Pediatric Cancer Population Research Articles

Electronic Patient Reported Outcomes Measures (e-PROMs) in Pediatric Palliative Oncology Care: A Scoping Review.

Objective: Research findings regarding child-centered care and electronic patient reported outcome measures (e-PROMs) within pediatric palliative oncology care reveal an intricate field of study. This study aimed to map innovations in e-PROMs for the pediatric cancer population in palliative care and their impact on symptom management, and communication with healthcare professionals. Methods: A scoping review was designed following the Arksey and O'Malley framework. Literature searches were conducted in CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS, and Web of Science. Inclusion criteria targeted children aged 0-18 years with cancer, receiving palliative and/or end-of-life care, and using e-PROMs. Results: Twelve articles were included: 10 quantitative studies, one qualitative study, and one mixed-method study. A narrative synthesis approach was used to summarize the findings, categorized into three sections: (a) technological innovation of e-PROMs in pediatric palliative oncology care; (b) the impact of e-PROMs on symptom monitoring, management, and children's care; (c) the effects of e-PROMs on communication between children and healthcare professionals in pediatric palliative oncology care. Conclusion: e-PROMs have proven effective in empowering children to express their perspectives and actively engage in their end-of-life care. Due to flexible software and devices designed for various age groups, these tools fit seamlessly into children's daily routines and preferences, including the use of play-oriented applications. They facilitate a deeper understanding, and management of physical and emotional symptoms while ensuring care remains child-centered. This emphasizes the importance of preserving the essence of childhood and addressing the unique needs and experiences of young patients in pediatric palliative oncology care.

A - 145 Cognitive Disengagement Syndrome in ALL Survivor

Abstract Objective Cognitive disengagement syndrome (CDS), previously known as sluggish cognitive tempo (SCT), presents with symptoms like mind-wandering, hypoactivity, and mental fogginess. There is a relatively high prevalence (23.7%) of CDS in survivors of acute lymphoblastic leukemia (ALL), although the neuropathology remains poorly understood, potentially involving autonomic nervous system dysfunction. Cognitive late effects, including slowed speed, inattention and executive dysfunction can occur post-cancer treatment. This case highlights the need for regular assessment of CDS, particularly in the pediatric cancer population. Given the symptom overlap it is important to discuss onset, duration, and variability of symptom presentation to rule-in/out the role of cognitive late effects. Method “Alex,” a 14-year-old, B cell ALL survivor, was struggling academically nine years post-treatment. She and parents reported slowness, fatigue, trouble concentrating, and social withdrawal, despite medical stability. She received two years of psychotherapy for anxiety and depression without improvement. Results Alex had average intellectual and cognitive functioning, with mild executive dysfunction. Despite reported slowness in daily activities, processing speed was average. Parent and self-report forms indicated significant problems with executive functioning, somatic symptoms, and inattention. Parents indicated significant symptoms on the SCT scale. Alex’s cognitive profile suggested ADHD-I with features consistent with CDS. Conclusions Discrepancies between testing scores and daily life challenges were inconsistent with cognitive late effects. Her physical symptoms (e.g., fatigue, social withdrawal) did not improve with mood as expected with depression. Identifying these discrepancies and symptom timeline was crucial in diagnosing CDS and guiding interventions, leading to a sense of relief and direction for Alex and her family.

Comparing the Diagnostic Yield of Germline Exome Versus Panel Sequencing in the Diverse Population of the Texas KidsCanSeq Pediatric Cancer Study.

To evaluate the relative diagnostic yield of clinical germline genomic tests in a diverse pediatric cancer population. The KidsCanSeq study enrolled pediatric cancer patients across six sites in Texas. Germline analysis included both exome sequencing and a therapy-focused pediatric cancer gene panel. The results were categorized by participants demographics, the presence of pathogenic or likely pathogenic (P/LP) variants, and variants of uncertain significance (VUS) in cancer predisposition genes (CPGs). Pediatric actionable CPGs were defined as those with cancer surveillance recommendations during childhood. Cancer P/LP variants were reported by at least one platform in 103 of 578 (17.8%) participants of which 76 were dominant cancer genes (13.1%) with no significant differences by self-described race or Hispanic ethnicity. However, the proportion of participants with VUS was greater in Asian and African American participants (P = .0029). Diagnostic yield was 16.6% for exome versus 8.5% for panel (P < .0001) with 42 participants with concordant germline results. Exome-only results included P/LP variants in 30 different CPGs in 54 participants, whereas panel-only results included seven participants with a copy number or structural P/LP variants in CPGs. There was no significant difference in diagnostic yield limited to pediatric actionable CPGs (P = .6171). Approximately 18% of a diverse pediatric cancer population had germline diagnostic findings with 50% of P/LP variants reported by only one platform because of CPGs not on the targeted panel and copy number variants (CNVs)/rearrangements not reported by exome. Although diagnostic yields were similar in this diverse population, increases in VUS results were observed in Asian and African American populations. Given the clinical significance of CNVs/rearrangements in this cohort, detection is critical to optimize germline analysis of pediatric cancer populations.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method.

Implementing an Oral Health Educator Contributes to Reduced MBI-CLABSI Rates for Pediatric Hematopoietic Stem Cell Transplant Patients

Mucosal barrier injury central line-associated bloodstream infections (MBI-CLABSIs) remain a challenge among the pediatric cancer population. These infections commonly occur by oral or gastrointestinal (GI) bacteria translocating through impaired gut or oral mucosa. Although strategies to prevent gut MBI-CLABSIs are well characterized, oral pathogen prevention strategies are lacking. The authors' oncodental collaboration quality improvement project, which included two Plan-Do-Study-Act (PDSA) cycles, aimed to improve MBI-CLABSI rates and oral care adherence on a pediatric hematopoietic stem cell transplant (HSCT) unit. PDSA cycle 1 integrated dental residents into existing rounds every third week to screen for dental, gum, and mucosal disease and provide targeted education to patients and families. PDSA cycle 2 implemented a novel oral health educator (OHE) role in which a trained dental hygienist rounded four days per week. Monthly MBI-CLABSI rates and oral care adherence were followed from December 2020 to May 2021 (baseline), June 2021 to March 2022 (PDSA cycle 1), and April 2022 to December 2022 (PDSA cycle 2). Qualitative surveys captured patient and family perception, and a cost savings analysis was completed. A 58.8% reduction in MBI-CLABSI rate (events per 1,000 central venous line days) was detected (baseline: 5.1; PDSA cycle 2: 2.1), oral care adherence improved 41.7% (baseline: 60.9%; PDSA cycle 2: 86.3%), 100% of patients found it beneficial to receive oral care demonstrations, and an annual cost savings of $541,000 was estimated. Direct patient outcomes have measurably improved. This project suggests the implementation of an OHE in pediatric HSCT inpatient units may be valuable to patients and families and may be a cost-effective way to reduce MBI-CLABSIs resulting from oral pathogens.

Abstract A140: A physiologically based pharmacokinetic modeling approach for predicting the exposure of irinotecan and its active metabolite (SN-38) in cancer patients

Abstract Introduction: Irinotecan is an inhibitor of the topoisomerase I enzyme that is essential in DNA transcription, replication, and repair. It is considered a “backbone” regime in colorectal cancer in adults and in pediatric gliomas to which other antineoplastic agents are added to improve the outcome. It is used as well in the treatment of many other types of adult and pediatric cancers. Irinotecan acts as a prodrug of SN-38 which has approximately 100-1000-fold greater cytotoxic activity. The metabolic and pharmacokinetic behavior of irinotecan is very complex and currently not completely elucidated. Clinical data have shown high variability in treated patients in the efficacy, toxicity, and pharmacokinetic profile of the drug. To increase safety and efficacy, a physiologically based pharmacokinetic modeling (PBPK) approach was used to predict the optimal dose for treatment initiation. Methods: Clinical data were used in combination with measured physicochemical and blood-binding data to inform the model. Hence a middle-out approach was used to build the parent model for a population of adult cancer patients. While the default Sim-Cancer population available within the Simcyp Simulator (v21) was used, the unbound fraction in plasma for the healthy population was incorporated into the PBPK model. By using the reverse translational tool and a retrograde approach, the irinotecan metabolism was described by incorporating CYP3A (Km 14.4±1.6 μM, Vmax 14.7± 0.6 pmol/min/mg protein) and an additional clearance. This additional clearance was then explained by scaled esterases (CES1 and CES2) enzyme kinetic from in vitro data. Besides the clinical study that was used to build the model, other independent intravenously administered irinotecan studies were used for verification. Results: The model predicted the plasma concentration of the parent drug and its metabolite (SN-38) in good agreement with observed data from the clinical study that was used to build the model, as well as from several clinical studies that were not used to build the initial model, covering a dose range of 50-750 mg/m2. Conclusion: We developed a PBPK model that accurately predicts the pharmacokinetic behavior of irinotecan and its metabolite (SN-38) in an adult cancer population. Future directions involve the adaption of the model to the pediatric cancer population to predict the optimal dose for initiation of first-in-human Phase I studies and to identify potential drug interactions and unanticipated toxicities when this “backbone” regimen is combined with other investigated anticancer agents. This will then lead to an increase in individualized treatment. Citation Format: Kristina Zoran Denic, Sibylle Neuhoff, Joel Reid, Rachel Kudget. A physiologically based pharmacokinetic modeling approach for predicting the exposure of irinotecan and its active metabolite (SN-38) in cancer patients [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr A140.

Differences in Absolute Neutrophil Count Eligibility Criteria of Pediatric Phase I and Phase I/II Oncology Clinical Trials According to Sponsorship

Introduction: Racial clinical trial enrollment disparities in oncology are well documented ( Pediatr Blood Cancer. 2020 10.1002/pbc.28296). Barriers to enrollment are multifactorial and include structural and clinical barriers like restrictive eligibility criteria ( Am Soc Clin Oncol Educ Book. 2016 10.1200/EDBK_156686). Many phase I/II oncology clinical trials have laboratory criteria such as a minimum threshold for absolute neutrophil count (ANC). The Common Terminology Criteria for Adverse Events (CTCAE) defines an ANC of less than 1500 cells/µL as the upper limit of a grade 2 toxicity ( J Clin Oncol. 2010 10.1200/JCO.2009.24.3881), and this has become the minimum eligibility threshold in many oncology trials ( J Clin Oncol. 2017 10.1200/JCO.2017.73.4186). Using a minimum ANC of 1500 cells/µL may contribute to further racial enrollment disparities due to the Duffy null phenotype, which has a prevalence of ~65% in Black/African American individuals ( PLoS Genet. 2011 10.1371/journal.pgen.1002108) and results in a lower number of circulating neutrophils compared to people without the Duffy null phenotype ( Blood. 2021 10.1182/blood.2020008600). Up to 23% of pediatric patients with the Duffy null phenotype have ANCs &amp;lt;1500 cells/µL ( Blood Adv. 2023 10.1182/bloodadvances.2022007680). A recent adult multiple myeloma study found that the most common reason for ineligibility among Black patients was failure to meet hematologic laboratory criteria ( Blood. 2023 10.1182/blood.2022018657). Less is known about eligibility criteria as a barrier to enrollment in the pediatric cancer population. We hypothesized industry-sponsored trials would have more restrictive eligibility criteria than non-industry-sponsored trials. To explore this further we describe ANC eligibility criteria of pediatric oncology phase I/II clinical trials according to sponsorship. Methods: We analyzed ANC eligibility criteria of interventional phase I and phase I/II oncology trials opened in the United States from January 2010 to May 2023 using the ClinicalTrials.gov registry. Trials that included pediatric participants only (up to age 18), pediatric and adolescent young adult participants (up to age 39), and adult studies that allowed pediatric participants were included. We excluded trials for non-malignant conditions and trials that did not report ANC eligibility criteria. ANC eligibility criteria were categorized as ≥1500 cells/µL and &amp;lt;1500 cells/µL. Trials were compared according to primary sponsorship (industry vs non-industry). Secondary objective was to describe language requirements explicitly mentioned for these trials. Distribution of trial characteristics were compared using Fisher's exact or Chi-squared tests. Logistic regression was used to evaluate potential changes in ANC criteria over time (in years), using ANC&amp;lt;1500 cells/µL as the reference group. Results: We identified 861 interventional trials that met our initial inclusion criteria. After review of the trials, 36 were excluded for enrolling participants with non-malignant diagnoses. Of the remaining 825 studies, 438 (53%) had ANC eligibility criteria reported. 89 (20%) studies were industry-sponsored (Table 1). Trial phase, age eligibility, diagnosis, and results reported differed statistically significantly by sponsor type. 76 (17%) studies required ANC ≥1500 cells/µL for enrollment. For industry sponsored trials, 26 (29%) required ANC ≥1500, while 50 (14%) non-industry sponsored trials required ANC ≥1500, with a risk ratio of 2.04 (95% CI 1.35-3.08, p=0.002) (Figure 1). Almost all studies (96%) did not explicitly state language requirements, and this did not vary by sponsor type. There was no significant change in odds of a trial requiring ANC ≥1500 cells/µL over time (odds ratio 1.05, 95% CI 0.98-1.12, p=0.138). Conclusion: A minority of trials (17%) required an ANC ≥1500 cells/µL for enrollment on a phase I or phase I/II interventional clinical oncology trial; however, industry-sponsored trials were twice as likely than non-industry trials to require this higher ANC threshold. Further studies are needed to investigate laboratory criteria as a possible reason for racial enrollment disparities in pediatric cancer trials.

Assessment of Risk Factors for Developing Iron Overload in Patients with Pediatric Cancer and Bone Marrow Transplant Survivors: A Single Center Retrospective Chart Review

Background: Pediatric cancer survivors and those with chronic hematologic disorders are at risk for iron overload secondary to frequent transfusion therapy. As this patient population increases in number due to improvement of therapies, it is essential to identify risk factors associated with the development of iron overload. Classifying these risk factors will help improve screening methods and assist in decreasing side effects from iron overload, such as iron deposition resulting in organ damage. Objective: Assessment of risk factors associated with the development of iron overload in pediatric cancer survivors and those who underwent bone marrow transplant. Methods: Retrospective chart review of patients who completed therapy for pediatric malignancy or underwent bone marrow transplant and were screened for iron overload utilizing magnetic resonance imaging (MRI). Iron overload was defined as T2* liver MRI with iron levels of &amp;gt;5mg/g dry weight. Individuals determined to screen positive for iron overload were evaluated for additional demographic and treatment variables, such as race, age at diagnosis, and total transfused blood volume, to assess for risk factors associated with the development of iron overload. Statistical analyses were performed via univariate and multivariate regression models of the variables collected. Results: We report a large cohort of patients with a mean age of 10.6 years who underwent screening T2* liver MRIs. Of 71 patients who underwent liver MRI screening, 89% met criteria for moderately severe iron overload. Blood volume administered (ml) and Non-White Race were found to be statistically significant in association with higher iron content. Mean iron content was 12.9 mg/g in the Non-White group versus 8.8 mg/g in the White group (p=0.0185). For every 100ml/kg increase in the cumulative blood volume transfused, the predicted iron content increased approximately 1 mg/g (p=0.0227); mean transfused blood volume was 340ml/kg among those who met criteria for iron overload versus 224ml/kg among those who did not (p=0.1858). We did not find any correlation between iron content and age at diagnosis, primary diagnosis, BMI at diagnosis, or gender. Conclusions: Iron overload continues to be a risk for pediatric cancer survivors and those who receive chronic transfusions. Our study revealed a statistically significant correlation between increased amount of blood transfusions and development of iron overload; however, no specific quantity of cumulative transfused blood volume was determined to be the threshold for risk. Our study also revealed a statistically significant correlation between Non-White race and the development of iron overload independent of cumulative transfused blood volume. It is possible there are race-based differences in iron metabolism that result in this increased risk. Further studies regarding specific quantities of blood transfusions, assessing physiologic characteristics of the Non-White patient population, and development of iron overload are needed. These findings indicate the importance of continuing to research the development of iron overload in the pediatric cancer and bone marrow transplant population, as well as provide guidance for understanding the risk each unique patient has for developing this complication.

Posterior reversible encephalopathy syndrome in children with malignancies - a single-center retrospective study.

Posterior reversible encephalopathy syndrome (PRES) diagnosis relies on clinical and radiological characteristics. Clinical manifestations include focal neurologic deficits, hemiparesis, seizures with symptoms of intracranial hypertension, headache, nausea, vomiting, and visual field disturbances. The majority of patients have typical changes in magnetic resonance imaging. The epidemiology and outcomes of PRES in the pediatric cancer population have not been well described. Most of the available data are from retrospective analyses. The aim of our study was to evaluate the clinical and radiological presentation as well as the outcome of PRES in children treated for cancers in a single center. We analyzed data from 1,053 patients diagnosed with malignancies in a single center over 15 years to determine the incidence of PRES. 19/1053 (1.8%) patients developed PRES. The diagnosis was accompanied by a range of clinical symptoms including hypertension, seizures, altered mental status, and headaches. Magnetic resonance imaging was performed in all patients, and 14/19 (73.7%) exhibited typical findings consistent with PRES. Four patients (21.0%) required treatment in the Intensive Care Unit. Posterior reversible encephalopathy syndrome (PRES) is a rare but significant complication in children with cancer.There is a clear need to establish clinical criteria for PRES to improve the diagnosis and treatment of patients with PRES, particularly in the pediatric oncological population.Further studies are needed to identify the risk factors for recurrent PRES, particularly in pediatric cancer patients undergoing chemotherapy or immunosuppressive treatment.

Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity.

There is a gap in the literature on the best treatment of clinical sequelae within adolescent and young adult pediatric cancer populations. Children, adolescents, and young adults are at risk for a multitude of immediate and late effects of their disease and treatment that warrant a comprehensive, multidisciplinary team approach to optimize care. Sports medicine providers are well-equipped with their background to join the oncology rehabilitation team in diagnosing and managing cancer-related impairments to help these populations live a healthier and more active lifestyle. In this manuscript, four essential clinical components to consider when returning children, adolescents, and young adults with cancer history to physical activity are discussed: chemotherapy-induced peripheral neuropathy, cardiotoxicity, nutritional deficiencies, and deconditioning.

Abstract 3163: Ontology guided navigation of somatic variants, mutational signatures, gene expression and histology images for pediatric cancer

Abstract PeCan Knowledgebase on St. Jude Cloud (pecan.stjude.cloud), initially developed as a resource of curated genomic variants of pediatric cancer (PeCan), is now significantly expanded to comprise a hub of interconnected data facets for over 9,000 hematologic (heme), CNS, and non-CNS solid (solid) tumor patient samples from around the world. The new data facets, which include gene expression, mutational signatures, and histology, can be explored alongside our existing variants data facet inspiring new hypothesis generation. Variants shows a genomic landscape view (i.e. oncoprint view) and gene- or genome-level view (i.e. ProteinPaint view). Expression data, generated from normalized RNA-seq of ~2,500 samples, can be explored via interactive 2-dimensional maps, revealing distinct subtypes relevant for patient stratification for precision therapy. Mutational signatures, identified from ~2,000 WGS samples, are presented as a heatmap across subtypes, in addition to a summary view for a user-defined cohort or individual sample for which we also display a mutation profile frequency plot together and identified signatures. Histology enables review of histological slide images and associated clinical notes for ~3,000 solid tumors via a searchable interface. As all samples on PeCan have been mapped to a WHO pediatric cancer classification based ontology, the user can customize the view of each data facet presented in PeCan by selecting a specific cancer subtype. Integrative analysis between the data facets has enabled new insights into pediatric cancer biology as demonstrated in the following two examples. First is the discovery of two potential subtypes of adamantinomatous craniopharyngioma. These were initially identified via expression analysis which revealed two distinct groups that were confirmed by examination of associated histology slide data which revealed delineation by brain invasion. Second is an analysis that links germline and somatic alterations in genes involved in DNA Damage Response with mutational signatures associated with homologous recombination deficiency (HRD). This provided new insights on the applicability of therapies targeting HRD in the pediatric cancer population. These examples demonstrate the potential value of PeCan in advancing clinical diagnosis classifications of pediatric cancer and exploration of new therapeutic opportunities. PeCan is an evolving knowledgebase, as we are continuously expanding the platform and adding data over time to foster scientific discovery for the global research community, with the goal of improving treatments for pediatric cancer. Citation Format: Alexander M. Gout, Stephanie Sandor, Delaram Rahbarinia, Jobin Sunny, James Madson, Lucian Vacaroiu, Wentao Yang, Ben Lansdell, Michael Macias, Samuel W. Brady, David Finkelstein, Victor Pastor, Kevin Benton, Andrew Frantz, Mark R. Wilkinson, Cynthia Cline, Brent A. Orr, Abbas Shirinifard, Elizabeth Stewart, Michael Rusch, Xin Zhou, Michael Dyer, David A. Wheeler, Clay McLeod, Jinghui Zhang. Ontology guided navigation of somatic variants, mutational signatures, gene expression and histology images for pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3163.

Role of Nutrition in Pediatric Patients with Cancer.

Children with cancer are at high risk for developing short-term and long-term nutritional problems related to their underlying disease and side effects of multimodal treatments. Nutritional status (NS) can influence several clinical outcomes, such as overall survival (OS) and event-free survival (EFS), treatment tolerance, risk of developing infections and quality of life (QoL). However, the importance of nutrition in children with cancer is still underestimated. This review focuses on alterations of NS that occurs in children during cancer treatment. In particular, we reviewed the pathogenesis of undernutrition in oncological children, as well as how NS affects treatment tolerance and response, the immune system and the risk of infections of children with cancer. Thanks to recent advances in all types of supportive therapy and to the progress of knowledge on this topic, it has been realized that NS is a modifiable prognostic factor that can be intervened upon to improve the outcome of these patients. Currently, there is a lack of a systematic approach and standard recommendations for nutritional care in the pediatric cancer population. Literature analysis showed that it is essential to define the NS and treat any alterations in a timely manner ensuring proper growth and development. Nutritional follow-up should become an integral part of the care pathway. Regular nutritional monitoring should be performed at diagnosis, during treatment and during follow-up. A close collaboration and sharing of expertise between pediatric oncologists and nutrition specialists, combined with careful and participatory sharing of the feeding experience with the family and the child (after age 6 years), is strongly required.

Validation of the nutritional screening tool for childhood cancer SCAN. Spanish version

the prevalence of undernutrition in the pediatric cancer population can vary considerably, an element that significantly influences the clinical outcome of patients. However, this is a potentially modifiable prognostic factor, which requires timely identification of nutritional risk to guide the nutritional care process. to evaluate the operational performance of the Spanish version of the nutritional screening tool for childhood cancer (SCAN) in the context of the validation process of this instrument in a high-complexity hospital in the city of Bogotá, Colombia. the methodological design for the validation of a diagnostic scale was followed. The final sample consisted of 96 patients between 0 and 17 years with cancer and hospitalized at the Children's Cancer Center of the HOMI Foundation in Bogota. The SCAN-SP was applied to each patient and a complete nutritional assessment (CNA) was performed as a gold standard to determine nutritional status. 82.3 % (n = 79) of patients were classified "at risk of malnutrition" by SCAN-SP and 69.8 % (n = 67) of the total sample had undernutrition. The evaluation of the operative performance of SCAN-SP against CNA showed excellent results: sensitivity of 100 %, specificity of 59 %, PPV of 85 %, NPV of 100 %, positive likelihood ratio of 2.4, and negative likelihood ratio of 0. the SCAN-SP scale performs well as a nutritional screening tool in pediatric cancer patients, so its use in clinical practice is recommended.

734: MORTALITY TREND FROM SEPSIS IN PEDIATRIC ONCOLOGY PATIENTS 2016-2019

Introduction: Sepsis continues to be a major cause of mortality in the pediatric oncologic population, and thus has been the subject of ongoing research. Whether improvements in chemotherapy and other advancements, especially the implementation of pediatric sepsis guidelines with early identification, has affected mortality in the pediatric cancer population is up for debate. We hypothesized that advances in chemotherapy regimens, including the introduction of immunologics, and early early identification of sepsis would decrease deaths in oncologic patients diagnosed with sepsis. Thus we aimed to identify and characterize deaths in oncologic patients who also diagnosed with sepsis. Methods: We analyzed the 2016 and 2019 Kids inpatient database (KID) data and noted the overall percentage of deaths from sepsis. We identified all patient mortalities with an oncologic as well as sepsis diagnostic code. T-test was conducted to find statistical differences between the incidence of deaths in these patients. In addition, we stratified each year into different cancer types and further characterized their demographic characteristics and identified other complications (i.e. if they developed acute renal failure) during their hospital stay. Results: In 2016, of the 1021 deaths in patients with an oncologic diagnosis, 264 (26%) had a sepsis diagnostic code. In 2019, there were 955 pediatric patients with oncologic diagnoses who died, and of those 230 (24%) had a sepsis diagnostic code. T-test revealed no statistical significance between both incidences of deaths with a P value 0.5. In both 2016 and 2019, most oncologic patients who died with a sepsis diagnosis had some form of leukemia, 59% in 2019 and 60% in 2016. Conclusions: With the stagnant mortality numbers over three years, more attention must be made to understanding and treating sepsis in this group. Are specific chemotherapies more likely to predispose certain groups to sepsis? Also, regardless of its high prevalence, the high proportion of leukemic patients does warrant further investigation. Specifically, what features of their immunologic response to infection and their chemotherapy regimens predispose them to mortality from sepsis. With the stagnation of mortality in oncologic patients from sepsis, further attention must be placed on this high-risk group.

A Review of Patient-Reported Outcome Measures in Childhood Cancer.

Patient-reported outcomes (PROs) are used in clinical work and research to capture the subjective experiences of childhood cancer patients and survivors. PROs encompass content domains relevant and important to this population, including health-related quality-of-life (HRQOL), symptoms, and functional status. To inform future efforts in the application of PRO measures, this review describes the existing generic and cancer-specific PRO measures for pediatric cancer populations and summarizes their characteristics, available language translations, content coverage, and measurement properties into tables for clinicians and researchers to reference before choosing a PRO measure that suits their purpose. We have identified often unreported measurement properties that could provide evidence about the clinical utility of the PRO measures. Routine PRO assessment in pediatric cancer care offers opportunities to facilitate clinical decision-making and improve quality of care for these patients. However, we suggest that before implementing PRO measures into research or clinical care, the psychometric properties and content coverage of the PRO measures must be considered to ensure that PRO measures are appropriately assessing the intended construct in childhood cancer patients.

Interventional Pain Management for the Pediatric Cancer Patient: A Literature Review.

This literature review examines the use of interventional treatments for pain management in pediatric cancer patients. While interventional procedures may be effective in cancer pain management, these procedures are infrequently employed in pediatric cohorts. This underutilization of interventional procedures may be supported by a deficit in randomized, controlled studies and literature regarding their role in pediatric cancer populations. Particularly because literature on the efficacy of interventional treatments in adult populations may not directly translate to pediatric populations, more research about the role of interventional procedures in managing pediatric cancer pain is necessary for a strengthened understanding of pediatric cancer pain treatment.

Barriers to physical activity among cancer pediatric cancer patients and survivors: a scoping review

Aim: The present scoping review aims to provide an overview of barriers to PA reported by pediatric cancer patients undergoing treatment as well as after treatment. This study further aims to describe and discuss the instruments used for assessing barriers in this population. Methods: Article search was performed in common medical databases and yielded five original research articles. Results: The included articles reported barriers to PA that can be grouped into the following categories: individuals, physical, environmental, and treatment. Among the instruments used to assess barriers to PA, it was observed that questionnaires and interviews are commonly adopted. This review underscores a paucity of studies in this area. Conclusion: A comprehensive understanding of barriers to PA in the pediatric cancer population is paramount for the development of tailored strategies and interventions aiming to promote PA in this under-researched group. In addition, future studies must adopt a mixed-methods approach, longitudinal design with specific instruments in the pediatric cancer population.

Suicidal ideation and executive functioning in pediatric cancer.

Neurocognitive impairments and psychological distress are among the most common difficulties experienced by children treated for cancer. Elevated rates of suicidal ideation (SI) are documented among cancer survivors, and a link between neurocognitive deficits and SI is evident, yet the relationship between SI and pediatric cancer-related neurocognitive effects has not yet been studied. Participants were 166 pediatric cancer patients (57.8% Brain Tumor, 31.3% leukemia, 10.8% other cancers) aged 6-23 (M=11.57, SD=3.82; 45.8% female) referred for neuropsychological surveillance. SI prevalence was measured by parent, teacher, or patient endorsement of self-harm related items on informant-report measures (e.g., the Child Behavior Checklist). Executive functioning (Behavior Rating Inventory of Executive Function), ADHD symptoms (ADHD Rating Scale), and performance-based measures were compared between those with SI and those without. 17.5% of pediatric cancer patients experienced SI, of which 44.7% had self-endorsement only, 58.5% parent-endorsement only, 20.6% teacher-endorsement only, and 24.1% had two endorsements. Those with SI had significantly greater impairments in global executive composite scores by both parent- and teacher-report (ps<0.05). Parents of children with SI endorsed significantly more inattention symptoms (M=6.10, SD=15.48) than those without SI (M=50.56, SD=8.70; p<0.01), but hyperactivity symptoms did not differ. Intellectual and executive function performance did not differ between those with and without SI (ps>0.1). An elevated number of children treated for cancer experience SI and related neurocognitive problems. Screening for SI and further assessment of the connection between executive functioning and SI in pediatric cancer populations is needed.

The Effect of Health Insurance on Childhood Cancer Survival in Pediatric Patients Treated With Radiation in Multi-Center Health Systems

<h3>Purpose/Objective(s)</h3> The impact of health insurance on cancer identification and survival remains understudied in the pediatric cancer population. This study was designed to assess the association between health insurance status and childhood cancer survival. <h3>Materials/Methods</h3> Data from 464 pediatric oncology patients age < 19 who were diagnosed between Jan. 1990 and Aug. 2019 and treated for cancer with radiation therapy at a large public hospital or a multi-center private hospital in a diverse metropolitan city were reviewed retrospectively. Variables collected included patient demographics, treatment, toxicities, recurrences, and death. Continuous variables were compared using ANOVA tests; categorical variables were compared with Chi-square test and Fisher's exact test excluding unknown. Cox regression modeling was used for univariable (UVA) and multivariable (MVA) analyses to assess associations between study variables and clinical outcomes: overall (OS) and recurrence free survival (RFS). Event-free individuals (alive for OS; alive without recurrence for RFS) were censored at date of last follow-up. Hazard Ratios (HR) and corresponding 95% confidence intervals (CI) were calculated with <i>P</i>-values of < 0.05 considered significant. <h3>Results</h3> Mean survival time was 1.52 years shorter in pediatric oncology patients with Medicaid/Medicare than in pediatric oncology patients with private insurance (<i>P</i> = 0.015). In UVA, Medicaid/Medicare patients had significantly worse OS than privately insured patients (HR 2.0, 95% CI 1.27, 3.70). RFS was also significantly worse in Medicaid/Medicare patients compared to privately insured patients (HR 1.79, 95% CI 1.27, 2.5). Inferior OS and RFS in Medicaid/Medicare patients remained significant in MVA when adjusting for diagnosis (OS: HR 2.0, 95% CI 1.04, 3.13; RFS: HR 1.52, 95% CI 1.08, 2.13). No significant survival differences were identified by race, ethnicity, sex, socioeconomic status, or treatment site. Across insurance groups, no significant differences between the times from diagnosis to chemotherapy initiation (<i>P</i> = 0.276), diagnosis to radiation initiation (<i>P</i> = .592), or initial radiation consult to radiation start (<i>P</i> = 0.391) were observed. <h3>Conclusion</h3> The analysis reveals significantly worse survival outcomes in pediatric cancer patients with Medicaid/Medicare. The disparity in survival between private vs. Medicaid/Medicare patients exists despite no differences in treatment initiation times or differences in survival between treatment sites. These findings suggest that factors outside of treatment in the hospital systems are contributing to the inferior outcomes in Medicaid/Medicare-insured pediatric cancer patients. These factors may include later stage of cancer at time of diagnosis due to inferior healthcare accessibility. Further research is necessary to discern what factors are driving the disparities observed in the Medicaid/Medicare pediatric cancer population in order to improve their outcomes.

Body composition of patients with neuroblastoma using computed tomography.

Computed tomography (CT) is often used to investigate muscle and fat mass in adult patients with cancer. However, this method has rarely been used in the pediatric cancer population. The present retrospective study aimed to investigate changes in body composition using CT during treatment in children with neuroblastoma. CT images of 29 patients with high-risk neuroblastoma were retrospectively analyzed at diagnosis and longitudinally during treatment. The cross-sectional area of skeletal muscle, intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) and skeletal muscle density at the level of the third lumbar vertebra were examined. To correct for height, cross-sectional areas were divided by height in meters squared. A linear mixed model was estimated to investigate changes in body composition over time. A small increase in skeletal muscle (p=.029), skeletal muscle density (p=.002), and IMAT (p<.001) was found. Furthermore, a rapid increase in VAT (p<.001) and SAT (p=.001) was seen early during treatment with the highest volumes after six cycles of chemotherapy. CT scans obtained during standard care provide insight into the direction and timing of changes in skeletal muscle and different types of adipose tissue in childhood cancer patients. Future research is needed regarding the consequences of the rapid increase of VAT and SAT early during treatment.