Childhood Cancer

We present a novel use of GPUs (Graphics Processing Units) for the analysis of histopathological images of neuroblastoma, a childhood cancer. Thanks to the advent of modern microscopy scanners, whole-slide histopathological images can now be acquired but the computational costs to analyze these images using sophisticated image analysis algorithms are usually high. In this study, we have implemented previously developed image analysis algorithms using GPUs to exploit their outstanding processing power and memory bandwidth. The resulting GPU code was contrasted and combined with a C++ implementation on a multicore CPU to maximize parallelism on emerging architectures. Our codes were tested on different classes of images, with performance gain factors about 5.6x when the execution time of a Matlab code running on the CPU is compared with a code running jointly on CPU and GPU.

A workshop designed to enhance school personnels' knowledge and understanding of childhood cancer was presented by a multidisciplinary team. Pre- and postworksho assessments were conducted of the participants' attitudes and concerns toward children with cancer, their beliefs concerning how they would react to such children, and their knowledge of medical facts and psychosocial impacts of cancer upon the child and their families. The results are examined in terms of changes in participants' knowledge and attitudes. Implications of these findings are discussed.

Central nervous system tumours Incidence Survival Population-based cancer registries Europe Trends A B S T R A C T This paper describes the incidence and survival of childhood central nervous system (CNS) tumours in Europe for the period 1978-1997. A total of 19,531 cases, aged 0-14 years, from the ACCIS database were analysed by five regions: the British Isles, East, North, South, and

The main objective was to compare parent-reported health-related quality of life (HRQL) of child and adolescent survivors of childhood cancer to that of controls who had no history of cancer. Methods We assessed HRQL of 800 child and adolescent survivors younger than 16 years and 923 randomly selected, age-and sex-matched controls from the general population in a national multicenter retrospective cohort study using the Child Health Questionnaire parent report. Participation was 69% among survivors and 57% among controls. Results Survivors had means that were consistently lower than controls on the HRQL physical summary (PH; 49.9 v 55.3; P Ͻ.005), psychosocial summary (PS; 49.4 v 52.6; P Ͻ .005), and all but one of the eight subscale scores. Clinically important survivor-control differences in means on PH were found for survivors of CNS tumors, bone tumors, lymphoma, leukemia, soft tissue sarcoma and Wilms' tumor (differences: Ϫ8.7, Ϫ7.0, Ϫ6.3, Ϫ5.4, Ϫ4.4, Ϫ3.8/100, respectively); on PS, survivors of CNS tumors were most compromised (Ϫ6.1/100). Survivor-control differences in both PH and PS were also large for survivors treated with radiation only (Ϫ5.8 and Ϫ11.9/100, respectively), or radiation combined with surgery (Ϫ6.6 and Ϫ5.9/100, respectively), or radiation combined with both surgery and chemotherapy (Ϫ7.8 and Ϫ5.1/100, respectively). Cranial radiation was associated with the most compromised HRQL. Conclusion According to parents, HRQL for survivors was somewhat poorer, overall, than for controls. Survivors of CNS tumors, lymphoma, and leukemia and those patients treated with cranial radiation were reported to have poorest HRQL. These findings support development of guidelines for levels of follow-up care for particular groups of survivors.

Although aggressive medical treatment protocols have led to 80% 5-year survival rates for most childhood cancers, many long-term survivors experience multiple troubling symptoms. Using data from 100 adult survivors of childhood cancers (ACC-survivors), we used latent variable mixture modeling to generate unique subgroups of survivors based on their experiences with a cluster of eight symptoms: lack of energy, worry, pain, difficulty sleeping, feeling irritable, feeling nervous, difficulty concentrating, and feeling sad (as measured by the Memorial Symptom Assessment Scale). We also examined factors that were likely to predict subgroup membership (chronic health conditions, health-promoting lifestyle, and demographic variables) and determined the extent to which satisfaction with quality of life (QoL) varied across the subgroups. The final mixture model included three subgroups of ACC-survivors: high symptoms (HS) (n=21), moderate symptoms (MS) (n=45), and low symptoms (LS) (n=34). ACC-survivors who reported at least one chronic health condition were six times as likely to be classified in the HS subgroup as compared to the LS subgroup. Mean health-promoting lifestyle scores were lowest in the HS subgroup and highest in the LS subgroup. Differences in QoL among the subgroups were statistically significant, thus validating that the subgroups were characterized uniquely for identifying those symptoms with highest life impact. To our knowledge, we are the first to identify distinct subgroups of ACC-survivors differentiated by symptom cluster experience profiles. The findings warrant additional research to confirm the subgroup-specific symptom cluster experience profiles in larger studies of ACC-survivors.

Given the increasing interest in quality of life research in cancer survivorship, psychometric properties of the Quality of Life-Cancer Survivors (QOL-CS) were explored in a group of childhood cancer survivors. The QOL-CS is a 41-item visual analog scale composed of four multi-item sub-scales (physical well-being, psychological well-being, social well-being, spiritual well-being) and two sub-components (fears, distress). This instrument was incorporated in a mailed survey completed by 177 respondents. The underlying factor structure and internal reliability of the instrument were explored. A preliminary assessment of the external validity of the factor structure was undertaken. Results of a factor analysis were theoretically consistent with elements assessed in the QOL-CS, although misclassification of several items was noted and discussed. Internal-consistency reliability was very good (Cronbach's alpha = 0.80-0.89) for five of the six factors. Moderate (0.30 < r < 0.45) ...

El cáncer infantil está considerado como la segunda causa de mortalidad en la edad infantil. El progreso en la investigación, los métodos diagnósticos y la eficacia del tratamiento permiten mejorar el índice de supervivencia. La propia neoplasia, como su tratamiento, puede ocasionar la aparición de desnutrición, lo que repercute en la supervivencia de los pacientes, la tolerancia y la respuesta a los tratamientos oncológicos y aumenta la mortalidad. Es necesario realizar una valoración del estado nutricional, conocer los síntomas asociados y el grado de riesgo del tratamiento antineoplásico para poder calcular las necesidades nutricionales. Asimismo, se deben concretar unos objetivos específicos y realizar la intervención nutricional adecuada, con la finalidad de aumentar la supervivencia, disminuir las complicaciones y mejorar la calidad de vida.

To test the hypothesis that exposure to high intensity lightning (around 400 nanometers) in neonatal nurseries increases the incidence of childhood leukemia, over 55,120 newborn children treated with phototherapy for hyperbilirubinemia were identified from the Danish Hospital Discharge Register for 1977-89. Linkage of the roster with the national cancer registry through 1991 revealed 87 childhood cancers, whereas 85 were expected from the rates for the general population. The incidence of leukemia in 34 children was not unusual (standardized incidence ratio [SIR] = 1.2, 95 percent confidence interval [CI] = 0.8-1.7). Subgroup analyses revealed no remarkable patterns for any category of leukemia subtype, gender, or age at diagnosis. We conclude that whole-body exposure to phototherapy (420-470 nm) shortly after birth is not a significant risk factor for childhood leukemia.

THERAPEUTIC RELATIONSHIP WITH THE CHILD AND THE ADOLESCENT AFFECTED WITH LEUKEMIA. The main psychosocial purpose in treating childhood cancer is to help children and their families to face the diagnosis of cancer and subsequent consequences. Children and their families, most of whose are in front of this new diagnosis without showing any sign of failure, need our help. We should

The diagnosis of cancer and the treatment decisions associated with it may cause uncertainty, stress, and anxiety among parents. Emotional tensions can affect parents' relationships during the trajectory of the child's cancer illness. We conducted an integrative review to examine the evidence related to the effects of childhood cancer on parents' relationships. Methods: An integrative literature search of studies published between 1997 and 2009 was conducted in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychology Information (PsycINFO), PubMed, Scopus, CUIDEN, and Latin American and Caribbean Health Science Literature (LILACS). The key words used were neoplasms, child, marriage, spouses, family relations, and nursing. Articles were reviewed if the (a) topic addressed parents' relationships during childhood cancer; (b) participants were mothers, fathers, or both; (c) design was either qualitative or quantitative; (d) language was English, Portuguese, or Spanish; (e) date of publication was between January 1997 and October 2009; and (f) abstract was available. Results: Fourteen articles met the search criteria and were reviewed using Cooper's framework for integrative reviews. Four themes emerged: (a) changes in the parents' relationship during the trajectory of the child's illness; (b) difficulty in communication between couples; (c) gender differences in parental stress and coping; and (d) role changes. Conclusions and Implications: Findings revealed positive and negative changes in parents' relationships, communication, stress, and roles. Nurses need to assess the impact of cancer diagnosis and treatments on parent relationships, offer support and encouragement, and allow expression of feelings. Future research is needed to develop and test interventions that increase parents' potentials and strengthen relationships during the challenging trajectory of their children's cancer and treatment. Clinical Relevance: The multiple sources of stress and uncertainty associated with a child's cancer diagnosis and treatment affect parents' relationships. Difficulties in communication appear frequently in parents' relationship. Our findings may guide healthcare professionals in identifying parents at risk for developing conflicts, communication problems, and lack of alignment between parents that could interfere with providing optimal care for their child with cancer. Healthcare professionals may promote dialogue and encourage parents to express their feelings, seek mutual support, and establish a partnership in dealing with the child's illness.

Overall survival from childhood malignancies has dramatically improved, with survival rates now reaching over 70%. Nevertheless, some types of childhood cancer remain a difficult challenge, and for those who survive the burden of treatment can be considerable. The current paradigm for new cancer therapies is to increase our knowledge of the molecular basis of carcinogenesis, followed by the development of cancer-cell specific therapies. Historically, drug development was focused on adult cancers, and the potential efficacy in childhood malignancies was not considered. Recently, a European academic consortium was established, namely 'innovative therapies for children with cancer' (ITCC), to address this unmet need. This initiative is focused on the evaluation of novel agents in pediatric cancer pre-clinical models, and early clinical development of promising new drugs. The number of pediatric patients eligible to participate in such trials is limited, and accurate pre-clinical evaluation may provide evidence-based prioritization for clinical development. Until recently, clinical development of new drugs in childhood cancer was restricted by the limited accessibility of such agents. Recent changes in EU legislation oblige pharmaceutical companies to provide pediatric clinical data for all new drugs relevant to children, including anti-cancer drugs. Pediatric consortiums like ITCC have established networks of expertise with the specific aim of evaluating new drugs for the treatment of childhood cancers. Through proper evaluation in collaborative clinical trials we will learn how best to use these new therapeutic approaches and improve the survival rates and reduce toxicity for children with cancer.

A workshop designed to enhance school personnels' knowledge and understanding of childhood cancer was presented by a multidisciplinary team. Pre- and postworksho assessments were conducted of the participants' attitudes and concerns toward children with cancer, their beliefs concerning how they would react to such children, and their knowledge of medical facts and psychosocial impacts of cancer upon the child and their families. The results are examined in terms of changes in participants' knowledge and attitudes. Implications of these findings are discussed.

Overview The aim of the study is to identify demographic characteristics, various histopathologies, and site preferences for each disease entity of malignant head and neck tumors in pediatric oncology patients & treatment outcomes in these patients, according to experience at South Egypt Cancer Institute which is the largest referral site in Upper Egypt.

En la Sociedad de Lucha contra la Leucemia y el Linfoma (LLS, por sus siglas en inglés), creemos que estamos viviendo un momento extraordinario. LLS tiene el compromiso de ofrecerle la información más actualizada sobre los distintos tipos de cáncer de la sangre. Sabemos lo importante que es para usted comprender con exactitud su diagnóstico, su tratamiento y sus opciones de apoyo. Una parte importante de nuestra misión es ofrecerle la información más reciente sobre los avances en el tratamiento para la leucemia linfoblástica aguda (ALL, por sus siglas en inglés). Con esta información, usted puede trabajar con su equipo de profesionales médicos para determinar las mejores opciones y obtener los mejores resultados. Nuestra visión es que, algún día, la gran mayoría de las personas con un diagnóstico de ALL se cure o pueda manejar la enfermedad y tener una buena calidad de vida. Esperamos que la información de este librito lo ayude en su camino.

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Both Sociologists and psychologist agree that the agents of socialization are classified in two main groups: primary and secondary. The family and peer groups are considered to be primary whereas the school, religious institutions and mass media are seen as secondary because of their positioning in the socialization process. Every individual is born into a family and the family serves as the initial contact or the gateway to the world. Even on the issue of human personality; which is an individual's unique and relatively stable patterns of behaviour, thoughts, and emotions-are shaped by the family and the environment. Therefore, both Sociologists and Psychologists who study different aspects of social sciences reveal that human behaviour is learnt, and is influenced by their social environment through either 'culturization', adaptation, imitation or experiences garnered from the various social agents – the family, the church, the school, political ideology or structure and other social institutions even the peer group. This paper reviews literature on the influence of the extended family system on adult education.

s u m m a r y Background & aims: Malnutrition is a serious concern for children with cancer and nutrition screening may offer a simple alternative to nutrition assessment for identifying children with cancer who are at risk of malnutrition. The present paper aimed to evaluate the nutrition screening tool for childhood cancer (SCAN). Methods: SCAN was developed after an extensive review of currently available tools and published screening recommendation, consideration of pediatric oncology nutrition guidelines, piloting questions, and consulting with members of International Pediatric Oncology Nutrition Group. In Study 1, the accuracy and validity of SCAN against pediatric subjective global nutrition assessment (pediatric SGNA) was determined. In Study 2, subjects were classified as 'at risk of malnutrition' and 'not at risk of malnu-trition' according to SCAN and measures of height, weight, body mass index (BMI) and body composition were compared between the groups. Results: The validation of SCAN against pediatric SGNA showed SCAN had 'excellent' accuracy (0.90, 95% CI 0.78e1.00; p < 0.001), 100% sensitivity, 39% specificity, 56% positive predictive value and 100% negative predictive value. When subjects in Study 2 were classified into 'at risk of malnutrition' and 'not at risk of malnutrition' according to SCAN, the 'at risk of malnutrition' group had significantly lower values for weight Z score (p ¼ 0.001), BMI Z score (p ¼ 0.001) and fat mass index (FMI) (p ¼ 0.04), than the 'not at risk of malnutrition' group. Conclusions: This study shows that SCAN is a simple, quick and valid tool which can be used to identify children with cancer who are at risk of malnutrition.

Survivors of childhood and adolescent cancer are at risk of vaccine preventable diseases and are recommended to receive booster vaccinations post-chemotherapy. The aim of this study was to describe the compliance of post-chemotherapy revaccination of childhood cancer survivors relative to current Australian guidelines. A multi-faceted retrospective review of childhood cancer survivors at the Royal Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Hospital, Melbourne, Australia was undertaken. Immunisation status was reviewed through four sources: (1) hospital records; (2) telephone survey of consenting participants; (3) Australian Childhood Immunization Register (ACIR); and (4) family practitioners immunisation records. Participants were 0-18 years, and at least 6 months post-treatment for their cancer. The study was conducted between March and September 2006. Eighty-nine patients with a median age at diagnosis of 5.3 years were included, 56% of patients had a diagnosis of leukaemia and 44% solid tumours. The median duration since completion of therapy was 3.1 years. Reviewing all sources, 39% (35/89) of participants had no evidence of booster vaccinations post-completion of therapy. Younger age (P = 0.001), and those diagnosed with leukaemia (P = 0.04) were more likely to have received at least one booster vaccine. Forty-seven percent (42/89) had received at least one influenza vaccination. This study highlights poor compliance with current guidelines for re-vaccination in survivors of childhood and adolescent cancer. More evidence is required and these re-vaccination guidelines need to take into account treatment intensity. Multi-component strategies are essential to ensure protection from vaccine preventable diseases in this population.

Recent diagnostic and therapeutic advances in pediatric oncology have led to greater survival rates in children with malignancies. However, while childhood and adolescent cancer therapies improve long-term survival, such treatments may lead to abnormal pubertal development, infertility, and gonadal failure. As more children and young adults survive childhood cancer and lead productive lives, these concerns are becoming increasingly important. Clinicians and researchers must be aware of current research in the area of fertility preservation in order to best guide patients through cancer treatment towards a healthy, fulfilled life. This chapter will review the effects of cancer treatments on reproductive potential, describe current methods of monitoring reproductive potential, and describe the fertility-sparing options available to young cancer patients of reproductive age. Specific attention will be paid to gaps in research pertinent to this topic.

In the study we extract the venous thromboembolism (VTE) data set from KEGG database including 70 adults with one or more prior VTE on warfarin and 63 healthy controls. Then we construct three-way gene networks by using arithmetic mean nonparametric methods such as Gini index, Kendall correlation coefficient, Spearman rank correlation coefficient. The R software version R-3.1.2 was used for statistical analysis. Ranks have a number of desirable properties: they are invariant under monotonic transformations of the individual variables, robust in outliers and unexpected observations. They are able to detect not only the linear relationships, but also any kind of monotone relation without making any assumptions about the distributions of the variables. The results of nonparametric correlation coefficients are not the same. The result in based on Spearman rank and Gini index are the same and both are different from Kenall's tau. The relationships were based on the arithmetic mean and the threshold of P-value greater than 0.95.

Previous studies showed that exercise in cancer patients is feasible and may reduce fatigue and improve physical fitness and quality of life. However, many previous studies had methodological weaknesses related to trial design, sample size, comparison group, outcome measures, short follow-up durations and programme content. This paper aims to present the rationale and design of the clinical research subprogramme of the Alpe d&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;HuZes Cancer Rehabilitation (A-CaRe) programme. A-CaRe Clinical Research includes four randomized controlled trials in patients: (a) after chemotherapy, (b) during chemotherapy, (c) after stem cell transplantation and (d) during childhood cancer. These trials compare high-intensity resistance and endurance exercise interventions with usual care or a waiting list control group. In two studies, a second intervention arm consisting of low-to-moderate intensity exercise is included. All four A-CaRe trials use similar methods. Outcome measures are carefully chosen based on the International Classification of Functioning Disability and Health model. Measurements will be performed prior to randomization (T0), after completion of the intervention (T1) and at follow-up (T2). The primary outcome measures are cardiorespiratory fitness, muscle strength and fatigue. Secondary outcome measures include health-related quality of life and psychosocial functioning. Furthermore, cost-effectiveness and cost-utility analyses are performed from a societal perspective. We hypothesize that exercise is more effective at improving physical fitness and thereby reducing fatigue and more cost-effective compared with usual care or a waiting list control group. If so, the programmes will be implemented in the Dutch clinical practice.

While fairly complete and reliable incident data on childhood cancers are available from the registries in India, mortality and survival information is not. Information concerning the latter was obtained by the Bangalore cancer registry through active follow-up involving visits to homes of patients. Between 1982 and 1989, 617 cases of cancers in childhood were registered, giving an age-standardized incidence rate of 84.8 and 48.4 per million in male and female children, respectively. Active follow-up provided mortality/survival information in 532 or 86.2 percent of these cases. Overall, observed five-year survival was 36.8 percent (both genders combined) with a relative survival of 37.5 percent when childhood mortality in the general population was taken into account. The five-year relative survival was best for thyroid carcinoma (100 percent) followed by Hodgkin's disease (73 percent) and retinoblastoma (72.9 percent). Survival was comparatively low, being 9.9 percent in acute nonlymphatic leukemia and less than 20 percent in rhabdomyosarcoma and the category grouped as ‘other malignant neoplasms.’ Survival in Hodgkin's disease was influenced by clinical stage at presentation, but was not statistically significant possibly due to small numbers.

This study presents initial data validating the use of a new instrument, the Impact of Traumatic Stressors Interview Schedule (ITSIS), to assess the occurrence of cancer-related posttraumatic stress in childhood cancer survivors and their mothers. Sixty-six child/adolescent cancer survivors and 64 of their mothers, as well as 130 young adult survivors, completed the ITSIS and other measures of posttraumatic stress and general distress. Five ITSIS factors were identified for the mothers and for the young adult survivors, and three ITSIS factors were identified for the child/adolescent survivors. Factors in all three samples reflected symptoms of posttraumatic distress, concern over medical late effects, communication, and changes in self due to cancer. Only young adult survivors had a factor reflecting a positive engagement with the cancer history. Factors correlated with validation measures in predicted ways. The findings further the conceptualization of posttraumatic stress in pediatric cancer by describing the traumatic experience for survivors and mothers. Comparing factors across samples allows an examination of different influences of cancer within families and over the course of development.

To describe selected components of pediatric palliative care from diagnosis to cure or end of life that combine to help nurses and other clinicians achieve goals of care for children with cancer and their families. DATA SOURCES: Published articles. CONCLUSION: Pediatric palliative care is characterized by diversity of care delivery models; effect of cancer on the family as the central focus of care; and consideration of culture, spirituality, communication, and ethical standards. End-of-life issues that can be anticipated by nurses and other clinicians include symptoms of cancer or its treatment, the importance of hopefulness, the relevance of trying to be a good parent in decision making, the meaning of legacy making of ill children, and family bereavement. IMPLICATIONS FOR NURSING PRACTICE: Direct nursing care strategies to achieve pediatric palliative care goals are vital to reduce child and family suffering from cancer.

PURPOSE Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey. METHODS A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease. RESULTS Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative. CONCLUSION The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.

Objective. Symptoms of posttraumatic stress disorder (PTSD) after life-threatening medical illness have been found to predict poor outcome in preliminary studies of adults and children. However, these symptoms are rarely recognized in general medical or pediatric settings. Here we report on the first large investigation to assess prevalence and correlates of self-reported symptoms of posttraumatic stress in a nonreferred sample of adolescent liver, heart, and kidney transplant recipients.

Aim: It is essential to minimize pain and distress during painful procedures in children. This study examined the effect of using non-immersive Virtual Reality (VR) during a needle-related procedure on reported pain or distress of children and adolescents in a paediatric oncology unit and surveyed their response to the use of VR-equipment during the procedure.

Background: The use of complementary and alternative therapies by children with cancer is common. Up to 84% of children have used complementary therapies along with conventional medical treatment for cancer. Methods: We reviewed the PubMed and CINAHL databases for studies published between 1994 and 2004 on the use of complementary and alternative therapies by children with cancer and reports from any publication year through 2004 of clinical trials involving complementary and alternative therapies for children with cancer. Results: Fourteen studies were retrieved reporting the results of survey or interview data collected from parents on children's use of complementary and alternative therapies during or after childhood cancer. Across studies, the use of such therapies ranged from 31% to 84%. Common reasons for using complementary and alternative therapies were to do everything possible for their child, to help with symptom management, and to boost the immune system. Many parents indicated they also hoped to treat or cure the cancer. In most cases, the child's treating physician had not been informed of the child's use of complementary and alternative therapies. Conclusions: Use of complementary therapies by children with cancer is common, although methodological variations limit the ability to compare results across studies. Treating physicians often do not know the child is using complementary therapies in addition to medical treatments. The scientific evidence is limited regarding the effects and mechanisms of action of complementary or alternative therapies, but research is being conducted on these topics. A growing number of pediatric cancer patients use complementary therapies as part of their treatment regimen to attempt to improve outcomes or enhance quality of life.

This review provides a survey of studies investigating physical activity and exercise interventions in patients during tumor treatment and survivors of childhood cancer. PubMed and Medline databases were searched using relevant terms. References of selected papers were tracked. A total of 28 studies could be identified. Seventeen studies investigated physical activity, 11 studies determined the effect of activity enhancing interventions during and after therapy. Even though most studies showed limitations and results were not consistent, considerably reduced physical activity is highly probable in patients during and after therapy. Studies on interventions provided promising results and revealed challenges to be faced.