Search Results (195)

Background/Objectives: The aim of this study is to describe fertility preservation (FP) techniques performed over the last 10 years at a tertiary hospital in northern Spain in patients under 18 diagnosed with cancer. Methods: A retrospective medical record review was conducted for patients aged 0 to 18 years diagnosed between January 2014 and December 2023 in the Pediatric Oncology Unit at a university hospital. We evaluated patient characteristics, the timing of FP procedures, and potential risk factors for ovarian insufficiency and early azoospermia. Additionally, we assessed the agreement between two gonadotoxicity risk classifications. Results: In our center, FP is more frequently offered to pubertal patients (12 to 16 years old), prior to treatment in those at high risk of subsequent gonadotoxicity (>80%), and after treatment in those at low risk (<20%). Additionally, the increased provision of FP over the last five years of the study suggests improved clinician uptake of this long-term effect of cancer treatment. Our study found weak agreement between available gonadotoxicity risk classifications, complicating the identification of FP candidates. Long-term follow-up of survivors allowed for the detection of ovarian insufficiency (1.2%) and early azoospermia (0.7%), enabling hormone replacement therapy when necessary. Hematopoietic stem cell transplantation (HSCT) emerged as a predictor of early infertility. Conclusions: Our study highlights the prevalence of gonadotoxicity in pediatric cancer patients at our center and the increasing access to FP techniques. The findings emphasize the importance of personalized medicine, tailored FP strategies based on individual risk, and long-term follow-up to assess fertility status. Full article

Background: The advances in cancer diagnosis and treatment have significantly improved survival rates in pediatric patients, with five-year survival now exceeding 80% in many high-income countries. However, these life-saving therapies often carry long-term consequences, including impaired fertility. The reproductive health of childhood cancer survivors has emerged as a key issue in survivorship care. Objective: This narrative review aims to examine the gonadotoxic effects of cancer treatments on pediatric patients, evaluate fertility preservation strategies in both males and females, and provide guidance on the long-term monitoring of reproductive function post treatment. Methods: A comprehensive literature review was conducted using PubMed, including randomized trials, cohort studies, and clinical guidelines published up to March 2024. The keywords focused on pediatric oncology, fertility, and reproductive endocrinology. Studies were selected based on relevance to treatment-related gonadotoxicity, fertility preservation options, and follow-up care. Results: Radiotherapy and alkylating agents pose the highest risk to fertility. Postpubertal patients have access to standardized preservation techniques, while prepubertal options remain experimental. Long-term effects include premature ovarian insufficiency, azoospermia, hypogonadism, and uterine dysfunction. The psychosocial impacts, especially in female survivors, are profound and often overlooked. Conclusions: Fertility preservation should be discussed at diagnosis and integrated into treatment planning in pediatric patients with cancer. While options for postpubertal patients are established, more research is needed to validate safe and effective strategies for younger populations. A multidisciplinary approach and long-term surveillance are essential for safeguarding future reproductive potential in childhood cancer survivors. Full article

Background/Objectives: The increasing population of childhood cancer survivors presents new challenges for healthcare systems worldwide. While advances in oncological treatments have dramatically improved survival rates, survivors face a broad spectrum of late effects that extend beyond the biological to encompass profound psychological and social dimensions. Methods: This quasi-systematic review synthesizes data from recent studies on adolescent survivors, revealing significant disruptions in cognitive function, mental health, social integration, education, romantic relationships, and vocational outcomes. Results: This review highlights the inadequacy of a solely biomedical model and advocates for a biopsychosocial approach to long-term follow-up care. An emphasis is placed on the necessity of personalized, interdisciplinary, and developmentally informed interventions, especially in countries like Poland, where structured survivorship care models remain underdeveloped. Conclusions: The findings underscore the importance of integrating medical, psychological, and social services to ensure adolescent cancer survivors achieve not only physical recovery but also meaningful life participation and emotional well-being. Full article

Background/Objectives: Childhood cancer survivors (CCS) experience chronic health problems and significant metabolic burden. Timely identification of CCS at higher metabolic risk requires novel biomarkers. Irisin, a novel myokine/adipokine has been associated with metabolic, bone and reproductive diseases, but its role in the health of CCS is unknown. The aim of this study was to examine irisin concentrations in children and adolescent CCS (vs. controls) and their association with metabolic, bone and hormonal parameters. Methods: Children and adolescent CCS, aged 8–18 years, as well as healthy controls, underwent a detailed physical, body composition, biochemical, hormonal and serum irisin assessment at least 6 months post-treatment. Results: A total of 59 children and adolescents (36 CCS, 23 controls; mean age ± SD 12.8 ± 2.9 years; 10 prepubertal, 49 pubertal) participated in the study. Serum irisin concentrations (ng/mL) were significantly lower in CCS than controls [median (IQR) 6.54 (4.12) vs. 11.70 (8.75) ng/mL, respectively, p < 0.001]. In the total study sample, serum irisin was correlated negatively with LH (r_s = −0.314, p < 0.05), CRP (r_s = −0.366, p < 0.005), age (r_s = −0.323, p < 0.05) and positively with ALP (r_s = 0.328, p < 0.05). Serum irisin was also positively correlated with ApoB and Lpa (r_s = 0.410 and 0.421, respectively, p < 0.05) in CCS, and with PTH (r = 0.542, p < 0.005) in controls. Multivariate linear regression analysis indicated parathyroid hormone (PTH) as the only independent variable affecting irisin concentrations. Conclusions: Study results reinforce the irisin–PTH interplay hypothesis. Future studies are needed to clarify the potential role of irisin as a bone biomarker of CCS in childhood and adolescence. Full article

Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes current guideline recommendations, and formulates strategies for implementing standardized surveillance protocols. Through examination of recent literature—encompassing retrospective cohort investigations, international consensus recommendations, and functional outcome assessments—we present an integrated analysis of challenges and opportunities in managing chemotherapy-associated hearing loss among childhood cancer survivors. Our findings demonstrate marked heterogeneity in monitoring methodologies, substantial implementation obstacles, and considerable impact on survivors’ functional status across multiple domains. Particularly concerning is the persistent absence of an evidence-based consensus regarding the appropriate duration of audiological surveillance for this vulnerable population. We propose a structured framework for comprehensive ototoxicity management emphasizing prompt detection, standardized assessment techniques, and integrated long-term follow-up care to minimize the developmental consequences of platinum-induced hearing impairment. This approach addresses critical gaps in current practice while acknowledging resource limitations across diverse healthcare environments. Full article

Childhood cancer survivors (CCSs) are at increased risk for chronic health issues due to late effects of cancer and its treatment. We address the impact of environmental exposures, such as air pollution, tobacco smoke, extreme weather events, and pesticides, on the health and survival of CCSs. These environmental hazards have been associated with worsening health outcomes and decreased survival among CCSs on a global scale. We also highlight that providers at a major pediatric cancer center in the United States have limited knowledge and practical skills about environmental risk factors and how to reduce exposures. Our survey results show that pediatric oncology providers would find an environmental referral service helpful and useful in their department. Integrating environmental health into pediatric cancer care can empower patients and families, promote healthier behaviors, and potentially reduce morbidity and mortality in this vulnerable population. Full article

Purpose: Cancer treatments can result in subfertility or infertility in female adult childhood cancer survivors (ACCSs). While ACCSs may utilize assisted reproductive technology (ART) or other family-building options, the limited evidence describing their experiences remains a hindrance to developing and implementing appropriate patient-centered supports. The study’s aim is to describe the challenges female ACCSs experienced while navigating ART and family-building options, to inform improvements in clinical practice in a western Canadian province. Methods: In this qualitative Interpretive Description study, interviews were conducted with 15 female ACCSs and data were analyzed using an interpretive thematic approach and constant comparative techniques. Results: ACCSs’ narratives suggest they experienced five prominent challenges while navigating ART and family-building options, including (1) confronting unexpected, impaired fertility, (2) grieving loss and redefining identity, (3) encountering unsupportive healthcare, (4) exploring alternative paths of adoption and international family-building, and (5) facing financial strain. Conclusions: This exploratory study provides initial insights into the significant and multifaceted challenges female ACCSs experience related to family building and highlights gaps in healthcare services. Further research is warranted to articulate these challenges across contexts and the development and implementation of mitigating approaches. Implications for Cancer Survivors: The integration of comprehensive informational, psychosocial, and financial supports into existing cancer survivor and family-building services is vital to meeting female ACCSs’ unmet needs. Full article

Background/Objective: Radiotherapy for leukemia, the most common childhood malignancy, often exposes patients to radiation, increasing the risk of second malignancies, including thyroid cancer. To assess the incidence and survival outcomes of thyroid cancer after childhood acute lymphoblastic leukemia (ALL). Methods: We systematically reviewed articles reporting the incidence of thyroid cancer in childhood leukemia survivors (age at diagnosis < 18 years) published between 2000–2024 in Science Direct, PubMed, Google Scholar, CENTRAL, and EMBASE. The Newcastle Ottawa Scale was utilized to appraise the methodological quality of the included studies. Descriptive statistics and calculations of incidence were performed using Microsoft Excel. Results: The literature search yielded 1265 articles, of which 18 met the inclusion criteria. Data from 135,861 childhood cancer survivors, among whom 102,070 had a confirmed diagnosis of childhood leukemia, including ALL. The crude incidence of secondary malignancies after childhood leukemia was 10.1 per 1000 patients. Among these, 1.5 per 1000 patients developed second thyroid carcinomas. Overall, 14.6% of the second malignancies in childhood leukemia survivors were thyroid carcinomas, mostly of the papillary type. Survival rates after second thyroid cancer were 100% in all 11/18 studies reporting this outcome. Radiotherapy had been used as part of ALL treatments in 17/18 studies. The use of radiotherapy, female sex, and younger age at the diagnosis of primary ALL emerged as important risk factors for thyroid cancer. Conclusions: Thyroid carcinomas account for ~15% of secondary malignancies after childhood leukemia, with radiation remaining a significant risk factor despite its overall reduced use for the treatment of ALL in the last few decades. Importantly, survival rates remain high. Further research is warranted to determine the incidence and outcomes of thyroid cancer in childhood ALL survivors Full article

Background: Childhood cancer survivors (CCSs) often experience impaired humoral immunity because of cancer treatments that increase their susceptibility to vaccine-preventable diseases. This study aimed to assess the seroprevalence of tetanus and rubella antibodies in CCSs compared to healthy, age-matched controls. Additionally, we explored the impact of cancer treatments on vaccine-induced immunity, examined the extent of revaccination after treatment completion, and evaluated the effectiveness of revaccination on seroprevalence. Methods: This retrospective study included 180 CCSs previously treated at Astrid Lindgren Children’s Hospital, Stockholm, between March 2019 and January 2023. Patient data were retrieved from electronic medical records. Seroprevalence data for rubella and tetanus antibodies in the 15–19-year age group were also obtained from a national seroprevalence study conducted by the Public Health Agency of Sweden. Results: CCSs exhibited significantly lower seroprevalence for both tetanus (77.7% vs. 92.7%) and rubella (79.1% vs. 97.5%) compared to age-matched controls. Revaccination with DTP-containing vaccines was more frequently administered than with the MMR vaccine. Tetanus and rubella seroprevalence were the lowest in children who had received intense chemotherapy. Among those who were revaccinated with the DTP vaccine after intensive treatment, 81 out of 98 (82.6%) had tetanus IgG levels above the threshold, compared to 24 out of 48 (50%) unvaccinated CCSs. In contrast, among those revaccinated with MMR, 57 out of 73 (78.1%) had positive rubella IgG, compared to 53 out of 73 (72.6%) unvaccinated CCSs with rubella IgG levels above the cut-off. Conclusions: Our findings highlight that vaccines are underutilized in CCSs with a notable gap in immunity, particularly among those who have undergone intensive treatments. Unexpectedly, MMR revaccination did not significantly affect rubella immunity. Given the increasing number of CCSs, it is essential to better understand how to effectively restore vaccine immunity in this population. Full article

Approximately 5% to 8% of patients with Wilms tumour have bilateral disease. The prevalence of bilateral Wilms tumour (BWT) is higher in individuals with genetic predisposition syndromes than in those without. The goal of therapy is to preserve as much renal tissue as possible without compromising the overall oncological outcomes, utilising neoadjuvant chemotherapy followed by nephron sparing surgery (NSS) if possible. The Children’s Oncology Group (COG) in North America and the International Society of Paediatric Oncology (SIOP) in Europe have developed the main protocols for the treatment of BWT. Both protocols are similar: initial biopsies are not indicated, and they both recommend surgical resection at week 6 or no later than week 12. Chemotherapy includes the use of vincristine and actinomycin-D in both protocols, but the COG approach also includes the use of doxorubicin, which is a cardiotoxic drug with important long-term effects on the cardiac function of childhood cancer survivors. What doxorubicin adds to patients with BWT in terms of radiological tumour response, resectability, long-term renal function and overall survival, is still not very well described and it may be variable depending on the tumour biology. This article describes the current approach for BWT in North America and Europe, focusing on the potential effect that doxorubicin may have on patient outcomes. Full article

Background: Although illness perception (IP) is a widely recognised factor in the psychosocial adjustment to cancer, little is known about the impact of individual dimensions of IP. This study aims to analyse the relationship between individual dimensions of IP and quality of life (QOL) in childhood cancer survivors. Methods: The sample consisted of 163 long-term survivors aged 11 to 25 who were administered the Brief Illness Perceptions Questionnaire and the Minneapolis–Manchester Quality of Life Scale. Results: In the correlational analysis, all dimensions of IP were associated with individual dimensions of QOL, except for understanding and treatment control. The results of the hierarchical regression analysis controlling for demographic and medical factors showed that IP had predicted individual dimensions of QOL above and beyond these factors, with emotional response, concern, consequences and understanding being the most predictive dimensions. Several age-specific relationships between IP and QOL were also identified. Conclusions: Illness perceptions significantly contribute to explaining QOL of childhood cancer survivors above and beyond demographic and medical factors. These results may contribute to more effective targeting of psychosocial interventions promoting QOL of survivors. Full article

Background: Childhood, adolescent, and young adult cancer survivors (CAYACS) face significant long-term health risks, yet adherence to long-term follow-up (LTFU) care remains inconsistent. This study explores the concept of akrasia (i.e., acting against one’s better judgment by engaging in behaviors known to be harmful or counterproductive) to understand the psychological, cognitive, and systemic barriers influencing survivor engagement in LTFU. Method: Using an ethical reflection approach based on a literature review, we discussed survivor experiences, behavioral science insights, and ethical principles to identify solutions that balance patient autonomy with supportive interventions. A narrative approach was used to summarize the key points discussed during the ethics reflection group meetings. Results: Our findings highlight key barriers such as trauma, avoidance behaviors, and cognitive constraints that contribute to non-adherence. Strategies such as shared decision-making, digital health tools, and nudge-based interventions are proposed to enhance survivor engagement. Ethical considerations emphasize the need for personalized and flexible care approaches that respect survivor agency while mitigating obstacles to adherence. Conclusions: Addressing akrasia through ethical and behavioral frameworks could improve LTFU adherence, ultimately enhancing survivorship care and long-term health outcomes. Full article

(1) Background: Inadequate physical activity is an ongoing issue for pediatric survivors of childhood cancer and hematopoietic stem cell transplant (HSCT), increasing their risk for chronic health conditions and decreasing quality of life. Team Survivors is a 12-week program in which survivors train as a group to participate in a community triathlon. Preliminary findings from a quality improvement project of Team Survivors were used to assess its feasibility in influencing survivors’ physical activity and quality of life and their family’s perception of the program. (2) Methods: Repeated measures t-tests evaluated changes in caregiver-reported exercise self-efficacy and health-related quality of life (HRQoL). These findings were supplemented by a narrative review of qualitative data from caregivers and survivors on their overall experience and satisfaction with the program. (3) Results: All participants successfully completed the triathlon, and families reported satisfaction with the program’s logistics (i.e., coordination, coaching, and practice). Neither caregiver-reported exercise self-efficacy nor HRQoL significantly differed between pre- and post-intervention, but notable improvements were reported in all domains of HRQoL. Qualitatively, the perceived benefits reported by caregivers and survivors were multifaceted. Physical benefits included improvements in survivors’ physical activity level and endurance. Psychosocially, caregivers and survivors reported greater confidence and motivation for physical activity, improved coping, and increased social engagement and feelings of normalcy. (4) Conclusions: Mixed method results support the feasibility of Team Survivors in positively impacting survivors’ ability to engage in physical activity. The multifaceted structure of the program may more broadly impact psychosocial functioning in addition to physical activity. Future studies require a larger sample size to adequately power the analyses. Full article

Background/Objectives: Dental caries is believed to be one of the most frequent dental long-term adverse effects of anticancer therapy. It may occur due to numerous chemotherapy-dependent oral symptoms or due to the possible neglection of oral care because of parental involvement in the monitoring of other long-term effects of the therapy. This study aimed to determine the incidence of dental caries and the impact of other risk factors in cancer survivors and age-matched controls. Methods: This cross-sectional study was conducted on 40 cancer survivors and 80 peers divided into three age groups. Indices such as dmft/s, DMFT/S, ft/s, FT/S, Plaque Index (PI), and Gingival Index (GI) were calculated to compare the study participants. The sum of dmft and DMFT was used to assess the possible impact of socioeconomic, oral hygiene, and dietary factors. Results: Caries frequency was found to be lower in cancer survivors (92.50%) than in controls (97.50%). No statistically significant differences were found between the study groups within all the caries indices examined. Strong positive correlations with PI and cariogenic diet in the youngest survivors and with PI in middle-aged survivors were observed. Strong negative correlations in middle-aged children were noticed in terms of father’s education in survivors and mother’s education in controls. Conclusions: The study findings suggest that there is no relationship between chemotherapy and dental caries in long-term cancer survivors. Careful dental care still remains a major contributor to maintaining oral health. Full article

The WHO Global Initiative for Childhood Cancer will likely increase the number of childhood cancer survivors in resource-poor countries. This study explored survivorship care in Kenya through parental reports on late effects and the follow-up needs of childhood cancer survivors. Parents of Kenyan childhood cancer survivors (under 18 years old) who completed treatment for at least one year were interviewed using semi-structured questionnaires from 2021 to 2022. Parents of 54 survivors were interviewed. Survivors had solid tumors (52%) and hematological tumors (48%). Most (52%) received chemotherapy combined with either surgery or radiotherapy. Many survivors (72%) experienced symptoms according to their parents. The most prevalent symptoms were pain (37%), fatigue (26%), and ocular problems (26%). Eleven percent of parents observed limitations in the daily activities of the survivors. Parents of survivors with two or more symptoms were more likely to rate symptoms as moderate to severe (p = 0.016). Parents expressed concern about late effects (48%). Only 28% were informed about late effects at the hospital, despite 87% indicating they would have welcomed this information. Follow-up care was deemed important by 98%. Recommendations included providing education about late effects and organizing survivor meetings. Survivorship clinics should be established to ensure that follow-up information and care are accessible. Full article