The cancer incidence and mortality among children and adolescents during the period of 2010-2014 in Henan Province, China

Patient-caregiver dyad concordance of transition readiness assessment for adolescent with cancer: A network analysis

AIMS

The concordance of adolescents with cancer and caregivers was examined, and the core elements of transition readiness were identified.

METHODS

In this cross-sectional study, 196 adolescent-caregiver dyads completed the Chinese version of Self-Management and Transition to Adulthood with Rx = Treatment Questionnaire and its parent version between March 2023 and August 2023. Intraclass correlation coefficients, paired t-tests and network analysis were used for data analysis.

RESULTS

Caregivers reported slightly lower scores for transition readiness than adolescents (3.28 vs. 3.32). Healthcare engagement and provider communication were core elements in transition readiness networks. At the dyad level, agreement between adolescents' and caregivers' transition readiness ranged from poor to fair (intraclass correlation coefficients 0.103-0.486), and a significant difference in structure was found between the two networks.

CONCLUSIONS

Caregivers tended to underestimate adolescents' transition readiness. Attaining better concordance between adolescents and family caregivers is critical to aligning roles and responsibilities in the transition process.

IMPLICATIONS FOR PAEDIATRIC CANCER CARE

This study extends the evidence on the variation in adolescents' transition readiness, clarifying the complex associative relationships among the elements of transition readiness, which can be potential pathways for improving transition readiness. Second, this study is the first to assess transition readiness from a dyad's perspective. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness, suggesting that targeted dyadic interventions should be developed and implemented to improve patient-caregiver transition readiness concordance, facilitate effective communication and mutuality between patients and caregivers, and contribute to their collaboration during the transition of adolescents and optimization of outcomes. WHAT PROBLEM DID THE STUDY ADDRESS?: Increased long-term survival rates of survivors of paediatric cancer highlighted the significant need for care continuity. Transitional readiness is an important predictor of adolescent survivor's ability to adapt to a long-term survival period. Assessments of adolescents' transition readiness are limited and overlook the synergies between family caregivers and adolescents in the transition period. WHAT WERE THE MAIN FINDINGS?: The levels of agreement on rating transition readiness varied from poor to fair among adolescent-caregiver dyads, and caregivers tended to underestimate adolescents' transition readiness. The findings highlighted the patient-caregiver incongruence in rating patients' transition readiness. Targeted dyadic interventions should be developed and implemented to improve patient-caregiver's transition readiness concordance, and facilitate effective communication and mutuality between patients and caregivers.

REPORTING METHOD

Study methods and results reported in adherence to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patients or members of the public were involved in the study.

CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY

The main findings introduce pathways for improving transition readiness, which can enhance healthcare transition among other medical populations.

Promoting psychological support services for parents of children with sarcoma through health-social partnership: A quality improvement project

PURPOSE

A significant portion of parents of children diagnosed with sarcoma experience excessive stress and anxiety disorder. This quality improvement project aimed to implement a psychological support service program tailored for parents of children with sarcoma and evaluate its effects.

DESIGN AND METHODS

An interprofessional team was formed through a health-social partnership to deliver comprehensive psychological support service program involving multiple cognitive-behavioral components to parents of children with sarcoma. Parents who were identified as having excessive stress and/or anxiety disorder and voluntarily agreed to participate were enrolled. Pre- and post-intervention assessments were conducted, and previously recorded data from parents of children hospitalized in the year prior to this quality improvement project were included as historical controls.

RESULTS

A total of 48 parents, including 35 mothers and 13 fathers, participated in the quality improvement project. Results showed that participants achieved greater reduction in emotional, somatic, and behavioral stress when compared with historical controls (all p < .001). Significantly lower prevalence of moderate to severe anxiety disorder was also found (4.2% vs. 85.4%, p < .001).

CONCLUSIONS

The implementation of a psychological support service program, informed by cognitive-behavioral theory and delivered through a health-social partnership, effectively alleviated multiple facets of stress and anxiety disorder in parents of children newly diagnosed with sarcoma.

PRACTICE IMPLICATIONS

Nurses can facilitate and coordinate the collaboration among interprofessional team to deliver specialized psychological support services and ensure that parents of children with sarcoma have access to these services, ultimately enhancing their psychological well-being.

Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry

Introduction

Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca).

Methods

A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype.

Results

A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states.

Conclusion

The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.

Persistently high incidence rates of childhood acute leukemias from 2010 to 2017 in Mexico City: A population study from the MIGICCL

Introduction

Over the years, the Hispanic population living in the United States has consistently shown high incidence rates of childhood acute leukemias (AL). Similarly, high AL incidence was previously observed in Mexico City (MC). Here, we estimated the AL incidence rates among children under 15 years of age in MC during the period 2010-2017.

Methods

The Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia conducted a study gathering clinical and epidemiological information regarding children newly diagnosed with AL at public health institutions of MC. Crude age incidence rates (cAIR) were obtained. Age-standardized incidence rates worldwide (ASIRw) and by municipalities (ASIRm) were calculated by the direct and indirect methods, respectively. These were reported per million population <15 years of age; stratified by age group, sex, AL subtypes, immunophenotype and gene rearrangements.

Results

A total of 903 AL cases were registered. The ASIRw was 63.3 (cases per million) for AL, 53.1 for acute lymphoblastic leukemia (ALL), and 9.4 for acute myeloblastic leukemia. The highest cAIR for AL was observed in the age group between 1 and 4 years (male: 102.34 and female: 82.73). By immunophenotype, the ASIRw was 47.3 for B-cell and 3.7 for T-cell. The incidence did not show any significant trends during the study period. The ASIRm for ALL were 68.6, 66.6 and 62.8 at Iztacalco, Venustiano Carranza and Benito Juárez, respectively, whereas, other municipalities exhibited null values mainly for AML.

Conclusion

The ASIRw for childhood AL in MC is among the highest reported worldwide. We observed spatial heterogeneity of rates by municipalities. The elevated AL incidence observed in Mexican children may be explained by a combination of genetic background and exposure to environmental risk factors.

Psychometric validation of the simplified Chinese version of the therapy-related symptom checklist in children with cancer

PURPOSE

To validate a simplified Chinese version of the therapy-related symptom checklist for children (TRSC-C) in children with cancer.

METHODS

Reliability was assessed by internal consistency and test-retest coefficients. Dimensionality and construct validity were clarified using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Pearson's correlation coefficient was calculated between the TRSC-C and the PedsQL 3.0 cancer model (PedsQL 3.0) and the Lansky Play Performance Scale (LPPS) to test concurrent validity. A Student's t-test was used to compare the scores of the simplified Chinese version of the TRSC-C subscales by gender, age groups, and functional status to test sensitivity of the TRSC-C.

RESULTS

A sample of 170 children with cancer was recruited (11.27 ± 2.31 years). Cronbach's alpha (0.89) and interclass correlation coefficient (0.98) were acceptable. Seven factors with eigenvalues >1 explained 56.86% of the total variances. CFA demonstrated an acceptable model (CFI = 0.93, RMSE = 0.04). Concurrent validity was supported by moderate to high correlations between the TRSC-C and both the PedsQL 3.0 (r = -0.71) and LPPS (r = -0.43). The TRSC-C scores significantly differed by age groups and functional status (effect size 0.40-0.93), indicating adequate sensitivity.

CONCLUSION

The simplified Chinese version of the TRSC-C demonstrated acceptable reliability, validity, and sensitivity to support its use in clinical practice and future studies.

Interferon regulatory factor-1 regulates cisplatin-induced apoptosis and autophagy in A549 lung cancer cells

This study aimed to investigate the expression and function of interferon regulatory factor-1 (IRF-1) in non-small cell lung cancer (NSCLC). IRF-1 expression and its prognostic value were investigated through bioinformatic analysis. The protein expression levels of IRF-1, cleaved caspase 3, and LC3-I/II were analyzed by western blotting. A lentiviral vector was used to overexpress or knockdown IRF-1 in vitro. Mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) were analyzed by JC-1 and DCFH-DA staining, respectively. ATP, SOD, MDA, cell viability, LDH release, and caspase 3 activity were evaluated using commercial kits. Compared to the levels in normal tissues, IRF-1 expression was significantly lower in lung cancer tissues and was a prognostic factor for NSCLC. Cisplatin treatment-induced IRF-1 activation, ROS production, ATP depletion, SOD consumption, and MDA accumulation in A549 lung cancer cells. IRF-1 overexpression promoted mitochondrial depolarization, oxidative stress, and apoptotic cell death and inhibited autophagy in A549 cells, and these effects could be reversed by IRF-1 knockdown. These data suggest that IRF-1 regulates apoptosis, autophagy and oxidative stress, which might be served as a potential target for increasing chemotherapy sensitivity of lung cancer.

Suspected Adverse Drug Reactions in Pediatric Cancer Patients in China: An Analysis of Henan Province Spontaneous Reporting System Database

Introduction

Adverse drug reactions (ADRs) in pediatric cancer patients have not yet received due attention in the world. Antineoplastic drugs are frequently related to ADRs. Few studies focus on the ADR and the intervention measures in pediatric cancer patients.

Methods

ADR reports submitted to Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 for individuals aged from birth to 17 years (including 17 years) were included. Data were analyzed with respect to gender, age, disease types, past history of ADR, occurrence time of ADR, polypharmacy, route of administration, off-label drug use, name of suspected drugs per ADR report, and severity of ADR reports.

Results

A total of 431 ADR reports related to antineoplastic drugs in pediatric patients were collected, 31.55% were serious ADRs (SADRs). The median age of patients was six years (inter quartile range, IQR: 3-11), the age groups with higher reporting rates were concentrated in 1-3-year-olds (130). Past history of ADR, occurrence time of ADR and polypharmacy were statistically associated with SADR. Myelosuppression was the most frequent ADR (15.55%), cytarabine was the most frequent drug (26.22%). The signal mining method produced 14 signals, three signals were off-label ADRs.

Conclusions

This study described the characteristics of ADRs in pediatric cancer patients. By conducting signal mining method, three off-label ADRs need further study. We should pay more attention to these ADRs and develop relative management strategies. More researches are needed to achieve a better understanding of the characteristics of ADRs in pediatric cancer patients of China.

Safety and Efficacy of Neoadjuvant Immune Checkpoint Inhibitor Therapy in Patients with Resectable Non-small-Cell Lung Cancer: A Systematic Review

BACKGROUND

Non-small-cell lung cancer (NSCLC) accounts for most new diagnoses of lung cancer, with high morbidity and mortality worldwide. Immune checkpoint inhibitor (ICI) therapy has transformed the treatment of metastatic and advanced NSCLC. For resectable NSCLC, while surgery is the cornerstone of standard treatment, a number of clinical trials of neoadjuvant immunotherapy have been conducted.

OBJECTIVE

To perform a systematic review on the safety and efficacy of neoadjuvant ICI therapy in patients with resectable NSCLC.

METHODS

This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We undertook a comprehensive literature search of PubMed, Embase, Cochrane Library, and abstracts and posters from annual meetings of the major oncology societies, American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), American Association for Cancer Research (AACR) up until 29 April 2021.

RESULTS

A total of 399 patients were identified from six articles and four meeting abstracts. 229, 140, and 30 patients received anti-programmed cell death ligand 1 therapy (anti-PD-L1, atezolizumab and durvalumab), anti-programmed cell death 1 therapy (anti-PD-1, nivolumab, pembrolizumab, sintilimab), and anti-PD-1/anti-CTLA-4 combination therapy (nivolumab and ipilimumab), respectively. 255 patients received only ICI therapy before surgery, and 144 patients received ICI and chemotherapy. While ICI therapy was generally well tolerated, grade 3 or higher immune-related adverse events were observed in 13 of 144 patients (9.0%) in the five studies that reported such adverse events data. Patients displayed an overall mean surgical resection rate of 87.5% (349/399, range, 66.7-100%), a surgical delay rate of 1.4%, and an incidence of surgical complications of 21%. On average, 45.6% (159/349), (range 17-83%) of patients exhibited major pathological response (MPR), while 76/349 (21.8%) patients achieved pathological complete response (pCR). In the studies with patients undergoing ICI and chemotherapy, the MPR rate was 66.7% and pCR rate was 35.4%.

CONCLUSIONS

ICI neoadjuvant therapy may be a safe and efficacious treatment option in patients with resectable NSCLC. Combined with chemotherapy, ICI appears to be more efficacious, but displays more adverse events. More ongoing clinical trials will shed further light on the safety and efficacy of ICI neoadjuvant therapy in patients with resectable NSCLC.

Basic research in childhood cancer: Progress and future directions in China

Childhood cancer is a leading cause of death in children. Some childhood cancers have a particularly high mortality rate. Following the World Health Organization's emphasis on child health, most governments worldwide have taken measures to facilitate childhood cancer research. Thus, the scientific community is showing increasing interest in this area. Chinese government has prominence in building a system for the diagnosis and treatment of childhood cancer, thereby promoting the development of childhood cancer research. This review summarizes the research progress, challenges, and perspectives in childhood cancer, and the increasing contributions of National Natural Science Foundation of China (NSFC) in the past decade (2008-2018).

Catastrophic health expenditures of households living with pediatric leukemia in China

Background

Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China.

Methods

A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE.

Results

Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE.

Conclusion

The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups.

Neoadjuvant PD-1 inhibitor (Sintilimab) in NSCLC

INTRODUCTION

Programmed death receptor-1 (PD-1) inhibitors have shown efficacy in first-line treatment of NSCLC; however, evidence of PD-1 inhibitor as neoadjuvant treatment is limited. This is a phase 1b study to evaluate the safety and outcome of PD-1 inhibitor in neoadjuvant setting.

METHODS

Treatment-naive patients with resectable NSCLC (stage IA-IIIB) received two cycles of sintilimab (200 mg, intravenously, day 1 out of 22). Operation was performed between day 29 and 43. Positron emission tomography-computed tomography scans were obtained at baseline and before the operation. The primary end point was safety. Efficacy end points included rate of major pathologic response (MPR) and objective response rate. Expression of programmed cell death ligand 1 was also evaluated (registration number: ChiCTR-OIC-17013726).

RESULTS

A total of 40 patients enrolled, all of whom received two doses of sintilimab and 37 underwent radical resection. A total of 21 patients (52.5%) experienced neoadjuvant treatment-related adverse events (TRAEs). Four patients (10.0%) experienced grade 3 or higher neoadjuvant TRAEs, and one patient had grade 5 TRAE. Eight patients achieved radiological partial response, resulting in an objective response rate of 20.0%. Among 37 patients, 15 (40.5%) achieved MPR, including six (16.2%) with a pathologic complete response in primary tumor and three (8.1%) in lymph nodes as well. Squamous cell NSCLC exhibited superior response compared with adenocarcinoma (MPR: 48.4% versus 0%). Decrease of maximum standardized uptake values after sintilimab treatment correlated with pathologic remission (p < 0.00001). Baseline programmed cell death ligand 1 expression of stromal cells instead of tumor cells was correlated with pathologic regression (p = 0.0471).

CONCLUSIONS

Neoadjuvant sintilimab was tolerable for patients with NSCLC, and 40.5% MPR rate is encouraging. The decrease of maximum standardized uptake values after sintilimab might predict pathologic response.

The relative survival and cure fraction of gastric cancer estimated through flexible parametric models using data from population-based cancer registration during 2003-2012 in Linzhou, China

PURPOSE

The proportion of cured gastric cancer patients has drawn the attention of patients, physicians, and healthcare providers after comprehensive prevention and control measures were carried out for several years. Therefore, the relative survival and cure fraction were estimated in our study.

METHODS

Population-based cancer registration data were used to estimate survival and cure fraction. A total of 7585 gastric cancer cases (ICD10:C16.0 ~ C16.9) were extracted and included in the final analysis. Cases were diagnosed in 2003-2012 and followed until the end of 2017. Relative survival was calculated as the ratio between the observed survival through the life-table method. The expected survival was estimated by the Ederer II method. The cure fraction was estimated using flexible parametric cure models stratified by age and calendar period when the cases were diagnosed.

RESULTS

The 5-year relative survival of cardia gastric cancer increased with the calendar period of 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012 (27.5%, 28.3%, 33.5%, 38.2%, and 46.8%, respectively). The increasing trend along with the calendar periods was also observed in cure proportion of cardia gastric cancer (24.8%, 25.2%, 31.7%, 36.0%, and 43.1%, respectively). Notable improvement of cure proportion was observed in the period of 2011-2012, compared with the initial period of 2003-2004. There was an improvement of 79.8% among all gastric cancer subjects, and it was 74.1% and 55.7% in cardia gastric and noncardia gastric cancer subjects, respectively. The median survival of "uncured" patients showed no significant improvement along with the calendar periods in all age groups.

CONCLUSIONS

Notable improvement of gastric cancer relative survival and cure proportion was observed in Linzhou during 2003-2012.

Expression of miR-34a and Ki67 in nasopharyngeal carcinoma and the relationship with clinicopathological features and prognosis

Expression levels of miR-34a and Ki67 in nasopharyngeal carcinoma (NPC) and the relationship with clinicopathological features and prognosis were studied. A prospective study was performed on 56 cases of NPC tissues and 56 cases of adjacent tissues collected in Xiangyang No. 1 People's Hospital. The expression levels of miR-34a, Ki67 in NPC and adjacent tissues were detected by RT-qPCR. The association among the expression levels of miR-34a and Ki67, the clinicopathological features and prognosis of patients was analyzed. The relative expression levels of miR-34a in 56 cases of NPC were lower than those of the adjacent tissues. The expression of miR-34a in NPC was significantly associated with bone metastasis and TNM staging (P<0.001). The relative expression of Ki67 in 56 cases of NPC was higher than that of the adjacent tissues. The expression of Ki67 in NPC was significantly associated with lymphatic metastasis and TNM staging (P<0.001). The 5-year survival of patients with low expression of miR-34a was significantly lower than that of patients with high expression, and the survival of patients with high expression of Ki67 was significantly lower than that of patients with low expression. According to Pearson's correlation analysis, Ki67 expression was negatively correlated with miR-34a expression in NPC tissues. In conclusion, the expression of Ki67 in NPC was upregulated, while the expression of miR-34a in NPC was downregulated. miR-34a expression in NPC was significantly associated with bone metastasis and TNM staging, and Ki67 expression in NPC was significantly associated with lymphatic metastasis and TNM staging. In addition, there was a negative correlation between miR-34a and Ki67 expression levels, and the two can be used as predictors of NPC-associated mortality. The expression levels of miR-34a and Ki67, as well as TNM staging were associated with the prognosis of NPC patients.

The cancer incidence and mortality among children and adolescents during the period of 2010-2014 in Henan Province, China

OBJECTIVE

The cancer etiology in children and adolescents is largely different with that in adults, and the description in epidemiology still remains deficiency. Therefore, we described the cancer incidence and related epidemiological features in children and adolescents to provide clues for etiological studies.

METHODS

Cancer incidence stratified by age, gender, and areas was calculated using data extracted from population-based cancer registries in Henan Province, China. All cancer among children aged 0-19 years were reclassified according to category criteria of the International Classification of Childhood Cancer, 3rd Edition (ICCC-3). Age-standardized rate (WSR) was calculated using Segi's world standardized population by the direct method, and it was expressed per million person-years.

RESULTS

The crude cancer incidence and mortality were 87.56 and 36.32 per million person-years among children aged 0-19 years, and the WSRs slightly changed compared with crude incidence and mortality, and they were 87.36 and 35.46 per million person-years. Leukemia and central nervous system neoplasms (CNS) were the most common cancer categories both in children aged 0-14 years and in adolescents aged 15-19 years in regardless of gender and areas. Tiny difference of incidence and mortality existed in different age groups across 0-14 years; however, they were higher in adolescents aged 15-19 years than that in children aged 0-14 years. Among children aged 0-19 years, the cancer incidence and mortality were predominant in boys, and the sex ratio was 1.19; however, it was varied by diagnostic categories.

CONCLUSION

This is the first study that described the cancer incidence and mortality among children aged 0-19 in Henan Province, and it would help researchers to understand the burden and epidemiological characteristics of childhood cancer, and hence suggested clues for the etiological studies.