Employment status among adult survivors in the Childhood Cancer Survivor Study

Global Prevalence of Suicide in Patients With Cancer: A Systematic Review and Meta-Analysis

AIM

Given that patients with cancer may commit suicide due to physical and mental problems, the present study objectives were to identify particular risk factors of different subgroup of patients including type of cancer, gender, age, type and time of suicide, and geographical region to facilitate early care and psychosocial support.

METHODS

A comprehensive review of databases including Embase, Scopus, PubMed, and Web of Science was conducted for original articles published in English from January 2000 to March 2022. It is based on the PRISMA checklist.

RESULTS

After reviewing 69 articles selected from 15 countries, the total prevalence rate of suicide among 34,157,856 patients with cancer was estimated 67,169, at 0.013 (95% CI, 0.008-0.021). The highest suicide prevalence was related to gastrointestinal cancer, estimated at 0.204 (95% CI, 0.161-0.255). A gender-based meta-analysis showed that the prevalence of suicide/suicidal ideation was higher among men, estimated at 0.013 (95% CI, 0.008-0.023) compared with women, at 0.006 (95% CI, 0.002-0.017).

CONCLUSION

Based on study results, suicide-prevention strategies should be aimed at patients younger than 40 years of age to effectively resolve their mental health disorders and promote their self-efficacy in successful management of the disease.

Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis

Importance

Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer.

Objective

To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers.

Data Sources

A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023.

Study Selection

Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors.

Data Extraction and Synthesis

Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model.

Results

The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls.

Conclusion and Relevance

Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.

Educational outcomes in childhood cancer survivors: A Scotland-wide record-linkage study of 766,217 schoolchildren

BACKGROUND

A cancer diagnosis during childhood greatly disrupts the lives of those affected, causing physical and psychological challenges. We aim to investigate educational outcomes among schoolchildren with a previous cancer diagnosis compared to their peers.

METHODS

Individual records from four national education databases and three national health databases were linked to construct a cohort of all singleton schoolchildren born in Scotland attending Scottish local-authority schools between 2009-2013. Pupils previously diagnosed with any cancer, haematological cancers, and central nervous system (CNS) cancers, were compared to their unaffected peers with respect to five educational outcomes: special educational need (SEN), absenteeism, school exclusion, academic attainment, and unemployment. Analyses were adjusted for sociodemographic and maternity factors and chronic conditions.

RESULTS

Of 766,217 pupils, 1,313 (0.17%) had a previous cancer diagnosis. Children with any cancer had increased odds of SEN (OR 3.26, 95% CI 2.86-3.71), absenteeism (IRR 1.82, 95% CI 1.70-1.94), and low attainment (OR 2.15, 95% CI 1.52-3.03) compared to their peers. Similar findings were observed for haematological (SEN OR 2.62, 95% CI 2.12-3.24; absenteeism IRR 2.04, 95% CI 1.85-2.25; low attainment OR 2.17, 95% CI 1.31-3.61) and CNS (SEN OR 6.44, 95% CI 4.91-8.46; absenteeism IRR 1.75, 95% CI 1.51-2.04; low attainment OR 3.33, 95% CI 1.52-7.30) cancers. Lower exclusions were observed among children with any cancer (IRR 0.51, 95% CI 0.31-0.83) and CNS cancer (IRR 0.20, 95% CI 0.06-0.61). No associations were observed with unemployment.

CONCLUSIONS

This study highlights the wider impacts of childhood cancer on educational outcomes. These children need to be supported, as poor educational outcomes can further impact later health.

Desire for children among male survivors of childhood cancer: A DCCSS LATER study

BACKGROUND

Knowledge of the desire for children among childhood cancer survivors (CCSs) is scarce. This study evaluated the desire for children in male CCSs in comparison with male siblings.

METHODS

A nationwide cohort study was conducted as part of the Dutch Childhood Cancer Survivor Study LATER study: 1317 male CCSs and 407 male sibling controls completed a questionnaire addressing the desire for children. Logistic regression analyses were used to explore the independent association between survivorship status and the desire for children. Furthermore, additional analyses were performed to identify which cancer-related factors were associated with the desire for children in male CCSs.

RESULTS

After adjustments for the age at assessment, the percentage of men who had a desire for children was significantly lower among CCSs compared with the siblings (74% vs. 82%; odds ratio [OR], 0.61; 95% CI, 0.46-0.82; p = .001). The association between survivorship status and the desire for children was attenuated after adjustments for marital status, level of education, and employment status (OR, 0.83; 95% CI, 0.61-1.14; p = .250). The percentage of men who had an unfulfilled desire for children remained significantly higher among CCSs compared with the siblings after adjustments for sociodemographic factors (25% vs. 7%; OR, 5.14; 95% CI, 2.48-10.64; p < .001).

CONCLUSIONS

The majority of male CCSs have a desire for children. The likelihood of having to deal with an unfulfilled desire for children is 5 times higher among CCSs compared with their siblings. This insight is important for understanding the needs and experienced problems of CCSs regarding family planning and fertility issues.

A Psychosocial Support Program for Young Adult Childhood Cancer Survivors in Austria: a Qualitative Evaluation Study

Many adolescents and young adult (AYAs) childhood cancer survivors face disease- or therapy-related late-effects, which limit their participation in various areas of daily life. AYAs are often left alone in our health care system, and many worry about their ability to cope with long-term sequelae, and some are even lost to follow-up. Therefore, in the present study, a targeted aftercare program was developed and evaluated with the goal of facilitating three important "life skills": (1) self-perception, (2) social interaction and conflict management, and (3) self-conscious communication of support needs. A total of n = 13 participants (19.2-30.2 years, mean age 22.8 years) completed a 3-day aftercare seminar, at the end of which each participant wrote a reflection letter ("letter to my future self"), elaborating on observed effects of the seminar, applicability of the given information in daily life, and the direct impact of the seminar on their individual circumstances. The reflection letters were analyzed using qualitative content analysis. All target life skills were mentioned in the reflection letters. The participants reported individual benefits from the program especially with respect to self-perception and self-confidence, giving and taking feedback, and acceptance of personal strengths and weaknesses. Moreover, the feeling of "not being alone" was associated with the survivors' experience of emotional and social support. This evaluation highlights the potential of a one weekend aftercare seminar to address important life skills that are known to positively influence health behavior in AYAs. The detailed description of the seminar can serve as a basis for making this kind of aftercare accessible for other people in similar circumstances.

Occupational outcomes after high‐grade or low‐grade brain tumors in childhood: A Swedish, nationwide, registry‐based study

BACKGROUND

Survivors of pediatric brain tumors are at high risk of late complications that may affect their daily life in both short- and long-term perspectives.

METHODS

In this nationwide registry-based study we explored the occupational outcomes, including employment, sickness or activity compensation and parental leave, in 452 individuals in Sweden, born 1988-1996, and diagnosed with a brain tumor before their 15th birthday. Their results were compared with 2188 matched controls.

RESULTS

There were significant differences between cases and controls for all assessed variables. The cases had benefitted from sickness or activity compensation 11 times more often than controls (CI 7.90-15.83; p < 0.001) between 2005 and 2016. Controls were almost three times more likely to have an employment (OR 0.36; CI 0.28-0.47; p < 0.001) and nearly twice as likely to have been on parental leave (OR 0.56; CI 0.39-0.80; p = 0.002). Although cases treated for high-grade tumors typically fared worse than those treated for low-grade tumors, significant differences for all assessed variables were also observed for cases treated for a low-grade tumor compared with controls.

CONCLUSIONS

Our findings emphasize the need for follow-up programs for all brain tumor diagnoses, not only those known to be at most risk. This is evident, for example, from the high number of cases who received sickness or activity compensation.

Large Improvements in Health-Related Quality of Life and Physical Fitness during Multidisciplinary Inpatient Rehabilitation for Pediatric Cancer Survivors

Rehabilitation is a key element in improving health-related quality of life (HRQOL) for pediatric cancer survivors. The aim of this study was to present data from a multidisciplinary inpatient rehabilitation treatment. Children took part in a four-week multidisciplinary family-oriented inpatient rehabilitation. A total of 236 children (>5−21 years) and 478 parents routinely completed electronic patient-reported outcomes (ePROs), performance-based assessments, and clinician-rated assessments before (T1) and at the end (T2) of rehabilitation. HRQOL was assessed with the PedsQL generic core and PedsQL cancer module. Data were analyzed using repeated measures analysis of variance (ANOVA). Statistically significant improvements with medium to large effect sizes were observed for most HRQOL scales (η2 = 0.09−0.31), as well as performance-based and clinician-rated assessments for physical activity and functional status (η2 > 0.28). Agreement between children’s PROs and parents’ proxy ratings was lower before (rICC = 0.72) than after (rICC = 0.86) rehabilitation. While the concordance between children and parents’ assessment of changes during rehab was low to moderate (r = 0.19−0.59), the use of the performance score led to substantially increased scores (r = 0.29−0.68). The results of this naturalistic observational study thus highlight the benefits of multidisciplinary pediatric inpatient rehabilitation for childhood cancer survivors. The use of the performance score is recommended in this field.

Employment among Childhood Cancer Survivors: A Systematic Review and Meta-Analysis

To date, there are heterogeneous studies related to childhood cancer survivors’ (CCS) employment rates. Given the importance of this topic, we aimed to perform a systematic review and meta-analysis to investigate the prevalence of employment among CCS and to examine its association with socio-demographic and clinical factors. We followed the PRISMA guidelines to search for pertinent articles in relevant electronic databases. Eighty-nine articles comprising 93 cohorts were included. The overall prevalence of employment was 66% (CI: 95% 0.63–0.69). Subgroup meta-analyses showed that lower rates were found for central nervous system tumor survivors (51%, CI: 95% 0.43–0.59), and for CCS treated with cranial-radiotherapy (53%, CI: 95% 0.42–0.64) or haematopoietic stem-cell transplantation (56%, CI: 95% 0.46–0.65). The studies conducted in Asia highlighted employment rates of 47% (CI: 95%, 0.34–0.60). Univariate meta-regressions identified the following socio-demographic factors associated with higher rates of employment: a female gender (p = 0.046), a higher mean age at the time of investigation (p = 0.00), a longer time since diagnosis (p = 0.00), a higher educational level (p = 0.03), and a married status (p = 0.00). In conclusion, this systematic review and meta-analysis provides evidence that two-thirds of CCS are employed worldwide. Identifying vulnerable groups of CCS may allow for the design of multidisciplinary support strategies and interventions to promote employment in this population.

Recommendations for the surveillance of education and employment outcomes in survivors of childhood, adolescent, and young adult cancer: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Educational achievement and employment outcomes are critical indicators of quality of life in survivors of childhood, adolescent, and young adult (CAYA) cancer. This review is aimed at providing an evidence-based clinical practice guideline (CPG) with internationally harmonized recommendations for the surveillance of education and employment outcomes in survivors of CAYA cancer diagnosed before the age of 30 years. The CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of 4 existing CPGs, the authors performed a systematic literature search through February 2021. They screened articles for eligibility, assessed quality, and extracted and summarized the data from included articles. The authors formulated recommendations based on the evidence and clinical judgment. There were 3930 articles identified, and 83 of them, originating from 17 countries, were included. On a group level, survivors were more likely to have lower educational achievement and more likely to be unemployed than comparisons. Key risk factors for poor outcomes included receiving a primary diagnosis of a central nervous system tumor and experiencing late effects. The authors recommend that health care providers be aware of the risk of educational and employment problems, implement regular surveillance, and refer survivors to specialists if problems are identified. In conclusion, this review presents a harmonized CPG that aims to facilitate evidence-based care, positively influence education and employment outcomes, and ultimately minimize the burden of disease and treatment-related late adverse effects for survivors of CAYA cancers. LAY SUMMARY: A multidisciplinary panel has developed guidelines for the surveillance of education and employment outcomes among survivors of childhood, adolescent, and young adult cancer. On the basis of evidence showing that survivors are at risk for lower educational achievement and unemployment, it is recommended that all survivors receive regular screening for educational and employment outcomes.

Central nervous system tumors in children under 5 years of age: a report on treatment burden, survival and long-term outcomes

Purpose

The challenges of treating central nervous system (CNS) tumors in young children are many. These include age-specific tumor characteristics, limited treatment options, and susceptibility of the developing CNS to cytotoxic therapy. The aim of this study was to analyze the long-term survival, health-related, and educational/occupational outcomes of this vulnerable patient population.

Methods

Retrospective study of 128 children diagnosed with a CNS tumor under 5 years of age at a single center in Switzerland between 1990 and 2019.

Results

Median age at diagnosis was 1.81 years [IQR, 0.98–3.17]. Median follow-up time of surviving patients was 8.39 years [range, 0.74–23.65]. The main tumor subtypes were pediatric low-grade glioma (36%), pediatric high-grade glioma (11%), ependymoma (16%), medulloblastoma (11%), other embryonal tumors (7%), germ cell tumors (3%), choroid plexus tumors (6%), and others (9%). The 5-year overall survival (OS) was 78.8% (95% CI, 71.8–86.4%) for the whole cohort. Eighty-seven percent of survivors > 5 years had any tumor- or treatment-related sequelae with 61% neurological complications, 30% endocrine sequelae, 17% hearing impairment, and 56% visual impairment at last follow-up. Most patients (72%) attended regular school or worked in a skilled job at last follow-up.

Conclusion

Young children diagnosed with a CNS tumor experience a range of complications after treatment, many of which are long-lasting and potentially debilitating. Our findings highlight the vulnerabilities of this population, the need for long-term support and strategies for rehabilitation, specifically tailored for young children.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11060-022-03963-3.

Family functioning and adaptation following pediatric brain tumor: A systematic review

INTRODUCTION

Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS.

METHODS

We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions.

RESULTS

Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs.

CONCLUSIONS

Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.

Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors.

Disparities in health care affordability among childhood cancer survivors persist following the Affordable Care Act

BACKGROUND

The Affordable Care Act (ACA) included many provisions that may have improved access to care for childhood cancer survivors (CCS). In this study, we sought to compare health insurance coverage and the affordability of health care among adult childhood CCS before and after the implementation of the ACA.

PROCEDURE

Using data from the National Health Interview Survey (NHIS), two cohorts of CCS age 21-65 years old and matched (1:3) controls without a history of cancer were identified. A difference-in-differences analysis was used to compare insurance coverage and health care affordability pre- (2011-2013) and post-ACA (2015-2017).

RESULTS

There were 309 CCS identified in the pre-ACA cohort and 324 in the post-ACA cohort. The two cohorts were similar in demographic composition. Prior to the ACA, CCS were 39% more likely to be uninsured than their peers (p = .046). Post, there was no difference in the odds of being uninsured between CCS and their peers. Following implementation of the ACA, the proportion of CCS who reported having difficulty with the affordability of health care decreased (p = .013) as did the proportion reporting skipping needed care due to cost (p < .001). However, 13% of CCS still reported being uninsured, 36% reported difficulty paying for health care, and 13% reported foregoing needed care due to cost. Relative to their peers, CCS saw improvement in foregoing needed care due to cost, but disparities still remain.

CONCLUSIONS

Although improvements were observed, health care affordability, and medical nonadherence remains a problem for CCS.

IMPLICATIONS FOR CANCER SURVIVORS

Additional efforts are needed to improve health care affordability among CCS.

Cohort Profile: The Socioeconomic Consequences in Adult Life After Childhood Cancer in Scandinavia (SALiCCS) Research Programme

INTRODUCTION

The growing number of survivors of childhood cancer, with many years of life ahead, demonstrates the increasing clinical and public health relevance of investigating the risks of social and socioeconomic impairment after a childhood cancer diagnosis and the life-saving treatment. To enrich understanding of the mental, social and socioeconomic difficulties that childhood cancer survivors may face during their life-course, identify particularly vulnerable survivors and overcome the limitations of previous research, we initiated the Socioeconomic Consequences in Adult Life after Childhood Cancer in Scandinavia (SALiCCS) research programme.

METHODS

This Nordic cross-border research programme is a collaboration between the Danish Cancer Society, the Finnish Cancer Registry and Karolinska Institutet to investigate a broad range of mental, social and socioeconomic conditions in long-term childhood cancer survivors in Denmark, Finland and Sweden. SALiCCS is based on a registry-based matched cohort design, comprising five-year survivors of cancer diagnosed at ages 0-19 years (1971-2008 in Denmark, 1971-2009 in Finland, 1971-2011 in Sweden), age-, sex- and country-matched population comparisons and sibling comparisons who were followed over time. Outcomes of interest included mental disorders, educational achievements, employment and profession, family life and the need of social security benefits. Individual-level data linkage among various national registries provided the data for the research programme.

RESULTS

The SALiCCS core population comprises 21,292 five-year survivors, 103,303 population comparisons and 29,644 siblings as a second comparison group. The most common diagnoses in survivors were central nervous system tumours, leukaemias and lymphomas.

DISCUSSION

SALiCCS is the largest, most comprehensive population-based research initiative in this field, based on high-quality registry data with minimal risk of bias. The findings will be informative for evidence-based survivorship care targeting not only somatic late effects but also psychosocial impairments.

Family Formation and Socio-Economic Status among 35-Year-Old Men Who Have Survived Cancer in Childhood and Early Adulthood: A Register-Based Cohort Study

INTRODUCTION

The number of children and young adults who survive cancer has steadily increased over the past decades. Consequently, life circumstances after cancer have gained increasing importance. The aim of this study was to explore family formation and socio-economic status among 35-year-old men having survived cancer in childhood or early adulthood compared to an age-matched comparison group.

METHODS

This study is a national, register-based cohort study among 35-year-old men. Men diagnosed with cancer in childhood and early adulthood were registered between 1978 and 2016. At the time of diagnosis, each patient was randomly matched with 150 men without cancer from the background population within the same birth year. Those still alive at the age of 35 years were included in the study population.

RESULTS

The study population consisted of 4,222 men diagnosed with cancer in childhood or early adulthood and 794,589 men in the age-matched comparison group. Men who have survived cancer during childhood or early adulthood have a reduced probability of having children, and lower probability of getting married or of cohabitation than those from an age-matched comparison group. Men who have survived CNS cancer also have a lower probability of having a higher education than high school and a higher probability of being outside the workforce than those from an age-matched comparison group.

DISCUSSION/CONCLUSION

Many men who have survived cancer during childhood or early adulthood are influenced by their cancer later in life, which was apparent in family formation, educational achievements, and labour market attachment. Continued focus on rehabilitation and needs for support among the male survivors of childhood and youth cancer is warranted.

Incidence of suicide among adolescent and young adult cancer patients: a population-based study

Background

As the survival rates of cancer patients continue to increase, most cancer patients now die of non-cancer causes. Several studies have been showing elevated suicide rates among patients with cancer. However, no large-scale study has thoroughly assessed the risk of suicide among adolescent and young adult (AYA) patients with cancer. This study was conducted to characterize suicide mortality among AYA patients in the US and identify risk factors associated with a higher risk of suicide.

Methods

Patients aged 15–39 years were residents of the US served by the Surveillance, Epidemiology, and End Results (SEER) program, who were diagnosed with cancers from 1973 to 2015.

Results

We report that 981 of the 572,500 AYA patients with cancer committed suicide, for an age-, sex-, and race-adjusted suicide rate of 17.68/100,000 person-years. The rate of suicide was 14.33/100,000 person-years in the corresponding general population, giving a standardized mortality ratio (SMR) of 1.234 [95% confidence interval (CI) 1.159–1.313]. Higher suicide rates were associated with male sex, white race, unmarried state, distant tumor stage, and single primary tumor. AYA patients with otorhinolaryngologic, gonad, stomach, soft tissue, and nasopharyngeal cancer were at the greatest risk of suicide compared with those with other types of cancer. In older patients (≥ 40 years), the risk was highest in those with lung, stomach, oral cavity and pharynx, larynx, and bone malignancies. SMRs were highest in the first 5 years after diagnosis for most types of cancer.

Conclusion

AYA patients with cancer in the US have over 20% higher the incidence of suicide of the general population, and most suicides occurred in the first 5 years following diagnosis. Suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of these young patients with cancer, particularly that of those with certain types of cancer, is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12935-021-02225-y.

Effects of chemotherapy for acute lymphoblastic leukemia on cognitive function in animal models of contemporary protocols: A systematic literature review

Survival rates of childhood acute lymphoblastic leukemia (ALL) have improved greatly due to advanced therapies and supportive care. Intrathecal chemotherapy replaced cranial radiation due to radiation-induced neurotoxicity and late-effects. Survivors treated with chemotherapy-only experience neurologic and cognitive problems following cessation of treatment. Very long-term cognitive outcomes remain unclear. Animal models are being generated to assess late-effects of chemotherapy on cognitive function. Although, few address juvenile models of chemotherapy-induced cognitive impairment (CICI) and developing brain, results of this review outline neurocognitive effects of chemotherapy consistent with childhood ALL therapy. Studies demonstrate deficits across cognitive domains including spatial memory, executive function, short-term memory, anxiety and depression. Inflammation, oxidative stress, excitotoxity, and other metabolic disruptions may lead to neurodegeneration associated with cognitive impairment observed in ALL survivors. Interventions directly targeting these mechanisms may prevent and/or promote recovery of cognitive function and improve long-term outcomes. Evidence suggests success of anti-inflammatory and antioxidant treatments in reducing cognitive decline. Animal models provide basis for assessing effects of chemotherapy on neurologic processes to guide future clinical investigations.

Psychometric Validation of the PERMA-Profiler as a Well-Being Measure for Young Adult Survivors of Pediatric Central Nervous System Tumor

This study aims to validate a measure of well-being, the PERMA-Profiler, among a sample of young adult survivors of pediatric central nervous system (CNS) tumor. Measurement structure of the PERMA-Profiler was evaluated using exploratory factor analysis and confirmatory factor analysis using pretest–posttest data. Reliability and concurrent validity of the PERMA-Profiler were examined. This study included 127 young adult survivors of pediatric CNS tumor between the ages of 18 and 30 ( M = 23.83, SD = 3.00) years. The results of factor analyses yielded a single-factor solution for well-being. Significant relationships between well-being and happiness, life satisfaction, perceived stress, and physical health were observed, providing support for the concurrent validity of the PERMA-Profiler. The PERMA-Profiler displayed good internal consistency and test–retest reliability. The PERMA-Profiler can help rehabilitation researchers and counselors better evaluate well-being in young adult survivors of pediatric CNS tumor, which provides opportunity for more targeted psychosocial interventions.

Impacts of physical late effects on presenteeism in childhood cancer survivors

BACKGROUND

Many childhood cancer survivors (CCSs) experience physical late effects related to their cancer types and treatment modalities. Physical late effects are an important factor in various occupational outcomes among CCSs. However, the relationship between physical late effects and presenteeism has remained unclear. This study aimed to estimate the impacts of physical late effects on presenteeism among employed CCSs.

METHODS

Childhood cancer survivors replied to a questionnaire regarding presenteeism, and their attending physicians assessed their physical late effects between September 2014 and December 2015. The Work Limitations Questionnaire was used to measure presenteeism. Propensity score analysis and a generalized linear model were used to adjust covariates related to physical late effects and / or presenteeism.

RESULTS

Of the 125 questionnaires distributed, 114 were returned. The data from 61 employed CCSs were analyzed. After controlling for covariates by propensity score analysis and generalized linear model, there were no significant differences in presenteeism between employed CCSs with either no or single physical late effects. However, employed CCSs with multiple physical late effects reported higher scores in Output (Estimate = 9.3, P = 0.041), Physical Demands (Estimate = 12.2, P = 0.020), and Productivity Loss scores (Estimate = 2.4, P = 0.045) on the Work Limitations Questionnaire than employed CCSs with no physical late effects.

CONCLUSIONS

Employed CCSs with multiple physical late effects were at an increased risk for presenteeism. Healthcare and social welfare systems should be established to provide vocational assistance for CCSs after being employed to alleviate presenteeism.

Self-reported and parent proxy reported functional impairment among pediatric cancer survivors and controls

Background

A unique and limiting component in the research on functional impairment among children has been the exclusive use of parent proxy reports about child functioning; and there is limited information regarding the impact of pediatric cancer treatment on children’s day-to-day functioning and how this is related to neurocognitive functioning. The objective of the current study was to examine a novel measure of self-reported functional impairment, and explore the relationship between self-reported and parent-reported child functional impairment in pediatric cancer survivors compared to controls.

Methods

A cross-sectional cohort of survivors (n = 26) and controls (n = 53) were recruited. Survivors were off treatment an average of 6.35 years (SD = 5.38; range 1–15 years) and demonstrated an average “medium” Central Nervous System treatment intensity score. Participants completed measures of functional impairment (FI), intellectual assessment (RIST) and executive functions (NIH Examiner), while parents reported on children’s functional impairment.

Results

Survivors were similar to controls in functional impairment. Regardless of group membership, self-reported FI was higher than parent-reported FI, although they were correlated and parent report of FI significantly predicted self-reported FI. Across groups, increased impairment was associated with four of seven Examiner scores.

Conclusions

Research regarding self-reported functional impairment of cancer survivors and its association with parent-reported functional impairment and neurocognitive deficits has been limited. Our results suggest that self-reported FI appears to be a reasonable and viable outcome measure that corresponds with and adds incremental validity to parent reported FI. While low treatment intensity may confer relative sparing of functional impairment among survivors, children report higher FI levels than parents, suggesting that FI can be of clinical utility. In conclusion, pediatric cancer survivors should be screened for self-reported functional difficulties.

Cancer-Related Distress: Revisiting the Utility of the National Comprehensive Cancer Network Distress Thermometer Problem List in Women With Gynecologic Cancers

PURPOSE

The Distress Thermometer (DT) includes a measure of cancer-related distress and a list of self-reported problems. This study evaluated the utility of the DT problem list in identifying concerns most associated with distress and poorer quality of life (QOL) in survivors of gynecologic cancer.

METHODS

Demographic, clinical, psychosocial functioning, and DT data were described among 355 women participating in a gynecologic cancer cohort. Problems from the DT list were ranked by prevalence, distress, and QOL. Logistic regression models explored factors associated with problems that were common (≥ 25% prevalence) and associated with distress and QOL.

RESULTS

The average age of participants was 59.9 years (standard deviation [SD], 10.8 years). Most participants were non-Hispanic white (97%) and had ovarian (44%) or uterine (42%) cancer. The mean DT score was 2.7 (SD, 2.7); participants reported a mean of 7.3 problems (SD, 5.9 problems). The most common problems were fatigue (53.6%), worry (49.9%), and tingling (46.3%); least common problems were childcare (2.1%), fevers (2.1%), and substance abuse (1.1%). Report of some common problems, including tingling, sleep, memory, skin issues, and appearance, was not associated with large differences in distress or QOL. In contrast, some rarer problems such as childcare, treatment decisions, eating, housing, nausea, and bathing/dressing were associated with worse distress or QOL. Younger age, lower income, and chemotherapy were risk factors across common problems that were associated with worse distress or QOL (fatigue, nervousness, sadness, fears, and pain).

CONCLUSION

The DT problem list did not easily identify concerns most associated with distress and low QOL in patients with gynecologic cancer. Adaptations that enable patients to report their most distressing concerns would enhance clinical utility of this commonly used tool.

Adaptations to a Generalized Radiation Dose Reconstruction Methodology for Use in Epidemiologic Studies: An Update from the MD Anderson Late Effect Group

Epidemiologic studies that include patients who underwent radiation therapy for the treatment of cancer aim to quantify the relationship between radiotherapy and the risk of subsequent late effects. Because of the long follow-up period required to observe late effects, these studies are conducted retrospectively. The studies routinely include patients treated across numerous institutions using a wide range of technologies and represent treatments over several decades. As a result, determining the dose throughout the patient's body is uniquely challenging. Therefore, estimating doses throughout the patient's body for epidemiologic studies requires special methodologies that are generally applied to a wide range of radiotherapy techniques. Over ten years ago, the MD Anderson Late Effects Group described various dose reconstruction methods for therapeutic and diagnostic radiation exposure for epidemiologic studies. Here we provide an update to the most widely used dose reconstruction methodology for epidemiologic studies, analytical model calculations combined with a 3D age-specific computational phantom. In particular, we describe the various adaptations (and enhancements) of that methodology, as well as how they have been used in radiation epidemiology studies and may be used in future studies.

Long-term effects of cancer on earnings of childhood, adolescent and young adult cancer survivors - a population-based study from British Columbia, Canada

Background

The patterns and determinants of long-term income among young people surviving cancer, and differences compared to peers, have not yet been fully explored. The objectives of this paper are to describe long-term income among young survivors of cancer, the impact of socio-demographic, disease, and treatment factors on long-term income, and income relative to the general population.

Methods

Retrospective cohort study with comparison group from the general population, using linked population-based registries, clinical data, and tax-records. Multivariate random effects regression models were used to determine survivor income, compare long-term income between survivors and comparators, and assess income determinants. Subjects included all residents of British Columbia (BC), Canada, diagnosed with cancer before 25 years of age and surviving 5 years or more. Comparators were selected from the BC general population matched by gender and birth year.

Results

Young cancer survivors earned significantly less than the general population. In addition, survivors of central nervous system tumors have significantly lower incomes than lymphoma survivors. Survivors who received radiation therapy have significantly lower income.

Results should be interpreted with caution as the comparator group was matched by gender and date of birth.

Conclusions

Depending on original diagnosis, treatment, and other characteristics, survivors face significantly lower income than peers and may require supports to gain and retain paid employment. Lower income will affect their opportunity for independent living, and will reduce productivity in the labour force.

Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes

Substantial improvements in childhood cancer survival have resulted in a steadily increasing population of childhood cancer survivors. Whereas somatic late effects have been assessed in many studies, less is known about the impact of childhood cancer on socioeconomic outcomes in survivors. The aim of this article was to evaluate and summarise the evidence on the socioeconomic conditions of childhood cancer survivors and to identify survivors at particular risk of adverse socioeconomic outcomes. An extensive literature search of three electronic databases was conducted. Of 419 articles identified, 52 met the inclusion criteria. All the selected articles were appraised for quality, and findings were summarised in a narrative synthesis. Childhood cancer survivors were at higher risk of adverse socioeconomic outcomes with regard to educational achievement, income and social security benefits than the general population or a sibling comparison group. The risks for unemployment and a lower occupational position were significantly increased only for survivors of a central nervous system tumour. Notably, survivors of central nervous system tumours, survivors treated with cranial radiotherapy and those diagnosed at younger age independent of cancer type were determinants of particular adverse socioeconomic outcomes. Given the increasing population of childhood cancer survivors, targeted follow-up interventions and support strategies addressing not only the somatic and psychiatric late effects but also the socioeconomic difficulties that some childhood cancer survivors face is of high importance to reduce social inequity, and ensure a high quality of life after childhood cancer.

Post-transplantation employment status of adult survivors of childhood allogeneic hematopoietic cell transplant: A report from the Center for International Blood and Marrow Transplant Research (CIBMTR)

BACKGROUND

Data are scarce regarding employment outcomes of survivors of childhood allogeneic hematopoietic cell transplantation (alloHCT) and the factors that affect their employment status.

METHODS

By using the Center for International Blood and Marrow Transplant Research database, the authors studied employment outcomes of ≥1-year survivors of childhood alloHCT who were age ≥18 years at their most recent assessment (year of transplantation, 1985-2010). Employment status was assessed at their attained ages (ages 18-22, 23-27, and 28-32 years) and according to transplantation center (TC) location (United States or International). A multivariable analysis assessing the factors that affected employed status (full-time/part-time work or student) was performed.

RESULTS

Unemployment rates among 2844 survivors were persistently high at all attained ages (United States TCs: ages 18-22 [14%], 23-27 [15%], and 28-32 [13%] years; International TCs: ages 18-22 [56%], 23-27 [53%], and 28-32 [68%] years). The factors associated a with higher likelihood of employment included: older age at alloHCT (ages 5-9-years: hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.65-2.6; ages 10-14 years: HR, 4.43; 95% CI, 3.58-5.47; ages 15-18-years: HR, 7.13; 95% CI, 5.72-8.88), myeloablative conditioning without total body irradiation (TBI) (HR, 1.56; 95% CI, 1.38-1.77), reduced-intensity conditioning with TBI (HR, 1.47; 95% CI, 1.19-1.8) or without TBI (HR, 2.51; 95% CI, 2.15-2.92), and US-based TC (HR, 1.84; 95% CI, 1.62-2.08).

CONCLUSIONS

Young adult survivors of childhood alloHCT have high unemployment rates at all studied attained ages after HCT. Future efforts should be directed toward understanding the causes of unemployment their and relation to quality of life using patient-reported outcome measures.

Neurocognitive deficits in children with chronic health conditions

Over 4 million children in the United States suffer from chronic health conditions, including cancer, sickle cell disease, and diabetes. Because of major advances in the early identification and treatment of these conditions, survival rates for these children continue to rise, and the majority now lives into adulthood. However, increases in survival have come with costs related to long-term effects of disease processes and treatments. Foremost among these consequences is impairment in brain development and neurocognitive function that may affect a substantial portion of children with chronic health conditions and follow many into adulthood. Impaired cognitive function may contribute to impairment in educational and occupational attainment, mental health, and quality of life for children with chronic conditions. Despite the significance and scope of this problem, advances in the identification and understanding of neurocognitive problems and the delivery of effective clinical care have been hindered in part because research has been "siloed"-conducted on each chronic condition in isolation. This review examines, for the first time, neurocognitive problems in a selected set of 6 chronic pediatric health conditions-leukemia, brain tumors, sickle cell disease, congenital heart disease, Type 1 diabetes, and traumatic brain injury-to define the magnitude of the problem and identify directions for future research and clinical care. Psychologists from many areas of specialization, including pediatric psychology, educational and school psychology, neuropsychology, behavioral medicine, and adult primary care, are uniquely positioned to contribute to every phase of this work, including research, identification, and intervention. (PsycINFO Database Record

A Systematic Review of the Role of Gender in Securing and Maintaining Employment Among Youth and Young Adults with Disabilities

Purpose There is a critical need for gender-specific vocational supports for young adults with disabilities as they transition to employment. We conducted a systematic review to explore the role of gender in securing and maintaining employment. Methods Systematic searches of seven databases identified 48 studies meeting our inclusion criteria. Using a narrative synthesis approach, these studies were analyzed in terms of the characteristics of the participants, methodology, results, and quality of the evidence. Results Among the 48 studies, 112,473 participants (56% male), mean age (of the total sample) was 21, represented across ten countries. Twenty-one studies reported that young men with disabilities had better employment outcomes than women with disabilities. Eight studies showed that females with disabilities had better employment outcomes than males. Five studies reported that there were no gender differences in employment outcomes for youth with various disabilities. With regards to maintaining employment, men with disabilities often work more hours and have better wages compared to women with disabilities. There are several gender-related barriers and facilitators to maintaining employment including social supports and gender role expectations. Conclusions Our findings highlight that there is a critical need for gender-specific vocational supports for young adults with disabilities.

Surviving a childhood cancer: impact on education and employment

Long-term consequences of childhood cancer encompass adverse psychosocial effects that may severely limit the opportunity to live a satisfying and productive life. We assessed the social integration of adults cured of a cancer in their first 14 years of life by record linkage between the population-based Childhood Cancer Registry of Piedmont and the Turin Longitudinal Study. We compared education and employment outcomes within the cohort of survivors and between the cohort of survivors and their peers in the general population through logistic regression. Individuals cured of a childhood tumour have a higher risk of not obtaining educational qualifications [odds ratio (OR) 0.67 (95% confidence interval 0.40-1.11) for compulsory school, OR 0.81 (0.61-1.07) for higher education] or employment, OR 0.66 (0.45-0.98), than the general population. This problem is particularly severe for individuals cured of a central nervous system neoplasm: OR 0.56 (0.31-1.01) for higher education and OR 0.28 (0.13-0.58) for employment. Within-cohort comparisons show that men are less likely to obtain educational goals than women, OR 0.72 (0.40-1.29), but more likely to be employed, OR 2.18 (0.90-5.28); parental education (university qualifications) is positively associated with the success of the child's education, OR 9.54 (2.60-35.02), but not with their employment status, OR 1.02 (0.21-4.85). Strategies should be put in place to mitigate the risk of adverse psychosocial effects from the beginning of treatment to cure and beyond to offer those suffering a cancer at a young age the possibility of full integration into society.

Occupational status among adult survivors following allogeneic stem cell transplantation in childhood

This study examined occupational status and factors associated with sick leave and disability pension among adult long-term survivors previously treated with allogeneic stem cell transplantation (allo-SCT) during childhood. Moreover, occupational status was compared to that of a reference group. Data were collected with questionnaires and from medical records. The SCT group included 59 adults (18-45 years old: response rate 63%) treated with allo-SCT in childhood with a median of 17 (range 3-28) years earlier. The reference group included 296 individuals randomly selected from the general population. The results show that 54% of the long-term survivors were working part- or full-time and that 19% were on sick leave or disability pension. A larger proportion of the SCT group was on sick leave or disability pension (19% vs. 6%: p < .001) than of the reference group. The logistic regression analysis revealed that being on sick leave or disability pension among long-term survivors was associated with late effects related to the allo-SCT (OR 12.28: 95% CI 1.3-111.6: p = .03). The results underscore that long-term survivors' engagement in paid work is influenced many years after treatment and highlights the need to include vocational assistance in the rehabilitation following allo-SCT in childhood.

"From Snail Mode to Rocket Ship Mode": Adolescents and Young Adults' Experiences of Returning to Work and School After Hematopoietic Cell Transplantation

PURPOSE

Resuming normal activities, such as work and school, is an important dimension of psychosocial recovery in cancer survivorship. Minimal data exist regarding adolescents or young adults' experiences of returning to school or work after cancer. The purpose of this study was to explore the processes of resuming work and school among adolescents and young adults after hematopoietic cell transplantation (HCT).

METHODS

In-depth interviews were conducted with 18 adolescents and young adults, who were 15-29 years when they underwent HCT and 6-60 months post-transplant at study enrollment. Interview transcripts were systematically analyzed using Grounded Theory methodology.

RESULTS

Participants described the context in which they attempted to return to work or school, specific challenges they faced, and strategies they developed in these environments. Feeling left behind from their peers and their pre-diagnosis selves, participants described "rushing" back to school and work impulsively, taking on too much too quickly while facing overwhelming physical and cognitive demands. Factors motivating this sense of urgency as well as barriers to successful and sustainable reentry in these settings are also addressed.

CONCLUSION

Findings are discussed in the context of important opportunities for clinical management, age-appropriate interventions, and implications for future research. A better understanding of psychosocial late effects, specifically related to school and work trajectories after cancer, is critical to survivorship care for adolescent and young adult cancer survivors.

Management of work through the seasons of cancer survivorship

PURPOSE OF REVIEW

Survival from cancer has expanded enormously over the past decades. It is estimated that 40-50% of all cancer survivors are of working age at time of diagnosis and thus potentially part of the labor force. The seasons of survivorship can be used as a steppingstone to describe issues regarding employability survivors are dealing with.

RECENT FINDINGS

The acute survival stage begins at the point of diagnosis. Disclosure of diagnosis, and flexibility of both employers and (occupational) healthcare professionals are important factors in this stage. Extended survival starts when the survivor has completed the basic course of treatment. Survivors become aware that the old normality at work will be difficult to achieve. Problems like fear of recurrence, cognitive, and physical limitations might intensify during this stage and affect work ability. Permanent survival can be called long-term remission. Prospective studies on work-related outcomes and work-related interventions in this stage are rare.

SUMMARY

It is important to improve our understanding of the seasons of survival and to explore concepts, such as employability, against the background of these seasons. This perspective may help both survivors and (occupational) healthcare professionals to develop better strategies for dealing with the difficult life event cancer represents in each specific stage.

Unemployment Following Childhood Cancer

BACKGROUND

Childhood cancer survivors are at risk of physical and mental long-term sequelae that may interfere with their employment situation in adulthood. We updated a systematic review from 2006 and assessed unemployment in adult childhood cancer survivors compared to the general population, and its predictors.

METHODS

Systematic literature searches for articles published between February 2006 and August 2016 were performed in CINAHL, EMBASE, PubMed, PsycINFO, and SocINDEX. We extracted unemployment rates in studies with and without population controls (controlled /uncontrolled studies). Unemployment in controlled studies was evaluated using a meta-analytic approach.

RESULTS

We included 56 studies, of which 27 were controlled studies. Approximately one in six survivors was unemployed. The overall meta-analysis of controlled studies showed that survivors were more likely to be unemployed than controls (Odds Ratio [OR] = 1.48, 95% confidence interval [CI]: [1.14; 1.93]). Elevated odds were found in survivors in the US and Canada (OR = 1.86, 95% CI: [1.26; 2.75]), as well as in Europe (OR = 1.39, 95% CI: [0.97; 1.97]). Survivors of brain tumors in particular were more likely to be unemployed (OR = 4.62, 95% CI: [2.56; 8.31]). Narrative synthesis across all included studies revealed younger age at study and diagnosis, female sex, radiotherapy, and physical late effects as further predictors of unemployment.

CONCLUSION

Childhood cancer survivors are at considerable risk of unemployment in adulthood. They may benefit from psycho-social care services along the cancer trajectory to support labor market integration.

Long-term Survivors of Childhood Brain Tumors: Impact on General Health and Quality of Life

PURPOSE OF REVIEW

We review and summarize the key issues affecting general health and quality of life (QOL) of pediatric long-term survivors of brain tumors.

RECENT FINDINGS

Long-term survivors of brain tumors are at risk of considerable late morbidity and mortality. Lengthening survival in brain tumors has highlighted the deep impact of tumor and its treatment on the physical, psychological, functional, and social health and QOL of these survivors. Evolution in tumor therapy including surgery, radiotherapy, and systemic therapies, etc., has the potential to mitigate this impact to some extent. Sensitization of health staff, policy makers, and the primary designers of clinical trials towards integration of QOL end points while measuring survival in brain tumor patients is the need of the hour. New developments in tumor therapeutics must not only provide quantitative gain but also improve the quality of survival in these long-term survivors. While majority of the issues presented pertain to survivorship in pediatric brain tumor population, similar challenges are likely to exist in young adults surviving brain tumors as well.

Self-Esteem and Academic Difficulties in Preadolescents and Adolescents Healed from Paediatric Leukaemia

Adolescents with cancer may demonstrate problems in their self-esteem and schooling. This study aims to screen the preadolescents and adolescents more at risk in their self-esteem perception and schooling difficulties post-five years from the end of therapy. Twenty-five paediatric ex-patients healed from leukaemia were recruited at the Haematology-Oncologic Clinic (University of Padua). The mean age of the children was 13.64 years (Standard Deviation (SD)) = 3.08, range = 10-19 years), most were treated for acute lymphoblastic leukaemia (ALL) (84%) and relatively equally distributed by gender. They filled in the Multidimensional Self-Esteem Test, while parents completed a questionnaire on their child's schooling. Global self-esteem was mostly below the 50 percentile (58.5%), especially regarding interpersonal relationships (75%). An independent sample t-test showed significant mean differences on the emotionality scale (t = 2.23; degree of freedom (df) = 24; p = 0.03) and in the bodily experience scale (t = 3.02; df = 24; p = 0.006) with survivors of Acute Myeloid Leukaemia (AML) having lower scores. An Analysis of Variance (ANOVA) showed significant mean differences in the bodily experience scale (F = 12.31; df = 2, p = 0.0001) depending on the survivors' assigned risk band. The parent reports showed that 43.5% of children had difficulties at school. Childhood AML survivors with a high-risk treatment were more at risk in their self-esteem perceptions. Preventive interventions focusing on self-esteem and scholastic wellbeing are suggested in order to help their return to their normal schedules.

Employment status and occupational level of adult survivors of childhood cancer in Great Britain: The British childhood cancer survivor study

The British Childhood Cancer Survivor Study (BCCSS) provides the first detailed investigation of employment and occupation to be undertaken in a large population-based cohort. Previous studies have been limited by design issues such as using small numbers of survivors with specific diagnoses, and involved limited assessment of employment status and occupational level. The BCCSS includes 17,981 5-year survivors of childhood cancer. Employment status and occupational level were ascertained by questionnaire from eligible survivors (n = 14,836). Multivariate logistic regression was used to explore factors associated with employment and occupation, and to compare survivors to their demographic peers in the general population. Employment status was available for 10,257 survivors. Gender, current age, cancer type, radiotherapy, age at diagnosis and epilepsy were consistently associated with being: employed; unable to work; in managerial or non-manual occupations. Overall, survivors were less likely to be working than expected (OR (99% CI): 0.89 (0.81-0.98)), and this deficit was greatest for irradiated CNS neoplasm survivors (0.34 (0.28-0.41)). Compared to the general population, survivors were fivefold more likely to be unable to work due to illness/disability; the excess was 15-fold among CNS neoplasm survivors treated with radiotherapy. Overall survivors were less likely to be in managerial occupations than expected (0.85 (0.77-0.94)). However, bone sarcoma survivors were more likely to be in these occupations than expected (1.37 (1.01-1.85)) and also similarly for non-manual occupations (1.90 (1.37-2.62)). Survivors of retinoblastoma (1.55 (1.20-2.01)) and 'other' neoplasm group (1.62 (1.30-2.03)) were also more likely to be in non-manual occupations than expected.

Educational and career goal attainments in young adult childhood cancer survivors

PURPOSE

Examine the educational and career outcomes of young adult childhood cancer survivors.

DESIGN AND METHODS

Descriptive study design using a survey sent to 336 survivors. Quantitative and qualitative data were analyzed separately.

RESULTS

Only 50 completed surveys were returned. Having a central nervous system tumor and radiation were associated with physical impairments. Four themes also emerged: future as medical professionals, dreams fallen short, peer relationships, and positive outlook on life.

PRACTICE IMPLICATIONS

Pediatric nurses caring for survivors should partner with oncology professionals to support survivors to enrich their educational and career opportunities.

Family Functioning Mediates the Association Between Neurocognitive Functioning and Health-Related Quality of Life in Young Adult Survivors of Childhood Brain Tumors

PURPOSE

Childhood brain tumor (BT) survivors experience significant neurocognitive sequelae that affect health-related quality of life (HRQOL). A model of neurodevelopmental late effects and family functioning in childhood cancer survivors suggests associations between survivor neurocognitive functioning, family functioning, and survivor HRQOL. This study examines the concurrent associations between survivor neurocognitive functioning, family functioning, and survivor emotional HRQOL, and the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning.

METHODS

Participants included young adult-aged childhood BT survivors (18-30 years old; N=34) who were on average 16 years post-diagnosis, and their mothers. A brief neuropsychological battery assessed working and verbal memory, processing speed, and executive functioning. Survivors and mothers completed measures of family functioning, and mothers completed a proxy-report measure of survivor HRQOL.

RESULTS

Spearman bivariate correlations examined the associations between indices of survivor neurocognitive functioning and concurrent family functioning and survivor emotional HRQOL. Poorer survivor processing speed, working memory, verbal memory, and executive function were significantly associated with worse survivor- and mother-reported family functioning (r's range: 0.36-0.58). Additionally, worse survivor processing speed and executive function were significantly associated with poorer survivor emotional HRQOL (r's range: 0.44-0.48). Bootstrapping analyses provided evidence for the indirect effects of neurocognitive functioning on survivor emotional HRQOL through family functioning.

CONCLUSION

These findings suggest that family functioning is an important variable that might mitigate the negative influence of neurocognitive late effects on survivors and is a potential target in future interventions.

Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors-a Finnish registry-based study

BACKGROUND

In order to assess neurocognitive and social outcomes after childhood cancer, we explored the educational and vocational attainments of Finnish survivors in comparison to matched population controls.

METHODS

From national registries, we identified survivors (n = 3243) born from 1960 to 1992 and aged below 16 at cancer diagnosis (years 1964-2009) as well as their controls (n = 16,215). Data on educational achievements, yearly income, employment status, and retirement were retrieved from Statistics Finland.

RESULTS

The median (range) age at study was 28 (17-50) years. The proportion of those with no education after comprehensive school was higher than controls for all the diagnostic groups: brain tumor (BT) (33.5 vs 23.0 %), solid tumor (ST) (25.0 vs 21.4 %), and leukemia/NHL (29.2 vs 23.1 %). Odds ratios (OR) for unemployment were not significantly elevated in any survivor group compared to controls, but OR for being retired was elevated in each survivor group (BT 14.8, ST 2.2, leukemia/NHL 4.0). Irradiation significantly increased that OR only in BT survivors. Leukemia/NHL survivors treated after 1992 had lower risk for early retirement (OR 0.6) compared to those diagnosed earlier.

CONCLUSIONS

Survivors had higher frequencies than controls for lacking further education after comprehensive school. Unemployment was not common, but risk for early retirement was significantly increased in each three survivor group.

IMPLICATIONS FOR CANCER SURVIVORS

Reassuring is that premature retirement was less common during the most recent treatment era. Screening and follow-up of psychosocial performance more effectively might be essential, and there is a need for studies on possibility for effective rehabilitation of the survivors.

Economic independence in survivors of cancer diagnosed at a young age: A Norwegian national cohort study

BACKGROUND

The impact of cancer on socioeconomic outcomes is attracting attention as the number of survivors of cancer in young age continues to rise. This study examines economic independence in a national cohort of survivors of cancer at a young age in Norway.

METHODS

Through the linkage of several national registries, the study cohort comprised 1,212,013 individuals born in Norway during 1965 through 1985, of which 5440 had received a cancer diagnosis before age 25 years. Follow-up was through 2007, and the main outcomes were receipt of governmental financial assistance, employment, income, and occupation. Analytic methods included Cox proportional hazard regression, log-binomial regression, and quantile regression models.

RESULTS

Individuals in the cancer survivor group had an increased probability of receiving governmental financial assistance (men: hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3-1.5; women: HR, 1.5; 95% CI, 1.3-1.6) and of not being employed (men: HR, 1.4; 95% CI, 1.2-1.7; women: HR, 1.4; 95% CI, 1.2-1.6) compared with those in the noncancer group. Income discrepancies were particularly pronounced for survivors of central nervous system tumors. There was no difference in representation in higher skilled occupations.

CONCLUSIONS

Survivors of cancer at a young age in Norway had an increased risk of being economically dependent and unemployed. This was evident in several tumor groups and was most pronounced in female survivors. There were only small differences in income or representation in higher skilled occupations for most employed survivors compared with the noncancer group. The current results are important for understanding the impact of a cancer diagnosis at a young age on subsequent job market outcomes. Cancer 2016;122:3873-3882. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Early Life Health, Trauma and Social Determinants of Lifetime Abstention from Alcohol

AIMS

Factors influencing lifetime abstention from alcohol may be relevant to the validity of analyses of alcohol's impact on health outcomes. We evaluate relationships between early life experiences, social factors, and demographic characteristics on lifetime abstainer status in models disaggregating by gender and, among women, race/ethnicity.

METHODS

Analyses use the landline sample (N = 5382) of the 2010 U.S. National Alcohol Survey. Surveyed participants who reported never drinking alcohol were defined as lifetime abstainers. Additional variables assessed included demographics, dispositions to risk taking and impulsivity, and indicators of early life stress like economic difficulty, childhood trauma and early onset of health conditions. Logistic regression models predicting lifetime abstention were estimated.

RESULTS

Lifetime abstainers are more likely to be women and, among women, to be non-White and Latina. Those reporting that their religion discouraged drinking and that religion was very important to them were more likely to be lifetime abstainers. Higher education levels were associated with reduced rates of lifetime abstention among women. Also among women, family problem drinking was associated with lower rates of lifetime abstention. However, childhood economic difficulty significantly predicted lower abstention only for White women, and childhood sexual abuse was significantly related to lower lifetime abstention only for Black women.

CONCLUSIONS

Understanding the characteristics and determinants of individuals who never drink alcohol is relevant to any analysis of alcohol-related health outcomes. Results point to specific factors related to lifetime abstention with potential to bias such analyses if not included as control measures.

SHORT SUMMARY

Analyses evaluating relationships between early life experiences, social factors, and demographics with lifetime abstainer status identified characteristics associated with both poor health and with better health. These included lower risk taking and impulsivity scores and lower rates of family problem drinking, childhood economic difficulties and childhood sexual abuse.