Survival and long-term socioeconomic consequences of childhood and adolescent onset of brain tumours

Evaluating a Self- and Family Management Framework for Young Adult Survivors of Childhood Brain Tumors

This study evaluated adaptations to the revised Self- and Family Management Framework aimed at enhancing support for families of young adult survivors of childhood brain tumors (YAS). Baseline data from condition-focused caregivers of YAS (N = 53) examined correlations between the Framework's Facilitators and Barriers (individual/contextual/clinical factors), Processes (caregiver problem-solving), Proximal Outcomes (YAS self-management, caregiver family management), and Distal Outcomes (YAS/caregiver HRQOL). All aspects of family management were associated with YAS HRQOL; only Parent Mutuality was associated with caregiver HRQOL. Problem-solving was partially supported as a process linked to family management and caregiver HRQOL. Individual/contextual/clinical factors were not associated with problem-solving. Self-management was not associated with problem-solving or HRQOL. Interventions grounded in concepts of family management may improve YAS HRQOL and have future potential for family nursing practice. Further research is needed to understand the divergence between HRQOL findings, partial support for problem-solving, and lack of associations with individual/contextual/clinical factors, and self-management.

Targeted Transition Readiness Workshops for Pediatric Brain Tumor Survivors: Feasibility, Acceptability, and Preliminary Effects

Pediatric brain tumor survivors (PBTS) are at risk for late effects related to their diagnosis and treatment. Long-term medical follow-ups are deemed essential, implying a transition from pediatric to adult healthcare settings. This pilot study aims to assess the feasibility, acceptability, and preliminary effects of a targeted transition readiness intervention for PBTS. The program consisted of three hybrid workshops that targeted disease-related self-management skills, social skills, and cognitive functioning, as well as parallel workshops for their caregivers. The feasibility and acceptability were assessed through recruitment, retention, and satisfaction rates. Preliminary effects were primarily assessed via a pre/post assessment of transition readiness skills using the Transition Readiness Assessment (TRAQ) questionnaire. Among the eligible dyads, 12 (38%) consented to participate. Ten dyads participated in at least two workshops, and six dyads participated in all workshops. Overall, the participants were satisfied with the intervention (parents = 86%; PBTS = 73%). Although not statistically significant, a clinically relevant post-workshop increase in transition readiness skills was observed for PBTS (d = 0.36) and their caregivers (d = 0.25). The results suggest the relevance of the intervention and encourage further developments. Adjustments are needed to optimize reach and efficacy. The workshops have the potential to be adapted to be more accessible and shorter.

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.

Prioritizing Solutions and Improving Resources among Young Pediatric Brain Tumor Survivors: Results of an Online Survey

Pediatric Brain Tumor Survivors (PBTS) often experience social, academic and employment difficulties during aftercare. Despite their needs, they often do not use the services available to them. Following a previous qualitative study, we formulated solutions to help support PBTS return to daily activities after treatment completion. The present study aims to confirm and prioritize these solutions with a larger sample. We used a mixed-methods survey with 68 participants (43 survivors, 25 parents, PBTS' age: 15-39 years). Firstly, we collected information about health condition, and school/work experience in aftercare. Then, we asked participants to prioritize the previously identified solutions using Likert scales and open-ended questions. We used descriptive and inferential statistics to analyze data, and qualitative information to support participants' responses. Participants prioritized the need for evaluation, counseling, and follow-up by health professionals to better understand their post-treatment needs, obtain help to access adapted services, and receive information about resources at school/work. Responses to open-ended questions highlighted major challenges regarding the implementation of professionals' recommendations at school/work and the need for timely interventions. These results will help refine solutions for PBTS and provide key elements for future implementation. Translating these priorities into action will need further work involving professionals and decision makers.

Global synergistic actions to improve brain health for human development

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.