Many young cancer patients do not receive adequate fertility information and support

All cancer patients of reproductive age should be provided with fertility information and referrals for fertility preservation, researchers urge | ScienceDaily

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In the analysis of 23 relevant studies, investigators found that many clinicians are broadly informed about the risk to their patients’ fertility brought about by cancer treatment, but many factors hinder the appropriate discussions and referrals needed to provide adequate fertility support to patients of reproductive age. For example, some oncology clinicians may lack appropriate fertility knowledge and be unsure whose role it is to provide fertility support.

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Non-pharmacological interventions for management of fatigue among children with cancer

Systematic review of existing practices and their effectiveness | BMJ Supportive & Palliative Care

Objectives: Fatigue is common among children living with cancer, particularly in advance stages. Little is known about the effectiveness of non-pharmacological approaches to manage this complex and distressing symptom among children. Thus, the present paper aim to critically examine the effectiveness and setting for non-pharmacological interventions to manage fatigue among children with cancer.

Methods: Six electronic databases were screened first in February 2013 and at second instance in March 2015. They include PsycINFO, Medline, EMBASE, CINAHL, Scopus and Cochrane library. All databases were systematically searched for literature on fatigue and cancer, limited to children (as age group) and English language.

Results: 1498 articles were identified, of which six were reviewed. Three types of interventions for managing fatigue were identified including (1) complementary and alternative medicine (healing touch/massage therapy), (2) exercise-based interventions and (3) nursing-based interventions. Most interventions were delivered during active treatment and in hospital settings where parents were involved to optimise participation. Despite fatigue scores being lower among intervention groups, no study findings were observed as being statistically significant.

Conclusion: Fatigue is common among children treated for and living with cancer. The most appropriate setting to deliver non-pharmacological interventions to manage fatigue appears to be in hospital. However, in absence of any strong evidence, professionals need to be cautious about existing non-pharmacological interventions. Future research must adopt more rigorous research designs that are adequately powered using validated measures to identify potential benefits. In addition, researchers may wish to test psychosocial interventions shown to be of benefit in adults.

Full reference: Bhardwaj, T. & Koffman, J. (2017) Non-pharmacological interventions for management of fatigue among children with cancer: systematic review of existing practices and their effectiveness. BMJ Supportive & Palliative Care. Published Online First: 31 July 2017

Young adult cancer survivors struggle to get back to normal

Cancer survivors often talk about wanting to get back to normal, but a new study indicates many young adults who survived the disease struggle with attaining this goal two years after their initial diagnosis |ScienceDaily

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Researchers collected data from 215 cancer patients aged 14 to 39 years who visited five medical facilities nationwide between March 2008 and April 2010. Patients completed a self-report measure of social functioning within the first four months of diagnosis, and again at 12 months and 24 months later. They also answered questions about their social interactions with family and friends, psychological needs and mental health.

Thirty-two percent of the survivors reported consistently low social functioning over time — and some had been off treatment. Zebrack and colleagues say this could stem from the transition from treatment to off-treatment survivorship, a time fraught with new challenges to a cancer survivor, including the negative impact on finances, body image, work plans, relationship with spouse/significant other and plans for having children.

In addition, those reporting low scores on social functioning also had high levels of distress, possibly reflecting an impaired ability to reintegrate into social activities due to the effects of cancer, the study showed.

Movies could replace anaesthetic for child radiotherapy

Children with cancer could be spared dozens of doses of general anaesthesia by projecting a video directly on to the inside of a radiotherapy machine during treatment | OnMedica

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The new research was presented this week at the ESTRO 36 conference (European Society for Radiotherapy & Oncology), taking place in Vienna, Austria.

Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium, told the conference that using video instead of general anaesthesia is less traumatic for children and their families, as well as making each treatment quicker and more cost effective.

The study included 12 children aged between one and a half and six years old who were treated with radiotherapy using a Tomotherapy® treatment unit at the university hospital. Six were treated before a video projector was installed in 2014 and six were treated after.

Before the video was available, general anaesthesia was needed for 83% of children’s treatments. Once the projector was installed, anaesthesia was only needed in 33% of treatments.

Read the full commentary here

Cancer as a stressful life event: Perceptions of children with cancer and their peers

Howard Sharp, K.M. Cancer. Published online: 4 May 2017

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Background: The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors’ knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children.

 

Conclusions: Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD.

Read the full abstract here

Psychosexual development and satisfaction in long-term survivors of childhood cancer

Lehmann, V. et al. Cancer. Published online: 6 February 2017

Background: Risk factors for impairment in psychosexual development and satisfaction among adult survivors of childhood cancer are poorly understood. The authors compared psychosexual outcomes between survivors and healthy controls, and tested whether at-risk survivors can be identified by 1) treatment neurotoxicity or 2) diagnosis.

Conclusions: The intensity of neurotoxic treatment may be a valuable indicator of risk for psychosexual impairment relative to diagnosis alone. Health care providers should assess romantic/sexual problems among survivors at risk and make referrals if needed.

Read the full abstract here

Respiratory Viral Infections and Coinfections in Children With Cancer, Fever and Neutropenia

Torres, J.P. et al. (2016). Pediatric Infectious Disease Journal. 35(9). pp. 949–954

colorized-transmission-electron-micrograph-of-avian-influenza-a-h5n1-viruses-seen-in-gold-grown-in-mdck-cells-660x544Background: Respiratory viral infections in episodes of fever and neutropenia (FN) in children with cancer are not well characterized. We compared the clinical outcome of infections caused by different respiratory viruses (RVs) and by RV coinfection in this population.

Methods: Children with cancer and FN at 3 hospitals in Chile were prospectively evaluated by clinical examination, blood cultures and detection of 17 RVs using multiplex polymerase chain reaction (nasopharyngeal samples). Clinical characterization and outcome variables were determined and compared by the type of RV detected.

Results: A total of 1044 episodes of FN in 525 children were included. At least 1 RV was detected in 46%. In 350 of 1044 (34%) episodes, we detected only RVs, of which 284 (81%) were classified as a single-RV infection and 66 (19%) as a viral coinfection. Respiratory symptoms were present at admission in 65% of the episodes with any detected RV. Median age was 6 years (interquartile range, 3–10), and 51% were women. The most common RVs detected were rhinovirus, respiratory syncytial virus, parainfluenza, influenza, adenovirus and human metapneumovirus. Episodes caused by different types of RVs had no differences in the clinical outcome (days of hospitalization, days of fever, O2 requirement, admission to the intensive care unit and death) and when comparing single and viral coinfection.

Conclusions: To our knowledge, this is the largest report comparing clinical outcome in FN episodes caused by different RVs in children with cancer. A positive polymerase chain reaction for RV at admission was significantly associated with the presence of respiratory symptoms. Our data showed a favorable outcome in all episodes with RV detection, including single and viral coinfections.

Read the abstract here