, van Dijk-Lokkart EM, van den Bergh EMM, de Boer N, Verhaak CM, Grootenhuis MA. First experience with electronic feedback of the Psychosocial Assessment Tool in pediatric cancer care. Support Care Cancer 2017; 25:3113-3121. [PMID: 28497388 PMCID: PMC5577050 DOI: 10.1007/s00520-017-3719-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/17/2017] [Indexed: 12/03/2022]
Abstract
Purpose The Psychosocial Assessment Tool (PAT) is a brief family screener, identifying families at universal or elevated risk for psychosocial problems. This study aimed to determine the feasibility and usability of the electronic PAT (ePAT) in pediatric cancer care. Methods Eighty-six parents of newly diagnosed children with cancer (0–18 years) agreed to participate and registered at the website www.hetklikt.nu (58%). Seventy-five families completed the ePAT at approximately 1 month post-diagnosis. Answers were transformed into an electronic PROfile (PAT ePROfile) and fed back to the psychosocial team. Team members completed a semi-structured evaluation questionnaire. Feasibility was measured as the percentage of website registrations, completed ePATs, and PAT ePROfiles reviewed or discussed by the team. Usability included perceived match of the PAT ePROfile with the team’s own risk estimation, perceived added value, and perceived actions undertaken as a result of the PAT ePROfile. Results Feasibility was 70% for website registration, 87% for completed ePATs, 85% for PAT ePROfile reviewing, and 67% for ePROfile discussion. Team members reported that the PAT ePROfile matched with their own risk estimation (M = 7.92, SD = 1.88) and did not provide additional information (M = 2.18, SD = 2.30). According to the team, actions were undertaken for 25% of the families as a result of the PAT ePROfile. More actions were undertaken for families with elevated risk scores compared to universal risk scores (p = .007). Conclusions Implementation of the ePAT seems generally feasible, but it is not always clear how this screener adds to current clinical practice. Strategies should be developed together with team members to improve quick exchange of ePAT results and allocate care according to the needs of the families.
Collapse
Affiliation(s)
- Sasja A Schepers
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, USA.
| | - Simone M Sint Nicolaas
- Department of Medical Psychology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Heleen Maurice-Stam
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | - Nienke de Boer
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center/Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| |
Collapse
|
11
|
van Dijk-Lokkart EM, Braam KI, van Dulmen-den Broeder E, Kaspers GJL, Takken T, Grootenhuis MA, Streng IC, Bierings M, Merks JH, van den Heuvel-Eibrink MM, Veening MA, Huisman J. Effects of a combined physical and psychosocial intervention program for childhood cancer patients on quality of life and psychosocial functioning: results of the QLIM randomized clinical trial. Psychooncology 2015; 25:815-22. [PMID: 26509236 DOI: 10.1002/pon.4016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although survival rates in childhood cancer have improved, prevention and reduction of late effects remain important. This study evaluates the effects of a combined physical exercise and psychosocial intervention on health-related quality of life (HrQoL) and psychosocial functioning in childhood cancer patients. METHODS In this multicenter randomized controlled trial, cancer patients (aged 8-18 years) and their parents filled in questionnaires on HrQoL, depressive symptoms, behavioral problems, and self-esteem. Measurements were conducted at baseline, shortly after the 12-week intervention period and 12 months after baseline. Generalized estimating equations analyses were performed to assess short-term and long-term psychosocial effects. RESULTS Of the 174 eligible patients, 68 (39.1%) participated. The intervention group consisted of 30 participants at baseline [mean age 13.0 (SD 3.0) years; 53% male], 26 at short-term and 22 at long-term follow-up. The 'care as usual' control group consisted of 38 participants at baseline [mean age 12.6 (SD 3.1) years; 53% male], 33 at short-term and 31 at long-term follow-up. Overall, the intervention did not improve psychosocial functioning and HrQoL. According to parent-proxy reports, the intervention leads to a greater improvement on pain-related HrQoL on both the short (β = 13.4; 95% CI: 3.0; 23.8) and long term (β = 13.0; 95% CI: 1.6; 24.4) and to greater improvement on procedural anxiety immediately after the intervention (β = 12.6; 95% CI: 1.9; 23.3). CONCLUSION A combined physical and psychosocial training for children with cancer did not have effects on HrQoL or psychosocial functioning, with exception of modest positive effects on parent-reported pain and procedural anxiety Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Katja I Braam
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina's Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial department, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Isabelle C Streng
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc Bierings
- Department of Pediatric Oncology/Hematology, Wilhelmina's Childrens Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Johannes H Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Margreet A Veening
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Huisman
- Department of Medical Psychology, Wilhelmina's Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
van Dijk-Lokkart EM, Braam KI, Huisman J, Kaspers GJL, Takken T, Veening MA, Bierings M, Merks JH, Grootenhuis MA, van den Heuvel-Eibrink M, Streng IC, van Dulmen-den Broeder E. Factors influencing childhood cancer patients to participate in a combined physical and psychosocial intervention program: Quality of Life in Motion. Psychooncology 2014; 24:465-71. [PMID: 25285989 DOI: 10.1002/pon.3677] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND For a multi-center randomized trial investigating the effects of a 12-week physical and psychosocial intervention program for children with cancer, we invited 174 patients (8-18 years old) on treatment or within 1 year after treatment; about 40% participated. Reasons for non-participation were investigated. METHODS Eligible patients received written and verbal information about the study. Those declining to participate were asked to complete questionnaires concerning: reasons for non-participation, daily physical activity, health-related quality of life (HrQoL), and behavioral problems. Participants completed the same questionnaires at baseline (excluding 'reasons for non-participation'). RESULTS Of 174 eligible patients, 106 did not participate; of these, 61 (57.5%) completed the one-time survey. The main reasons for non-participation as reported by the parents were 'too time consuming' and 'participation is too demanding for my child', while children most frequently reported 'too time consuming' and 'already frequently engaged in sports'. No differences between participants and non-participants were found for age, HrQoL, parental-reported behavior problems, sport participation, school type, BMI, and perceived health. A greater distance from home to hospital resulted in reduced participation (β: -0.02; p = 0.01). Non-participants rated their fitness level higher (p = 0.03). Participating children (11-18 years old) reported more behavioral problems (p = 0.02), in particular internalizing problems (p = 0.06). CONCLUSIONS Participation of childhood cancer patients in an intensive physical and psychosocial intervention program seems related to the burden of the intervention and the travel distance from home to hospital. In general, non-participants rated their fitness level higher compared with participants. Patients with more (internalizing) behavioral problems seem more likely to participate in the study.
Collapse
|