Examining decisional needs and contextual factors influencing fertility status assessment among young female survivors of childhood cancer: A sequential mixed methods study protocol

INTRODUCTION

Female cancer survivors who received gonadotoxic cancer treatment are at risk for profound diminished ovarian reserve and/or primary ovarian insufficiency with resulting infertility, which can be associated with distress and decreased quality of life.. Despite prioritizing future parenthood, many survivors are unsure of the impact of their treatment on their future fertility, and little is known about the perceived reproductive health needs and factors associated with receipt of a fertility status assessment (FSA). There is a lack of developmentally appropriate reproductive health decisional support interventions available for emerging adult cancer survivors. This study will explore the perceived reproductive health needs of emerging adult female survivors of childhood cancer and to identify decisional and contextual factors that influence pursuit of FSA using an explanatory sequential quantitative to qualitative mixed methods design.

METHODS AND ANALYSIS

This study will enroll 325 female survivors (aged 18 to 29 years and >1-year post treatment; diagnosed with cancer < age 21 years) from four cancer centers in the United States. Sociodemographic and developmental factors, reproductive knowledge and values, decisional needs, and receipt of an FSA will be assessed through a web-based survey. Informed by survey findings, a subset of participants will be recruited for qualitative interviews to explore decisional factors associated with uptake of an FSA. Clinical data will be abstracted from the medical records. Multivariable logistic regression models will be developed to identify factors associated with FSA and qualitative descriptive analysis will be used to develop themes from the interviews. Quantitative and qualitative findings will be merged using a joint display to develop integrated study conclusions and direct future interventional research.

The psychology of natural history

Natural history observations are an integral part of ecology and evolution. However, they can be underappreciated because they operate independent of the scientific method. Here, we illustrate that the science of natural history has its own methodology based on a well-known psychological paradigm that describes how the human mind learns.

Fertility preservation in children and young adults with cancer

PURPOSE OF REVIEW

The issue of fertility preservation has become increasingly relevant as survival rates of children with cancer exceeds 80% at 5 years. Fertility preservation options are being utilized alongside less gonadotoxic therapeutic regimens in the treatment of these patients. The purpose of this review is to summarize the recent advances in fertility preservation in the pediatric, adolescent, and young adult population.

RECENT FINDINGS

Education research involves both patient and provider; to increase understanding on both sides for improved adoption of techniques and higher rates of posttreatment fertility. Basic science research, specific to the pediatric population, has worked to further understanding of protective techniques and cryopreserved tissue transfer. Research on the techniques of preservation confirms the safety of surgical gonadal (ovarian and testicular) tissue retrieval for cryopreservation but a viable pathway for testicular tissue utilization, as it has for ovarian, has yet to be realized. Outcomes may be improving but it is apparent that robust registries are necessary to track patients long-term. Possibly the largest advancement in the recent past are group efforts, such as by PanCareLIFE, to create guidelines for these issues using larger cohorts and registries than were available.

SUMMARY

Current research implies the need for the development of a national strategy to ensure that pediatric patients undergoing gonadotoxic regimens are educated, alongside their family, about fertility options and outcomes thereafter.

Treatment of posttransplant lymphoproliferative disorder with poor prognostic features in children and young adults: Short-course EPOCH regimens are safe and effective

No guidelines exist for which intensive chemotherapy regimen is best in pediatric or young adult patients with high-risk posttransplant lymphoproliferative disorder (PTLD). We retrospectively reviewed patients with PTLD who received interval-compressed short-course etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (SC-EPOCH) regimens at our institution. Eight patients were included with median age of 12 years. All patients achieved a complete response with a manageable toxicity profile. Two patients developed second, clonally unrelated, EBV-positive PTLD and one patient had recurrence at 6 months off therapy. No graft rejection occurred during therapy. All eight patients are alive with median follow-up of 29 months.

Gender dimorphism in the virulence of a dioecious mistletoe

Parasite virulence often differs between male and female hosts. However, less is known about how virulence might differ between male and female parasites. Here, I show that female plants of the dioecious mistletoe Misodendrum quadrifolium (Misodendraceae) grow larger than male plants. Correspondingly, females reduce the photosynthetic capacity of infected host branches more than males. Results indicate that in addition to playing an important role in determining host susceptibility to parasitism, gender can also play an important role in determining the virulence of dioecious parasites.

Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group

Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger and their families. Moreover, the guideline panel formulated considerations of the ethical implications that are associated with these procedures. Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the evidence and recommendations. In this clinical practice guideline, existing evidence and international expertise are combined to develop transparent recommendations that are easy to use to facilitate ongoing communication between health-care providers and patients with childhood, adolescent, and young adult cancer who might be at high risk for fertility impairment and their families.

Fertility preservation for female patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group

Female patients with childhood, adolescent, and young adult cancer are at increased risk for fertility impairment when treatment adversely affects the function of reproductive organs. Patients and their families desire biological children but substantial variations in clinical practice guidelines reduce consistent and timely implementation of effective interventions for fertility preservation across institutions. As part of the PanCareLIFE Consortium, and in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in female patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. This clinical practice guideline leverages existing evidence and international expertise to develop transparent recommendations that are easy to use to facilitate the care of female patients with childhood, adolescent, and young adult cancer who are at high risk for fertility impairment. A complete review of the existing evidence, including a quality assessment, transparent reporting of the guideline panel's decisions, and achievement of global interdisciplinary consensus, is an important result of this intensive collaboration.

Development of a Pediatric Fertility Preservation Program: A Report From the Pediatric Initiative Network of the Oncofertility Consortium

Infertility is known to decrease quality of life among adults. In some cases, infertility is caused by medical conditions and/or treatments prescribed in childhood, and using methods to protect or preserve fertility may expand future reproductive possibilities. Structured programs to offer counseling about infertility risk and fertility preservation options are essential in the care of pediatric patients facing fertility-threatening conditions or treatments, yet multiple barriers to program development exist. This report was developed from the institutional experiences of members of the Pediatric Initiative Network of the Oncofertility Consortium, with the intent of providing guidance for health care providers aiming to establish programs at institutions lacking pediatric fertility preservation services. The mechanics of building a fertility preservation program are discussed, including essential team members, target populations, fertility preservation options (both established and experimental), survivorship issues, research opportunities, and ethical considerations. Common barriers to program development and utilization, including low referral rates and financial concerns, are also discussed, and recommendations made for overcoming such barriers.

Hypothalamic-pituitary function following childhood brain tumors: Analysis of prospective annual endocrine screening

BACKGROUND

Outcomes for childhood brain tumors are now associated with a five-year survival rate of 75%. Endocrine effects of brain tumors are common, occurring in 43% of patients by 10 years from tumor diagnosis. Optimal timing of screening for endocrinopathies remains undefined. We aim to identify incidence and timing of endocrinopathies following brain tumor diagnosis, to better refine screening guidelines.

METHODS

Retrospective chart review of patients referred to our hospital's neuro-oncology clinic for evaluation and treatment of brain tumors. Inclusion criteria were a positive history for brain tumor diagnosis and evaluation at our center. Data collection included demographics, tumor diagnosis, tumor therapy, and endocrinopathy diagnosis and timing. Laboratory data and clinical documentation were reviewed.

RESULTS

Four hundred nineteen subjects were included for analysis. Tumor locations included supratentorial 158 (38%), posterior fossa 145 (35%), suprasellar 96 (23%), and upper spinal cord 20 (5%). Only 61% had undergone endocrine screening. Forty-five percent of screened patients had endocrinopathies. Endocrinopathy diagnosis typically occurred within six years after tumor diagnosis. Tumor recurrence and repeated therapies increased the risk for endocrinopathies within the subsequent six years after tumor therapy. Higher rates of endocrinopathies were identified in patients who had received cranial irradiation for posterior fossa, supratentorial, or suprasellar tumors.

CONCLUSION

Endocrine screening should occur in childhood brain tumor survivors, particularly those who have received irradiation. Our study suggests that in children with brain tumors, the highest yield for finding a pituitary deficiency is within the first six years after tumor diagnosis and treatment. Screening should continue annually beyond six years, but with special attention in the subsequent six years after therapy for tumor recurrence. Prospective screening and endocrinology referral should be implemented in childhood brain tumor survivors.

An alternative water transport system in land plants

The evolution of vascular tissue is a key innovation enabling plants to inhabit terrestrial environments. Here, we demonstrate extra-vascular water transport in a giant, prop-rooted monocot from Lord Howe Island. Pandanus forsteri (Pandanaceae) produces gutter-like leaves that capture rainwater, which is then couriered along a network of channels to the tips of aerial roots, where it is stored by absorptive tissue. This passive mechanism of water acquisition, transport and storage is critical to the growth of aerial prop roots that cannot yet attain water via vascular conduction. This species therefore sheds light on the elaborate means by which plants have evolved to attain water.

Fertility preservation options in pediatric and adolescent patients with cancer

The incidence of childhood cancer has steadily increased since the 1950s, with approximately 16,000 children diagnosed each year. However, with the advent of more effective multimodal therapies, childhood cancer survival rates have continued to improve over the past 40 years, with >80% of patients now surviving into adulthood. Fertility preservation (FP) has become an important quality-of-life issue for many survivors of childhood cancer. As a result, the therapeutic options have become less gonadotoxic over time and more patients are being offered FP options. This review examines the indications for consultation, male and female FP options both in the prepubertal patient and adolescent patient, and the unique ethical issues surrounding FP in this vulnerable population. Cancer 2018;124:1867-76. © 2018 American Cancer Society.

Viral surveillance using PCR during treatment of AML and ALL

BACKGROUND

While viral surveillance of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus using PCR is routine in patients undergoing hematopoetic stem cell transplant and solid organ transplant, the utility in the nontransplant pediatric leukemia population is unknown. Our institution screens patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) for viral DNAemia by PCR as part of clinical care.

PROCEDURE

This retrospective chart review included patients treated for newly diagnosed or relapsed AML or ALL between April 2010 and September 2014. We retrieved data for viral PCR screening, detection and quantification, duration of positivity, and prophylaxis or treatment.

RESULTS

One hundred eleven patients were included in analyses. Forty (36.0%) had at least one blood PCR positive for EBV, CMV, or adenovirus. Patients with ALL had significantly higher rates of persistent viral detection and treatment than those with AML (P < 0.02, P < 0.01, respectively). International patients had significantly higher rates of viral detection (P < 0.01), persistence (P < 0.01), any treatment (P < 0.03), and antiviral treatment (P < 0.01); 16.9% of patients who received intravenous immunoglobulin (IVIG) prophylactically had viral detection compared to 63% of patients who did not receive prophylactic IVIG (P = 0.0008).

CONCLUSIONS

Patients with ALL were more susceptible than those with AML to viral reactivation that was persistent or resulted in treatment. Patients with relapsed ALL, refractory ALL, or infantile ALL are most likely to benefit from asymptomatic screening for CMV and adenovirus. International patients are at higher risk for reactivation and may merit screening. EBV reactivation was not significant and does not warrant screening.

What causes size coupling in fruit--frugivore interaction webs?

The simplest and arguably the most ubiquitous pattern in seed dispersal mutualisms is size coupling: large frugivores tend to consume larger fruits and small frugivores tend to consume smaller fruits. Despite the simplicity of this pattern, the potential mechanisms responsible for fruit--frugivore size coupling are mechanistically divergent and poorly resolved. Size coupling could arise deterministically, if large frugivores actively seek out larger fruits to maximize their foraging efficiency. Alternatively, size coupling could also arise passively, if frugivores forage randomly, but are able to consume only those fruit species that are smaller than their gape width. I observed birds forage for fruits in a New Zealand forest reserve at approximately five-day intervals for six years to test for fruit--frugivore size coupling. I then derived a suite of network analyses to establish whether fruit--frugivore size coupling was best explained by active or passive foraging by frugivores. Results showed a strikingly strong pattern in size coupling; the average size of fruits consumed by each frugivore species increased with their maximum gape width. Simulation analyses revealed that over 70% of variation in interaction frequencies in the observed fruit-frugivore web could be explained by a size-constrained, passive, foraging model. Foraging models in which birds foraged actively for different-sized fruits to improve their foraging efficiency performed more poorly. Results were therefore consistent with the hypothesis that apparently nonrandom patterns in seed dispersal mutualisms can sometimes arise from simple stochastic processes.

Memory for multiple cache locations and prey quantities in a food-hoarding songbird

Most animals can discriminate between pairs of numbers that are each less than four without training. However, North Island robins (Petroica longipes), a food-hoarding songbird endemic to New Zealand, can discriminate between quantities of items as high as eight without training. Here we investigate whether robins are capable of other complex quantity discrimination tasks. We test whether their ability to discriminate between small quantities declines with (1) the number of cache sites containing prey rewards and (2) the length of time separating cache creation and retrieval (retention interval). Results showed that subjects generally performed above-chance expectations. They were equally able to discriminate between different combinations of prey quantities that were hidden from view in 2, 3, and 4 cache sites from between 1, 10, and 60 s. Overall results indicate that North Island robins can process complex quantity information involving more than two discrete quantities of items for up to 1 min long retention intervals without training.

Seed dispersal: the blind bomb maker

A recent study shows that a desert shrub uses a 'mustard oil bomb' to regulate the behaviour of seed-predating rodents - transforming these predators into mutualistic seed dispersers.

Allometry of sexual size dimorphism in dioecious plants: do plants obey Rensch's rule?

Rensch's rule refers to a pattern in sexual size dimorphism (SSD) in which SSD decreases with body size when females are the larger sex and increases with body size when males are the larger sex. Many animal taxa conform to Rensch's rule, but it has yet to be investigated in plants. Using herbarium collections from New Zealand, we characterized the size of leaves and stems of 297 individuals from 38 dioecious plant species belonging to three distantly related phylogenetic lineages. Statistical comparisons of leaf sizes between males and females showed evidence for Rensch's rule in two of the three lineages, indicating SSD decreases with leaf size when females produce larger leaves and increases with leaf size when males produce larger leaves. A similar pattern in SSD was observed for stem sizes. However, in this instance, females of small-stemmed species produced much larger stems than did males, but as stem sizes increased, SSD often disappeared. We hypothesize that sexual dimorphism in stem sizes results from selection for larger stems in females, which must provide mechanical support for seeds, fruits, and dispersal vectors, and that scaling relationships in leaf sizes result from correlated evolution with stem sizes. The overall results suggest that selection for larger female stem sizes to support the weight of offspring can give rise to Rensch's rule in dioecious plants.

A hierarchical framework for investigating epiphyte assemblages: networks, meta-communities, and scale

Epiphytes are an important component of many forested ecosystems, yet our understanding of epiphyte communities lags far behind that of terrestrial-based plant communities. This discrepancy is exacerbated by the lack of a theoretical context to assess patterns in epiphyte community structure. We attempt to fill this gap by developing an analytical framework to investigate epiphyte assemblages, which we then apply to a data set on epiphyte distributions in a Panamanian rain forest. On a coarse scale, interactions between epiphyte species and host tree species can be viewed as bipartite networks, similar to pollination and seed dispersal networks. On a finer scale, epiphyte communities on individual host trees can be viewed as meta-communities, or suites of local epiphyte communities connected by dispersal. Similar analytical tools are typically employed to investigate species interaction networks and meta-communities, thus providing a unified analytical framework to investigate coarse-scale (network) and fine-scale (meta-community) patterns in epiphyte distributions. Coarse-scale analysis of the Panamanian data set showed that most epiphyte species interacted with fewer host species than expected by chance. Fine-scale analyses showed that epiphyte species richness on individual trees was lower than null model expectations. Therefore, epiphyte distributions were clumped at both scales, perhaps as a result of dispersal limitations. Scale-dependent patterns in epiphyte species composition were observed. Epiphyte-host networks showed evidence of negative co-occurrence patterns, which could arise from adaptations among epiphyte species to avoid competition for host species, while most epiphyte meta-communities were distributed at random. Application of our "meta-network" analytical framework in other locales may help to identify general patterns in the structure of epiphyte assemblages and their variation in space and time.

Ontogenetic colour changes in an insular tree species: signalling to extinct browsing birds?

* Animals often use colours to hide from predators (crypsis) or advertise defences (aposematism), but there is little evidence for colour-based defence in plants. * Here, we test whether ontogenetic changes in leaf colour of lancewood (Pseudopanax crassifolius) may have been part of a defensive strategy against flightless browsing birds called moa, which were once the only large herbivores in New Zealand. We tested this hypothesis by conducting spectrographic measurements on different-sized plants grown in a common garden. We also compared these results with observations on a closely related, derived species that evolved in the absence of moa on the Chatham Islands. * Spectrographic analyses showed that birds would have difficulty distinguishing seedling leaves against a background of leaf litter. Conversely, brightly coloured tissues flanking spines on sapling leaves are highly conspicuous to birds. Once above the reach of the tallest known moa, adults produce leaves that are typical in appearance to adult leaves. The Chatham Island species lacks ontogenetic colour changes entirely. * Overall, the results indicate that P. crassifolius goes through a remarkable series of colour changes during development, from cryptically coloured seedlings to aposematically coloured saplings, which may have formed a defensive strategy to protect against giant browsing birds.

Competitive assembly of South Pacific invasive ant communities

BACKGROUND

The relative importance of chance and determinism in structuring ecological communities has been debated for nearly a century. Evidence for determinism or assembly rules is often evaluated with null models that randomize the occurrence of species in particular locales. However, analyses of the presence or absence of species ignores the potential influence of species abundances, which have long been considered of major importance on community structure. Here, we test for community assembly rules in ant communities on small islands of the Tokelau archipelago using both presence-absence and abundance data. We conducted three sets of analyses on two spatial scales using three years of sampling data from 39 plots on 11 islands.

RESULTS

First, traditional null model tests showed support for negative species co-occurrence patterns among plots within islands, but not among islands. A plausible explanation for this result is that analyses at larger spatial scales merge heterogeneous habitats that have considerable effects on species occurrences. Second, analyses of ant abundances showed that samples with high ant abundances had fewer species than expected by chance, both within and among islands. One ant species, the invasive yellow crazy ant Anoplolepis gracilipes, appeared to have a particularly strong effect on community structure correlated with its abundance. Third, abundances of most ant species were inversely correlated with the abundances of all other ants at both spatial scales. This result is consistent with competition theory, which predicts species distributions are affected by diffuse competition with suites of co-occurring species.

CONCLUSION

Our results support a pluralistic explanation for ant species abundances and assembly. Both stochastic and deterministic processes interact to determine ant community assembly, though abundance patterns clearly drive the deterministic patterns in this community. These deterministic patterns were observed at two spatial scales. Results indicate that abundance-based null models may be more sensitive in detecting non-random patterns in community assembly than species co-occurrences analyses.

Adaptive numerical competency in a food-hoarding songbird

Most animals can distinguish between small quantities (less than four) innately. Many animals can also distinguish between larger quantities after extensive training. However, the adaptive significance of numerical discriminations in wild animals is almost completely unknown. We conducted a series of experiments to test whether a food-hoarding songbird, the New Zealand robin Petroica australis, uses numerical judgements when retrieving and pilfering cached food. Different numbers of mealworms were presented sequentially to wild birds in a pair of artificial cache sites, which were then obscured from view. Robins frequently chose the site containing more prey, and the accuracy of their number discriminations declined linearly with the total number of prey concealed, rising above-chance expectations in trials containing up to 12 prey items. A series of complementary experiments showed that these results could not be explained by time, volume, orientation, order or sensory confounds. Lastly, a violation of expectancy experiment, in which birds were allowed to retrieve a fraction of the prey they were originally offered, showed that birds searched for longer when they expected to retrieve more prey. Overall results indicate that New Zealand robins use a sophisticated numerical sense to retrieve and pilfer stored food, thus providing a critical link in understanding the evolution of numerical competency.

Attitudes regarding fertility preservation in female adolescent cancer patients

Infertility is a devastating side effect of cancer treatment. Advances in fertility research have brought new preservation techniques to the forefront for women. The implication of this research in the field of pediatric oncology has not been reported. The objective of this study was to determine whether female adolescents with a diagnosis of cancer and their parents were interested in trying to preserve fertility. We conducted a cross-sectional survey of female patients, aged 10 to 21 years, and their parents. There were 39 parent/adolescent pair responses, 3 parent-only responses, and 8 adolescent-only responses. We found that adolescents and parents had thought about the future and were interested in research treatments to help preserve fertility, but not willing to postpone cancer therapy. Achieving a state of good health was most important to the adolescent group (P<0.001). There was no statistical difference between attitudes of parents and adolescents. In summary, parents and female adolescents are interested in options to help preserve fertility during cancer treatments, but they are not willing to postpone treatment for this purpose.

Seed Dispersal by Weta

Weta are giant, flightless grasshoppers that are endemic to New Zealand. In the absence of native mammals, weta are thought to perform similar ecological functions. As such, they might be expected to be important seeds dispersers. However, insects are not known to consume fleshy fruits and to disperse seeds after gut passage. We conducted a series of observations and experiments to test whether weta form mutualistic partnerships with fleshy-fruited plants as seed dispersers, similar to small mammals elsewhere in the world. Results showed that weta are indeed effective seeds dispersers, providing an example of ecological convergence between unrelated organisms.

Motion sickness incidence: distribution of time to first emesis and comparison of some complex motion conditions

A statistical mixture model is used to fit time-to-emesis data. The Weibull probability distribution is shown to provide a good fit for those subjects who either become sick or withdraw from the experiment within 2 h. The second part of the mixture accounts for those subjects who neither quit nor vomit within 2 h. The log-normal probability model is shown to give a poorer fit to the data and figures showing the relative fits of the estimated Weibull and log-normal distributions are provided. A nonparametric test is used to compare the five motion conditions of the Correlation Study. That test shows that there are significant differences in severity among the conditions.