Disaster Survivors Research Articles

Factors Influencing Post-Traumatic Growth in Surviving Students of the Sewol Ferry Disaster: A Long-Term Follow-Up Study.

Disaster survivors often experience negative impacts on their mental health, but some may also exhibit posttraumatic growth, overcoming adversity, and finding positive outcomes. This study aimed to identify psychological factors influencing posttraumatic growth (PTG) among students who survived the Sewol ferry disaster. The study used a longitudinal design. Data were collected at 6-month intervals between high school graduation and 6 years after the ferry disaster. Data were obtained from 48 adolescents who completed self-report measures of rumination, meaning in life, coping, PTG, family adaptability and cohesion. Generalized estimating equation models were fitted to 11 waves of follow-up data. Intrusive rumination (coefficient [coef]=0.165; p<0.001; 95% confidence interval [CI] 0.081-0.250) and deliberate rumination (coef=0.554; p<0.001; 95% CI 0.376-0.732) were significantly associated with PTG. Concerning meaning in life, the presence of meaning (coef=0.312; p<0.001; 95% CI 0.189-0.435) and the search for meaning (coef=0.216; p=0.001; 95% CI 0.093-0.340) were also significantly associated with PTG. Finally, the problem-focused (coef=0.682; p=0.011; 95% CI 0.153-1.210) and emotion-focused (coef=0.736; p=0.009; 95% CI 0.186-1.285) coping strategies both showed significant associations with PTG. The results of this study indicate that rumination, meaning in life, and adaptive coping (including cognitive and emotional coping) were protective factors for mental health problems among adolescents who survived the Sewol ferry disaster. These psychological factors may promote PTG over time.

Registered physiotherapists' knowledge of terms related to responding to evacuees during disasters and its status of use

Objectives Healthcare professionals are expected to adopt a multidisciplinary approach to protect the health status of individuals, particularly those with frailty, following unprecedented disasters. This study focused on the terms "individual evacuation plan," "residents requiring assistance in evacuation," and "welfare shelters" among physiotherapists, and the degree of knowledge and factors associated with knowledge of these terms were examined to consider ways for physiotherapists to participate more actively in disaster response.Methods A web-based survey was conducted among members of the Fukushima Physical Therapy Association from March 8-31, 2023. The survey items included basic attributes, knowledge of "individual evacuation plan," "residents requiring assistance in evacuation," and "welfare shelters," and the presence of opportunities to acquire knowledge, own evacuation experience, and experience supporting disaster survivors. The association between knowledge and length of career as a physiotherapist, presence of opportunities to acquire knowledge, own evacuation experience, and experience supporting disaster survivors were examined using the χ2 test and residual analysis. Additionally, respondents were asked regarding their understanding of the physiotherapy recipients' "individual evacuation plan" and participation in formulating those plans. Those who understood and participated in those plans were asked to provide a free-form response about the use of the "individual evacuation plan" in providing routine physiotherapy and specific activities.Results Of the 1,645 participants, 171 (10.4%) responded. The respondents' mean age was 38.4 ± 8.5 years. Seven (4.1%) ，21 (12.3%) ，and 17 (9.9%) respondents answered that they knew "individual evacuation plan," "residents requiring assistance in evacuation," and "welfare shelters," respectively. Those who knew the specifics of the recipients' "individual evacuation plans" used them to conduct evacuation drills that assumed actual conditions and shared information with other healthcare professionals. The presence of opportunities to acquire knowledge, length of career, and experience supporting disaster survivors were associated with knowledge of "individual evacuation plan," "residents requiring assistance in evacuation," and "welfare shelters," whereas the presence of own evacuation experience was not.Conclusion The percentage of current physiotherapists who knew "individual evacuation plan," "residents requiring assistance in evacuation," and "welfare shelters" ranged from 4.1-12.3%. Enhancing curricula in pre-graduate education and ensuring learning opportunities for physiotherapists may be helpful in collaboratively participating in disaster responses.

Moderated mediation role of trust in authorities by the Kahramanmaras earthquake survivors

ABSTRACT This article examines the moderated mediation role of trust in authorities in the direct and indirect effects of earthquake exposure on psychological distress symptoms (depressive, anxiety and stress symptoms) through somatic fear (sleep loss and increased heart rates). Convenience and snowball sampling methods were used to collect survey data from 552 adult participants (221 men, 331 women) living in the earthquake zone. The independent variable is earthquake exposure, the mediating variable is somatic fear, and the moderating variable is trust in authorities (emergency plans and strategies, government policies, and media information). Factor analysis using structural equation modelling confirmed one factor for fear of earthquake and trust in authorities and three factors for symptoms of psychological distress. Regression results showed that disaster survivors had low trust in authorities in Turkiye. Mediation and moderated mediation results based on the bootstrap method showed that somatic fear mediated the effect of earthquake exposure on depressive symptoms, anxiety symptoms and stress symptoms, and trust in authorities moderated the indirect effects of earthquake exposure on stress symptoms through somatic fear. Increased trust in authorities in Turkiye would alleviate psychological distress symptoms among the Kahramanmaras earthquake survivors.

Performance replication of the Hospital Mental Health Risk Screen in ethnoracially diverse U.S. patients admitted through emergency care.

Patients admitted to hospitals after emergency care for injury or acute illness are at risk for later mental health problems. The American College of Surgeons Committee on Trauma Standards for care of injured patients call for mental health risk screening, and the Hospital Mental Health Risk Screen (HMHRS) accurately identified at-risk patients in a developmental study that included patients from five ethnoracial groups. Replication of these findings is essential, because initial positive results for predictive screens can fail to replicate if the items were strongly related to outcomes in the development sample but not in a new sample from the population the screen was intended for. Replication of the predictive performance of the 10-item HMHRS was studied prospectively in ethnoracially diverse patients admitted after emergency care for acute illness or injury in three hospitals across the U.S. Risk screen scores and follow-up mental health outcomes were obtained for 452 of 631 patients enrolled (72%). A cut score of 10 on the HMHRS correctly identified 79% of the patients who reported elevated levels of depression, anxiety, and PTSD symptoms two months post-admission (sensitivity) and 72% of the patients whose symptoms were not elevated (specificity). HMHRS scores also predicted well for patients with acute illness, for patients with injuries, and for patients who reported an Asian American/Pacific Islander, Black, Latinx, Multirace, or White identity. Predictive performance of the HMHRS was strong overall and within all five ethnoracial subgroups. Routine screening could reduce suffering and health care costs, increase health and mental health equity, and foster preventive care research and implementation. The performance of the HMHRS should be studied in other countries and in other populations of recent trauma survivors, such as survivors of disaster or mass violence.

Effect of an Educational Training Program for Nurses Regarding Triage System Working Competency

Background: The term "triage" means sorting out. Medically, it's a process used to prioritize who needs emergency medical attention first, whether injured or sick people or disaster survivors. Aim: The current study aimed to evaluate the effect of an educational training program for nurses regarding Triage System working competency. Design: Quasi experimental research design was used in this study. Setting: The study was conducted at Ain-Shams Specialized Hospital. Subject: Consist of a convenience sample (50) of emergency nurses. Data collection: three tools were used in this study as 1st tool: Self-administered Questionnaire that consisted of two parts, part 1: nurses' demographic data, part 2: Self administrated sheet for nurses' knowledge about triage system. 2nd tool: Nurse's Observational checklist.3rd tool: Nurse's communication and interpersonal relationships Observation Checklist. Results: The majority of nursing personnel had good level of knowledge regarding triage system in post program and slightly decline at follow up as compared with preprogram phase and there were statistical significant differences between pre- training program implementation and immediately, as well 2 months post training program implementation among the studied nurses regarding total level of practice at P-value ≤ 0.05 also the majority of them had satisfactory level of communication skills practice post educational training program implementation. Conclusion: The study concluded that there was highly statistically significant positive correlation between total knowledge among the studied nurses and total nurse’s performance regarding triage system. Recommendations: Continuous training programs or sessions must emphasize on all aspects of triage system for nurses, increasing and applying for the triage training program, information and research findings should be disseminated online

THE PSYCHOLOGICAL IMPACT OF SURVIVORS OF THE EARTHQUAKE, TSUNAMI, AND LIQUEFACTION: A QUALITATIVE STUDY

Introduction: Natural disasters in the form of earthquakes, tsunamis, and liquefactions in Central Sulawesi in 2018 had several impacts on disaster survivors' psychology. These psychological problems have developed as an effect from serious injuries or loss of family members of the survivors. Psychological disorders, such as anxiety, depression, to Post traumatic stress disorder, can affect long-term quality of life. This study aims to explore the psychological impacts experienced by survivors of the earthquake, tsunami, and liquefaction in Central Sulawesi. Method: A qualitative study with a phenomenological approach. In-depth interviews were conducted using semi-structured guideline, observation and voice recording of 18 survivors of the earthquake, tsunami, and liquefaction disasters. The determination of the sample is using a purposive sampling technique based on inclusion criteria. The results of the interviews were transcribed, member checking, and analyzed using the Van Mannen method. Results: This study produced four themes and fifteen sub-themes. The research themes consist of the grieving phase, post-traumatic stress disorder, social support and health services support. Conclusions: Further screening of disaster survivors who experienced psychological disorders is needed, not only as a preventive measure but also as a psychological support to improve their quality of life.

Epigenetics of violence against women: a systematic review of the literature.

Violence against women is a pervasive global issue with profound impacts on victims' well-being, extending across cultural boundaries. Besides immediate physical harm, it triggers mental health consequences such as post-traumatic stress disorder (PTSD). Indeed, it is the trauma experienced during a violent event that can lead to epigenetic modifications, ultimately contributing to the onset of PTSD. While research on the epigenetic effects of trauma initially focused on war veterans and disaster survivors, there is a dearth of studies on violence against women. In this article, we performed a systematic review aimed to fill this gap, examining existing studies on the epigenetic impact of violence on women. The review assessed sample sizes, study validity, and gene-specific investigations. Currently, there is insufficient data for a comprehensive meta-analysis, highlighting a nascent stage in understanding this complex issue. Future research is crucial for deeper insights into the epigenetic mechanisms related to violence against women, contributing to improved interventions and support healthcare systems for affected individuals.

The Relationship Between Post-Traumatic Stress, Hopelessness and Resources Adequacy in Fire Disaster Survivors: A Mediation Analysis

AbstractThis study explores the psychosocial aftermath of the fire disaster by focusing on the levels of post-traumatic stress, hopelessness and perception of adequacy of resources of the affected population in the Manavgat district of Antalya province. The data of this study, which is a descriptive correlational research, were collected between 01 March-31 May 2022. The Information form, Impact of Events Scale, Beck Hopelessness Scale and Perception of Adequacy of Resource Scale were used as the data collection tools. A total of 245 individuals, predominantly farmers and with a low-income status, participated in the study. Field data revealed a high level post-traumatic stress (39.56 ± 15.71), moderate hopelessness (10.53 ± 6.83), and moderate perception of adequacy of resources (104.17 ± 32.15) among the participants. Another important finding of the study is; sociodemographic variables were significantly associated with the impact of events, hopelessness, and perception of adequacy of resources. Being female, low education and income level, being farmer, having heavily damaged house and living in a prefabricated house emerged as risk factors for Post-Traumatic Stress Disorder (PTSD). The results demonstrated a strong correlation between hopelessness, perception of adequacy of resources and post-traumatic stress. Hopelessness partially mediated the relationship between adequacy of resources and post-traumatic stress. The massive physical, economic and social losses caused by wildfire have led to persistent psychosocial problems among the affected population. The findings highlight the importance of assessing losses related to socioeconomic status and applying risk management accordingly. The data obtained in this study can shed light on the determination of risky groups after fire disaster, psychosocial interventions to be applied and the duration of interventions.

Earthquake diaries: Psychosocial difficulties and life experiences of nurses working in the disaster zone after the earthquake: A phenomenological study.

The aim of this study was to evaluate the psychosocial difficulties and life experiences of nurses working in the disaster area following the earthquake on February 6, Kahramanmaraş centered earthquake with a phenomenological approach. After natural disasters such as earthquakes, nurses play a significant role in providing both physical and psychosocial support. Therefore, the experiences of nurses in this field are necessary both to support them and to assist disaster survivors. In this study, in which the phenomenological research method was used, semi-structured in-depth interviews with 18 nurses who provided health care services during the February 6 Kahramanmaraş earthquake were conducted between January and February 2024 via Whatsapp mobile application. Snowball sampling method was used to reach the sample group. Interviews continued until data saturation was achieved. All interviews were audio recorded and then transcribed. The data were analyzed using thematic analysis. The study was conducted and reported according to the COREQ checklist. Data analysis revealed two themes (psychological and social difficulties caused by the earthquake, traumatic stress and coping experiences as a nurse) and five sub-themes (social difficulties, psychological difficulties, traumatic events, reactions and coping). As a result of the study, it was determined that nurses providing health care services were negatively affected psychosocially by the traumatic stress situations they experienced in the earthquake centered in Kahramanmaraş on February 6. It was determined that nurses had great difficulty in coping with the traumatic stress situations they experienced. It was concluded that the February 6 earthquake caused secondary traumatization in nurses.

The role of reconstructive plastic surgery in the treatment of victims of the 2023 Kahramanmaraş earthquake

Objective: As a result of the 2023 Kahramanmaraş earthquake, medical institutions experienced a large influx of patients requiring acute multidisciplinary surgical and medical care. This study aimed to evaluate the patient demographics and treatment management of survivors admitted to our reconstructive plastic surgery department. Materials and Methods: We retrospectively analyzed the age, sex, time under the wreckage, time of admission, types and locations of injuries, treatment modalities, receipt of hyperbaric oxygen therapy, and receipt of vacuum-assisted closure therapy of the earthquake victims referred to our department. Results: The definitive management of all 42 earthquake survivors admitted to our department was reviewed. This included five free flaps, four regional flaps, 18 split-thickness skin grafts, and one maxillofacial fracture repair. Eight patients were treated conservatively including two with non-displaced maxillofacial fractures. Of the 26 patients treated for lower extremity injuries, four were already amputees. Among the remaining 22 patients with such injuries, one underwent Charcot amputation plus free flap reconstruction to preserve extremity length and one underwent below-the-knee amputation. Of the 16 upper extremity injuries, two patients referred with extensive forearm necrosis underwent forearm amputation. To preserve extremity length and ensure the limbs were suitable for biomechanical orthoses, free transverse upper gracilis musculocutaneous flaps and free chimeric Anterolateral- Vastus Lateralis musculocutaneous flaps were performed. Conclusion: This study illustrates the value of multi-modal reconstructive plastic surgery in the treatment of disaster survivors, particularly in the management of multi-trauma.

Exploring Perspectives of Disaster Survivors on Islamic-Based Nurses' Disaster Response Competencies: A Study from Disaster Front Area

Exploring Perspectives of Disaster Survivors on Islamic-Based Nurses' Disaster Response Competencies: A Study from Disaster Front Area

CBT Intervention Post-2023 Southeast Türkiye Quake: A Case Study

This case study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) in treating Post-Traumatic Stress Disorder (PTSD) in an individual survivor of the catastrophic 2023 Southeast Türkiye Earthquake. The study aims to provide detailed insights into the therapeutic process and outcomes of CBT applied in a post-disaster context. A 38-year-old female survivor, pseudonymously named Serpil, participated in an eight-week structured CBT program specifically tailored to address her severe PTSD symptoms following the earthquake. The therapeutic interventions included exposure therapy, cognitive restructuring, and relaxation techniques. Data collection was achieved using quantitative methods such as the Clinician-Administered PTSD Scale (CAPS) and the Beck Depression Inventory (BDI), supplemented by qualitative assessments through detailed therapy session notes and Serpil’s personal reflections. The intervention led to significant improvements in Serpil's PTSD symptoms, particularly a reduction in the frequency and severity of nightmares and flashbacks. Serpil reported enhanced coping mechanisms, which improved her overall psychological resilience and functionality. The data illustrate a notable decrease in PTSD symptomatology, corroborated by scores from CAPS and BDI, indicating an overall improvement in mental health and quality of life. This case study underscores the potential of CBT as a potent intervention for managing PTSD in survivors of natural disasters. It highlights the necessity of integrating specialized psychotherapeutic techniques in disaster response initiatives to address the psychological impacts effectively. The findings advocate for broader implementation and evaluation of similar interventions across diverse post-disaster settings to confirm these results and optimize treatment protocols. Further research with larger sample sizes and longer follow-up periods is recommended to enhance the generalizability and understanding of CBT's long-term effectiveness in disaster-stricken populations.

Assessing the ripple effects of natural disasters on healthcare systems: a narrative review.

Natural disasters are on the rise, driven by shifts in climatic patterns largely attributed to human-induced climate change. This relentless march of climate change intensifies the frequency and severity of these disasters, heightening the vulnerability of communities and causing significant harm to both lives and socio-economic systems. Healthcare services are particularly strained during extreme weather events, with impacts felt not only on infrastructure but also on patient care. This narrative review explored the overarching impact of natural disasters on healthcare infrastructure. We delved into how these disasters impact diverse health conditions, the healthcare systems of low and middle-income countries (LMICs), the psychological toll on both clinicians and survivors, and the ramifications for end-of-life care. Natural disasters significantly impact healthcare, especially in LMICs due to their limited resources. Patients with cancer or chronic diseases struggle to access care following a natural disaster. Those in need for palliative care experience delay due to shortages in medical resources. Psychological consequences like posttraumatic stress disorder on disaster survivors and healthcare providers highlight the need for mental health support. Addressing challenges requires proactive disaster preparedness policies and urgent public policy initiatives are needed for optimal disaster response.

The Effect of Group-Based Patience Therapy on Reducing Anxiety Levels

The earthquake at the end of 2022 which occurred in Cugenang Cianjur, West Java, left quite a deep psychological impact on some of the people, especially marked by the emergence of symptoms of anxiety. If intervention is given too late, it will result in more severe psychological disorders. The aim of this research is to examine how much influence patience therapy has on reducing anxiety levels in earthquake victims. The patience therapy used is an approach that integrates targets into aspects biopsikososiospiritual. The research design used is experimental design in the shape of pre test-post test control group design. The population in this study were all students at the Girls' Islamic Boarding School in Cugenang Cianjur. Sampling in this research used Purposive sampling technique. The sample used in this research consisted of 12 subjects who were earthquake survivors in Cugenang Cianjur.A measuring tape used HRS-A Scale from Hamilton which consists of 14 statements which have a validity value of 0.81 and a reliability of 0.91, which includes four aspects, including physiological aspects, cognitive aspects, affective aspects and behavioral aspects. Measurement results on pre test-post test showed a reduction in anxiety levels of 53.4%. Meanwhile, statistical analysis using the independent mann whitney showed a score of 0.00 (p&lt;0.05), which means that patience therapy was significantly effective in reducing anxiety levels in survivors of the earthquake natural disaster in Cugenang Cianjur.

Navigating the Aftermath: Exploring Business Decision-Making and Family Recovery in Palu, Sulawesi, Indonesia, After a Natural Disaster

This qualitative case study examines the decision-making process of a family that experienced a natural disaster in Palu. The participants of the study were Mr. FP, the head of the family, and his wife, Mrs. VP. Primary data was collected through in-depth interviews with FP and VP conducted by relatives who witnessed the family’s gradual recovery. Additionally, supporting data was gathered through data mining, including pre -and post-disaster photographs. The family, like many others, faced an unpredictable and devastating event that not only resulted in the loss of their main source of livelihood but also inflicted deep trauma. The study aimed to delve into this family’s experiences when confronted with an unexpected disaster, exploring the impact they faced, the recovery process they undertook, and the factors influencing their decision-making, with particular emphasis on the head of the family. The head of the family played a vital role in family dynamics, making their decision-making process of great importance. The primary objective of this research was to gain a deeper understanding of the experiences of family members, particularly the head of the family, as they navigate the challenges of post-disaster recovery, specifically focusing on decision-making in economics and finances. By comprehending their experiences and decisions, the study sought to shed light on how families can rebuild their lives, particularly in terms of achieving economic and financial stability. Narrative analysis was employed in this study, as it allowed for an exploration of the experiences and decision-making of natural disaster survivors in a subjective and unrestrictive manner. This analysis enabled the capturing of the narratives shared by Mr. FP and Mrs. VP, the main informants, and facilitated the interpretation of supporting documents. Consequently, the collected data yielded rich and in-depth insights, further strengthening the findings of this research. Keywords: resilient decision-making, natural disaster, family economy, recovery process, qualitative case study

Path Planning for Data Collection Multiagent System with Priority and Moving Nodes in a Sensing Field with Obstacles

Nowadays there is a more and more common need for one-off data collection in a specified area. For example, in case of searching for the survivors of disasters or wars, or for skiers who get into trouble. The simplest way of collecting such data is using wireless sensor network (WSN). However, data transmission within the network uses great amount of energy that may significantly reduce the lifetime and operation time of the battery-operated sensors. For this reason, the data transfer between the given sensor nodes is carried out by robots. In order to minimize the latency of data collection, it is possible to use cooperating robots. It frequently occurs that one of the nodes requires more urgent visit than the other ones, for example, the serious injuries require urgent medical attendance. The sensor nodes can also be moved to collect more usable data in a larger field. To solve this, path planning for data collection from priority and moving nodes are also presented here. The algorithm developed here to perform the one-off data collection operates so that the agents start from preliminary determined or random points and then visit all the sensor nodes, download the data from these nodes and after this arrive at a designated point where they upload the collected information. The goal here is the minimization of cost that include not only the walk-through time but also the consequences of the late visit of the higher priority nodes. The optimization is solved using the ant colony optimization.

Understanding ‘citizenship’ to protect human rights of liquefaction survivors in South Palu

Disaster management is a critical component of national development, particularly in the aftermath of natural disasters. The relocation process of liquefaction disaster survivors in Petobo, located in South Palu, Central Sulawesi, underscores the pivotal role of the government in safeguarding Indonesian citizens' rights, including providing adequate housing within a healthy and secure environment. This research was conducted in the wake of the disaster with the primary objective of evaluating the legal protection and human rights afforded to survivors residing in Petobo Village, which has been designated as a red zone due to the severity of the disaster. The study uncovered significant damage to infrastructure, loss of life, and ecosystem degradation as direct consequences of the disaster. These findings underscore the government's obligation to provide permanent housing (hence HUNTAP) to fulfill the basic needs of survivors. Providing decent housing is fundamental to ensuring the well-being and dignity of every citizen affected by the disaster. Moreover, it aligns with the core principles of citizenship and human rights, which are essential for fostering sustainable and harmonious communities, particularly in regions grappling with the aftermath of natural calamities. Shortly, the relocation of liquefaction disaster survivors in Petobo, South Palu, Central Sulawesi, highlights the government's pivotal role in safeguarding its citizens' rights, especially in times of crisis. By prioritizing permanent housing and ensuring a healthy and secure environment for survivors, the government demonstrates its commitment to upholding human rights and fostering resilient communities in disaster-affected areas.

Influencer Academy: Implementasi Pengembangan Strategi Komunikasi Relawan Penyintas Bencana

In higher education, where it is required to create superior human resources, digitalization is a challenge that must be overcome both administratively and in, terms of learning functions. The occurrence of the COVID-19 pandemic seems to encourage and force the implementation of digital education, one of the implementations of which is an online learning system. The online learning system should not be an obstacle that discourages the pursuit of knowledge. The academic community of Universitas Putra Indonesia (UNPI) Cianjur in collaboration with the Faculty of Psychology, Jayabaya University is trying to answer all the challenges above in the form of Community Service activities with the Short Class – Influencer Academy program. Through the Short Class – Influencer Academy program. This activity uses the Service-Learning or SL method, which is an activity that involves practical experience, academic learning, and community involvement. Activities will take place from 20 December 2022 to 20 January 2023. From the activities that have been carried out, it is concluded that this activity can not only be carried out for disaster survivors but can become an annual program to prepare advanced students to enter higher education.

The Impact of Relocation Patterns on Psychological Stress

This study investigated how relocation patterns affect disaster survivors’ psychological stress on the diverse durations and spaces of relocation. It analyzed a 10-year data set of 1,236 families affected by 2009’s Typhoon Morakot in Taiwan, identifying six relocation patterns through dynamic time warping (DTW). A hierarchical linear model was utilized, revealing the discernible impacts of environmental factors, sociocultural factors, and family-level socioeconomic factors on psychological stress. The study revealed that survivors who quickly found stable residences after the disaster initially experienced lower stress levels, but in the long term, their stress increased. Conversely, those with unstable residences experienced higher initial stress but lower long-term stress. Comparing similar patterns, we found that survivors who had more time for preparation and who sought opportunities, coped, or adapted to secondary stressors before long-distance relocation faced lower stress levels. These findings suggest that relocation patterns have a greater impact on the psychosocial stress of disaster survivors than time or relocation distance.

Long-term neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy: a multicentre cohort study of the International Network on Cancer, Infertility, and Pregnancy

The main data available on the safety of radiation during pregnancy originate from animal studies and from studies of survivors of atomic or nuclear disasters. The effect of radiotherapy to treat maternal cancer on fetal development is uncertain. This report presents a unique cohort and aims to determine the long-term neurocognitive, psychosocial and physical outcomes of offspring of mothers treated with radiotherapy during pregnancy. In this international, multicentre, mixed retrospective-prospective cohort study, we recruited participants between Aug 5, 2006, and Aug 24, 2023, aged between 1·5 and 46 years, at three referral centres in Belgium, the Netherlands, and the USA. Participants were eligible if they were born from mothers treated with radiotherapy during pregnancy. Fetal radiation doses were obtained from medical records and participants were followed up at predefined ages (1·5, 3, 6, 9, 12, 15, and 18 years) and 5-yearly in adulthood, based on age at enrolment, using a neurocognitive test battery (measuring intelligence, attention, and memory), parent-reported executive function and psychosocial questionnaires, and a medical assessment. Results were compared with test-specific normative data. Linear regression models investigated associations between radiotherapy factors (fetal radiation dose, gestational age at the start and end of radiotherapy, and radiotherapy duration) and outcomes. 68 maternal cases of radiotherapy during pregnancy were registered by the three participating centres, of which 61 resulted in a livebirth and were therefore eligible to participate in the child follow-up study. After excluding those who did not give consent, 43 participants born from 42 mothers treated with radiotherapy during pregnancy were included in the study (median age at first assessment 3 years [IQR 2-11]; median age at last assessment 12 years [9-18]; median number of assessments two [1-4]). 18 (42%) of the included participants were female and 25 (58%) male, and 37 (86%) were of White ethnicity. Mean neurocognitive outcomes of the entire cohort were within normal ranges. No associations were found with fetal radiation dose or timing of radiotherapy during pregnancy. Six (16%) of 38 participants with neurocognitive outcomes scored lower than one SD on at least one neurocognitive outcome, three (7%) reported chronic medical conditions (spasmophilia, spastic diplegia, and IgG deficiency), and three (7%) were diagnosed with attention-deficit hyperactivity disorder (of whom two scored lower on attention). Of ten (23%) participants with lower neurocognitive score(s), a chronic medical condition, or attention-deficit hyperactivity disorder, eight were born preterm. The remaining 33 (77%) participants showed no neurocognitive, psychosocial, or chronic physical problems. We show on average normal neurocognitive, psychosocial, and physical outcomes after prenatal exposure to radiotherapy. Differences in outcomes could not be explained by exposure to radiotherapy during pregnancy. These results suggest that extra-abdomino-pelvic radiotherapy exposure during pregnancy in general does not adversely affect outcomes of liveborn children. Further research with a larger sample is necessary to confirm these findings. Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Research Foundation Flanders.