Publications by authors named "Kathryn Russell"

60 Publications

Do Anxiety and Mood Vary among Disparate Sleep Profiles in Youth with Craniopharyngioma? A Latent Profile Analysis.

Behav Sleep Med 2021 Mar 4:1-12. Epub 2021 Mar 4.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennesse.

Introduction: Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. Method: Actigraphs recorded nightly sleep data, including measures of sleep onset latency and wake after sleep onset, in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. Results: The latent profile analysis revealed three sleep profiles: "variable sleepers" (48.3%), "consistently poor sleepers" (45.4%), and "night wakers" (6.4%). Consistently poor sleepers had lower rates of anxiety ( = .76; = .009) and depression ( = .81; = .003) than variable sleepers and had significantly lower rates of anxiety than night wakers ( = .52; = .05); all other differences were nonsignificant (s > .05). Discussion: Youth with craniopharyngioma who have nightly variations in sleep may have worse psychological functioning than those with more consistent, albeit poor, sleep patterns. Patients with craniopharyngioma who report variable sleep should be assessed for anxiety and depression to prevent and intervene on emotional difficulties that may be reciprocally related to sleep.
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http://dx.doi.org/10.1080/15402002.2021.1892679DOI Listing
March 2021

Centrality of the childhood cancer experience and its relation to post-traumatic stress and growth.

Psychooncology 2021 Apr 15;30(4):564-570. Epub 2020 Dec 15.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.

Objective: Event centrality, the degree to which a traumatic event is perceived as central to one's identity, has been associated with post-traumatic stress (PTS) symptoms and post-traumatic growth (PTG) outcomes in various trauma samples. Trauma frameworks are widely used to understand the psychological impact of pediatric cancer; however, event centrality has not been studied in this population. We investigated event centrality in pediatric cancer survivors and healthy comparisons, and its relation with PTS and PTG outcomes.

Method: Cancer survivors, age 13-23 (N = 196) and healthy comparisons (N = 131) completed the Centrality of Events Scale and PTS and PTG measures in reference to their most traumatic life event. Cancer survivors who first identified a non-cancer-related event repeated all measures in reference to cancer.

Results: Centrality scores were significantly higher when referencing cancer compared to non-cancer events, even in survivors for whom cancer was not rated as most stressful (53.1%). Centrality scores for non-cancer events were not significantly different between survivors and healthy comparisons. Event centrality showed significant positive relations to both PTS and PTG outcomes.

Conclusion: The pediatric cancer experience is perceived as central to survivors' identity regardless of whether the experience is perceived as highly traumatic. Centrality of cancer is a significant predictor of both positive and negative psychological outcomes in cancer survivors.
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http://dx.doi.org/10.1002/pon.5603DOI Listing
April 2021

Neurocognitive functioning in long-term survivors of pediatric hematopoietic cell transplantation.

Bone Marrow Transplant 2021 Apr 14;56(4):873-882. Epub 2020 Nov 14.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.

Survivors of pediatric hematopoietic cell transplantation (HCT) are at risk for impairment in cognitive and academic function. Most research to date has focused on the first years following transplant, and less is known about the long-term effects. We examined global and specific neurocognitive functioning in long-term (>5 years post HCT) survivors in comparison to both normative data and a sample of demographically similar healthy peers. A comprehensive battery of neurocognitive measures was obtained from 83 long-term survivors and 50 healthy comparisons. Analyses were conducted to assess for differences in neurocognitive functions between survivors, normative means, and healthy comparisons, and to examine the impact of medical and demographic variables on neurocognitive performance. Survivors' performance was within the Average range across most measures, although significantly lower than both test norms and healthy comparisons on several measures. Despite generally intact neurocognitive functioning in the survivor group as a whole, survivors who experienced graft-vs.-host disease demonstrated slower processing speed and weaker verbal learning. Use of total body irradiation was not associated with any performance-based measure of neurocognitive functioning. Although subgroups of patients may be at relatively higher risk of neurocognitive impairment, the long-term neurocognitive impact for most survivors is relatively small.
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http://dx.doi.org/10.1038/s41409-020-01125-5DOI Listing
April 2021

Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia.

J Pediatr Psychol 2021 02;46(2):168-178

St. Jude Children's Research Hospital.

Objective: Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL.

Methods: There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD) = 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership.

Results: Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (80-89%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p = 0.020), female sex (p = 0.018), and experiencing sepsis (p = 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p = 0.035) and fewer ratings of attention problems (p = 0.013) over time.

Conclusions: Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.
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http://dx.doi.org/10.1093/jpepsy/jsaa086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896273PMC
February 2021

Doctor narratives on burnout and allergic reactions to talking about feelings: what are the unspoken rules when talking to doctors?

Authors:
Kathryn Russell

N Z Med J 2020 09 4;133(1521):106-108. Epub 2020 Sep 4.

Clinical Psychologist, Psychological Medicine, Counties Manukau Health, Auckland.

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September 2020

Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy.

Behav Sleep Med 2020 Aug 4:1-13. Epub 2020 Aug 4.

Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Objective/background: Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy.

Participants: 51 AYA patients with newly diagnosed solid tumors, including lymphoma.

Methods: Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale.

Results: Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group.

Conclusions: This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy trial.ClinicalTrials.gov Identifier Number: NCT02429063.
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http://dx.doi.org/10.1080/15402002.2020.1797744DOI Listing
August 2020

Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma.

J Pediatr 2020 08 9;223:141-147.e4. Epub 2020 Jun 9.

Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN.

Objective: To examine the contribution of anesthesia exposure during treatment for childhood medulloblastoma to neurocognitive outcomes 3 years after tumor diagnosis.

Study Design: In this retrospective study, anesthesia data were abstracted from medical records for 111 patients treated with risk-adapted protocol therapy at St Jude Children's Research Hospital. Neurocognitive testing data were obtained for 90.9% of patients.

Results: For the 101 patients (62.4% male) who completed testing, mean age at diagnosis was 10.1 years, and 74.3% were staged to have average-risk disease. Anesthesia exposure during treatment ranged from 1 to 52 events (mean = 19.9); mean cumulative duration per patient was 21.1 hours (range 0.7-59.7). Compared with normative expectations (16%), the group had a significantly greater frequency of at-risk scores (<1 SD) on measures of intelligence (28.7%), attention (35.2%), working memory (26.6%), processing speed (46.7%), and reading (25.8%). Including anesthesia exposure duration to linear regression models accounting for age at diagnosis, treatment intensity, and baseline IQ significantly increased the predicted variance for intelligence (r = 0.59), attention (r = 0.29), working memory (r = 0.31), processing speed (r = 0.44), and reading (r = 0.25; all P values <.001).

Conclusions: In survivors of childhood medulloblastoma, a neurodevelopmentally vulnerable population, greater exposure to anesthesia significantly and independently predicts deficits in neurocognitive and academic functioning. When feasible, anesthesia exposure during treatment should be reduced.
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http://dx.doi.org/10.1016/j.jpeds.2020.04.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387137PMC
August 2020

Parent recommendation to bank sperm among at-risk adolescent and young adult males with cancer.

Pediatr Blood Cancer 2020 10 26;67(10):e28217. Epub 2020 May 26.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Background: Adolescent and young adult (AYA) males newly diagnosed with cancer are often faced with making quick decisions about whether to cryopreserve ("bank") sperm prior to treatment initiation. Given that parental influence is crucial among young patients, the present study examines the prevalence of and factors associated with parent recommendation to bank sperm.

Procedure: Parents of 13- to 21-year-old males newly diagnosed with cancer and at risk for infertility secondary to impending gonadotoxic treatment completed questionnaires typically within one week of treatment initiation. Medical and sociodemographic data, communication factors, and psychological factors were considered in a logistic regression model of parent report of parental recommendation to bank sperm (yes/no).

Results: Surveys from 138 parents (70.3% female) of 117 AYA males (mean age = 16.1 years, SD = 2.0) were analyzed. Over half of parents recommended banking to their sons (N = 82; 59.4%). Parents who received a provider recommendation to bank sperm (odds ratio [OR] = 18.44, 95% confidence interval [CI], 4.20-81.01, P < 0.001) or who believed in the benefits of banking (OR = 1.22, 95% CI, 1.02-1.47, P = 0.03) were significantly more likely to recommend sperm banking.

Conclusions: Given parents' role in influencing sperm banking outcomes, provider recommendation and promotion of banking benefits may influence parents and empower initiation of these sensitive discussions with their sons. Utilization of this approach should yield beneficial outcomes regardless of the banking decision.
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http://dx.doi.org/10.1002/pbc.28217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688489PMC
October 2020

Characterizing Posterior Fossa Syndrome: A Survey of Experts.

Pediatr Neurol 2020 03 29;104:19-22. Epub 2019 Nov 29.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address:

Background: Despite recent efforts, disagreement remains among frontline clinicians regarding the operational definition of a syndrome commonly referred to as posterior fossa syndrome or cerebellar mutism syndrome.

Methods: We surveyed experts in the clinical care of children with posterior fossa tumors to identify trends and discrepancies in diagnosing posterior fossa syndrome.

Results: All surveyed professionals conceptualized posterior fossa syndrome as a spectrum diagnosis. The majority agreed that mutism is the most important symptom for diagnosis. However, results highlighted ongoing discrepancies related to important features of posterior fossa syndrome.

Conclusions: Greater posterior fossa syndrome conceptual alignment among providers is needed to formulate specific diagnostic criteria that would further research and clinical care. The authors propose preliminary diagnostic criteria for posterior fossa syndrome that require refinement through careful clinical characterization and targeted empirical investigation.
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http://dx.doi.org/10.1016/j.pediatrneurol.2019.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010537PMC
March 2020

Laparoscopic pyloromyotomy can be performed safely by senior pediatric surgery trainees without supervision at high volume centers.

J Pediatr Surg 2020 Oct 16;55(10):2080-2082. Epub 2019 Dec 16.

Division of General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,. Electronic address:

Aim Of The Study: Pediatric surgery trainees at our institution perform 15 to 20 supervised laparoscopic pyloromyotomies during their junior year, and are allowed to perform the operation independently without supervision during their senior year. We reviewed the outcomes of laparoscopic pyloromyotomies performed by senior trainees operating without supervision and compared them to experienced pediatric surgeons.

Method: We did a retrospective reviewed of all unsupervised laparoscopic pyloromyotomies (n = 90) performed by the last 12 pediatric surgery fellows (2012-2018) during their senior year, and the most recent 90 consecutive laparoscopic pyloromyotomies performed by 9 experienced pediatric surgeons. Statistical significance was determined by T-test and Fisher's exact test. Data is expressed as mean (SD) or median (range). A p value of ≤0.05 was considered significant.

Results: Mean age at surgery was 4.7 (SD: 1.6) and 5 (SD: 2.3) weeks in the trainees and surgeons group, respectively (p = 0.38). Mean operative time was 28 (SD: 13) minutes in the trainees group vs. 25 (SD: 10) minutes in the surgeons group (p = 0.09). Intraoperative complications occurred in 3 of 90 (2.7%) cases in the trainees group (three mucosal perforations, all detected during the operation, one repaired laparoscopically, two repaired open), and none in the surgeons group (p = 0.11). One postoperative complication requiring reoperation occurred in the trainees group (omentum eviscerated through an incision site), while none occurred in the surgeons group (p = 0.36). No incomplete pyloromyotomies occurred in either group. The median length of postoperative hospital stay was 1 (1 to 10) and 1 (1 to 6) days in the trainees and surgeons group, respectively (p = 0.63).

Conclusion: Senior trainees at high-volume training programs can perform unsupervised laparoscopic pyloromyotomies safely as a mean to promote surgical autonomy without compromising patient outcomes.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2019.11.023DOI Listing
October 2020

The Adolescent and Caregiver Sickle Cell Disease Self-management Skills Checklist: Preliminary Reliability and Validity.

J Pediatr Hematol Oncol 2020 01;42(1):12-19

Department of Psychology.

Adolescents with sickle cell disease (SCD) need assistance in developing the knowledge and skills that contribute to increased disease self-management and successful transition to adult-based health care. This study evaluated the preliminary psychometric properties of the Self-Management Skills Checklist (SMSC and SMSC-C; Adolescent and Caregiver versions), a measure of perceived SCD-specific knowledge and skills. A retrospective cohort study included 114 adolescents (mean=15.6 y) and their caregivers. We examined internal structure and reliability, score changes over time, and group differences. Cronbach coefficient alphas were 0.79 and 0.74 for caregiver-reported Skills and caregiver-reported knowledge, respectively, and 0.77 and 0.44 for adolescent-reported skills and adolescent-reported knowledge, respectively, indicating good internal consistency for 3 of the subscales. Poor reliability in the adolescent-reported knowledge summary score and factor analysis suggest an interpretation item-by-item, independent of one another. Participant group differences in age and chronic transfusion treatment existed in both summary and subscale scores of the SMSC and SMSC-C. Follow-up administrations of the scales indicated an increase in caregiver-reported skills for their adolescents from time 1 scores (M=3.72±0.83) to time 2 scores (M=3.99±0.63) (t16=2.178, P=0.045). Findings provide preliminary support for the usage of the SMSC and continued development to improve its psychometrics.
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http://dx.doi.org/10.1097/MPH.0000000000001618DOI Listing
January 2020

Daily mood profiles and psychosocial adjustment in youth with newly diagnosed cancer and healthy peers.

Health Psychol 2020 Jan 4;39(1):1-9. Epub 2019 Nov 4.

Department of Psychology.

Objective: A new cancer diagnosis leads to many daily changes in the lives of youth. We aimed to determine how short-term emotion dynamics relate to psychosocial adjustment over time in youth with newly diagnosed cancer and healthy peers.

Methods: Youth with newly diagnosed cancer (n = 71, weeks since diagnosis: M = 6.56, SD = 1.94) and age-matched controls (n = 63), aged 8-17 years, reported on their daily mood across the week (T1). Two to 4 months later (T2), youth reported on perceived parental care and overprotection, anxiety, and quality of life. Primary caregivers reported on youth's externalizing and internalizing problems and on parental distress. Latent profile analysis (LPA) was conducted to identify individual daily mood profiles at T1. These profiles were used to predict adjustment at T2, controlling for sociodemographic factors and looking at differences between cancer patients and comparisons.

Results: LPA revealed 4 daily mood profiles: stable positive mood (SPM, 61.6%), stable negative mood (SNM, 4.8%), intermediate mood (27.6%), and fluctuating negative mood (FNM, 6%). No sociodemographic or cancer/comparison differences were found across mood profiles. Results showed several relations between mood profiles across the week and adjustment outcomes at T2. Overall, a SPM related to favorable adjustment outcomes, whereas a SNM related to less favorable adjustment. Compared to an FNM, SNM demonstrated less youth-reported perceived parental care (p = .02) and higher youth-reported anxiety (p = .05).

Conclusions: Most children show healthy emotions during treatment for cancer. Close monitoring of mood during treatment is important to identify youth at risk for adverse psychosocial adjustment outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000810DOI Listing
January 2020

Factors Associated with Intention of Human Papillomavirus (HPV) Vaccine Initiation Among Females With and Without a History of Childhood Cancer.

J Clin Psychol Med Settings 2020 12;27(4):716-726

Departments of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.

Vaccination is available to prevent human papillomavirus (HPV) types that cause cervical and other cancers. This study aimed to describe and compare vaccine intention among young females with and without a cancer history, in addition to identifying factors associated with a HPV vaccination intention. Vaccine-naïve females (aged 18-26 years, n = 120) and maternal caregivers with vaccine-naïve daughters (aged 9-17 years, n = 197) completed surveys querying HPV vaccination intention, HPV knowledge, and communication, along with sociodemographic, medical, and health belief factors. Multivariable logistic regression was utilized to calculate odds ratio (OR) and 95% confidence intervals for HPV vaccination intention. No differences in vaccine intention were identified across cancer and comparison groups. Vaccine intention and predictors of intention among vaccine-naïve females differ by age, and there is variation in the factors which influence vaccine intention by age group. These results suggest interventions should be tailored based on developmental level.
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http://dx.doi.org/10.1007/s10880-019-09664-wDOI Listing
December 2020

Bedside Antisaccades: A Time-Efficient Method to Assess Cognition.

Pediatr Neurol 2019 08 6;97:74-75. Epub 2019 Apr 6.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.

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http://dx.doi.org/10.1016/j.pediatrneurol.2019.03.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6635030PMC
August 2019

Urban sediment supply to streams from hillslope sources.

Sci Total Environ 2019 Feb 30;653:684-697. Epub 2018 Oct 30.

University of Melbourne, 500 Yarra Boulevard, Burnley, VIC, Australia.

Coarse-grained sediments supplied to a stream, in concert with the flow regime, play an important role in channel form and functioning, but are poorly understood in urban catchments. Improved knowledge of coarse-grained (>0.5 mm) sediment sources and supply rates will underpin strategies to mitigate impacts of urbanization on streams. We quantified key hillslope (i.e. non-channel) sources of sediment in urban areas by monitoring coarse-grained sediment yields from nine street-scale stormwater catchments over one year. From our observations, we developed a suburban hillslope sediment budget and a conceptual model of the response of hillslope coarse-grained sediment supply to different levels of urbanization. Coarse-grained sediment supply from the urban land surface was substantial. The highest unit-area yields came from infill construction sites (2800 kg/ha/yr), followed by gravel surfaces (740 kg/ha/yr), grass/mulch surfaces (84 kg/ha/yr), then impervious surfaces (21 kg/ha/yr), with the latter still producing yields far above background conditions. In typical suburban catchments grass and mulch surfaces and construction areas were key sources, with gravel and impervious surfaces making smaller contributions. Small source areas were important, for example construction produced 32% of sediment from 0.5% of the area. Connectivity of sediment sources to impervious surfaces, and hence to drainage systems, was important in driving sediment yields. Our conceptual model indicates that hillslope coarse-grained sediment supply increases with urbanization from natural to suburban conditions as connectivity increases, then declines with higher levels of urbanization as sources become scarcer. Impervious surfaces provide sources and supply pathways of coarse sediment, but also increase sediment transport capacity, causing severely supply-limited conditions and reducing the persistence of bed sediments in streams. When reducing hydrological connectivity to address the urban flow regime, consideration should be given to maintaining coarse-grained sediment supply through bypass or replenishment arrangements, to help reduce stream degradation and maintain form and functioning.
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http://dx.doi.org/10.1016/j.scitotenv.2018.10.374DOI Listing
February 2019

The impact of connectedness on social functioning in youth with brain tumors.

Pediatr Blood Cancer 2019 05 6;66(5):e27607. Epub 2019 Jan 6.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.

Purpose: Children with brain tumors (BT) are at risk for difficulties with social functioning. Research to date has focused on deficits, with no studies identifying areas of strength or resilience. Our objective was to assess the potential influence of connectedness on social functioning in youth with BT as compared with children with other cancers.

Methods: Children with cancer (20 with BT, 33 with other diagnoses) were enrolled on a longitudinal study of psychosocial functioning. The current study included measures from time 2 (+1 year after enrollment; M = 13.11 ± 2.31, M = 4.95 ± 3.74 years) and time 3 (+3 years after enrollment; M = 14.98 ± 2.36, M = 6.82 ± 3.81 years). Youth completed the Hemingway Measure of Adolescent Connectedness (HMAC) at time 2. Two years later, social functioning was assessed by the self- and proxy-report versions of the Social-Emotional Assets and Resilience Scale (SEARS).

Results: Youth with BT perceived that they were less connected to friends (t(50) = -2.13, P = 0.04), but similarly connected to peers as youth with other cancers. Youth with BT also demonstrated lower social functioning by self- and parent report. Connectedness to friends significantly mediated the relationship between diagnostic category and self-reported social functioning, such that youth with BT who reported being more connected to friends also indicated greater social functioning. Analyses using connectedness to peers and/or parent-reported social functioning were nonsignificant.

Conclusions: Perceiving a connection to a friend may be a protective factor that could mitigate deficits in social functioning in youth with BT. Additional research is needed to further assess the potential benefits of this construct.
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http://dx.doi.org/10.1002/pbc.27607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428615PMC
May 2019

Laparoscopic appendectomy - Outcomes of senior trainees operating without supervision versus experienced pediatric surgeons.

J Pediatr Surg 2019 Feb 7;54(2):276-279. Epub 2018 Nov 7.

Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address:

Aim Of The Study: Pediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent operative decision-making skills. We reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to experienced pediatric surgeons.

Methods: We reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 pediatric surgery trainees during their last year of training (first 50 cases of each trainee). We compared the outcomes of those 500 cases to the outcomes of 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 cases of each surgeon). Data are expressed as mean (SD), unless otherwise indicated. A P value of ≤0.05 was regarded as significant.

Main Results: Median age in the "trainees" and "surgeons" groups was 11 (range 2-22) and 12 (2-20) years, respectively (P = 0.35). The proportion of perforated appendicitis was similar: 98/500 (19.6%) in the trainees group and 42/200 (21%) in the surgeons group, respectively (P = 0.75). Mean operative time was 41 (SD 14.5) min in the trainees group vs. 39 (SD 16.1) min in the surgeons group (P = 0.05). Minor intraoperative complications occurred in 3/500 (0.6%) cases in the trainees group vs. 1/200 (0.5%) in the surgeons group (P = 0.69). No major complications occurred in either group. Mean hospital stay was 2 (range 0.5-26) and 2.3 (range 0.5-18) days in the trainees and surgeons groups, respectively (P = 0.25). There were 13/500 vs. 5/200 readmissions (P = 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (P = 0.91).

Conclusion: Allowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision to stimulate surgical autonomy is safe and does not compromise patient outcomes.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.10.092DOI Listing
February 2019

A quality improvement project to improve pediatric medical provider sleep and communication during night shifts.

Int J Qual Health Care 2019 Oct;31(8):633-638

Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-101, Memphis, TN, USA.

Quality Problem Or Issue: Night-shift medical providers frequently experience limited sleep resulting in fatigue, often because of paging activity. Streamlined medical-specific communication interventions are known to improve sleep and communication among these providers.

Initial Assessment: We found that non-urgent paging communication occurred frequently during night-shifts, leading to provider sleep disturbances within our institution. We tested a quality improvement (QI) intervention to improve paging practices and determined its effect on provider sleep.

Choice Of Solution: We used a Plan-Do-Study-Act QI model aimed at improving clinician sleep and paging communications.

Implementation: We initially conducted focus groups of nurses and physician trainees to inform the creation of a standardized paging intervention. We collected actigraphy and sleep log data from physicians, nurse practitioners, and physician trainees and performed electronic collection of paging frequency data.

Evaluation: Data were collected between December 2015 and March 2017 from pediatric residents, pediatric hematology/oncology (PHO) fellows, hospitalist medicine nocturnists and nurses working during night-shift hours in PHO inpatient units. We collected baseline data before implementation of the QI intervention and at 1 month post-implementation. Although objective measures and provider reports demonstrated improved medical-specific communication paging practices, provider sleep was not affected.

Lessons Learned: Provider-based standardization of paging communication was associated with improved medical-specific communication between nurses and providers; however, provider sleep was not affected. The strategies used in this intervention may be transferable to other clinics and institutions to streamline medical-specific communication.
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http://dx.doi.org/10.1093/intqhc/mzy221DOI Listing
October 2019

Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Mental Health and Addictions.

J Acad Nutr Diet 2018 10;118(10):1975-1986.e53

In 2016, there were 44.7 million adults affected by mental illness, and 20.1 million people aged 12 years or older affected by substance use disorder. More than 8.2 million Americans are afflicted with co-occurring disorders or dual diagnosis, such as both a mental illness and an addiction. Registered dietitian nutritionists (RDNs) have an important role in the treatment of this population, as optimizing nutrition status improves cognitive and emotional functioning. The Behavioral Health Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Mental Health and Addictions for three levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for care of individuals with mental illness and/or addictions. The SOPP describes six domains that focus on professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs caring for individuals with, or specializing in, mental health and addictions and practicing in other mental health and addictions-related areas, including research. The SOP and SOPP are intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
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http://dx.doi.org/10.1016/j.jand.2018.07.013DOI Listing
October 2018

Adjustment in Childhood Cancer Survivors, Healthy Peers, and Their Parents: The Mediating Role of the Parent-Child Relationship.

J Pediatr Psychol 2019 03;44(2):186-196

Department of Psychology, St. Jude Children's Research Hospital.

Objectives: Aims were to (1) determine whether the associations between parent psychological functioning and adjustment outcomes of childhood cancer survivors (CCS) were mediated by the parent-child relationship and (2) examine possible differences in pathways for CCS and healthy peers.

Method: The study included CCS (n = 206), healthy peers (n = 132), and their primary caregivers. Youth (8-21 years) reported on the quality of the parent-child relationship and on their positive and negative adjustment outcomes. Parents reported on their own distress, posttraumatic growth, quality of the parent-child relationship, and their child's positive and negative adjustment outcomes. Two mediation models were tested, first examining youth-reported adjustment as the outcome and second examining parent-reported youth adjustment. Differences between model path coefficients of CCS and healthy peers were assessed by multigroup analyses.

Results: In the youth-reported model, the parent-child relationship mediated the relation between parental distress and adjustment, with more care leading to better youth-reported adjustment outcomes and more overprotection leading to poorer adjustment outcomes. In the parent-reported model, relational frustration and attachment mediated the link between parental distress/growth and parent-reported youth adjustment, with more relational frustration and less attachment relating to poorer youth adjustment outcomes. Multigroup analyses revealed no differences in model path coefficients between CCS and healthy peers.

Conclusions: Parental distress and the parent-child relationship likely play an important role in both youth- and parent-reported adjustment, and associations among these constructs do not differ between CCS and healthy peers. Families with less optimal parental functioning may benefit from interventions improving the quality of parent-child interactions.
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http://dx.doi.org/10.1093/jpepsy/jsy069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365093PMC
March 2019

Parent-reported executive functioning in young children treated for cancer.

Child Neuropsychol 2019 05 26;25(4):548-560. Epub 2018 Jul 26.

a Department of Psychology , St. Jude Children's Research Hospital , Memphis , TN , USA.

It is well known that children treated for cancer are at risk for cognitive and functional impairments. Such research is largely based on studies of late effects in school-aged or older children. However, far less is known about executive function weaknesses in preschool-aged children treated for cancer. Thus, the aim of this study was to examine executive functioning in a clinically referred sample of young oncology patients, and its association with broader domains of functioning. Data from 61 young children with cancer, who were referred for clinical cognitive evaluations, were abstracted and included in this study. Patients were 5.00 years of age (SD = 0.72) at assessment, 54.1% male, and two-thirds (63.9%) had been treated for brain tumors. Most executive functions were significantly discrepant from the mean, with 47.5% of preschoolers having parent-reported working memory concerns within the clinically significant range. There were no differences in executive functioning based on diagnosis or treatment status. Parent-reported executive functioning was strongly correlated with global intelligence and adaptive functioning, with some indices also associated with nonverbal problem solving and pre-academic skills. Ultimately, results indicate the presence of emerging weaknesses in executive functioning in young children with cancer, and add to a growing body of literature highlighting the potential cognitive and behavioral risks associated with a cancer diagnosis in early childhood.
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http://dx.doi.org/10.1080/09297049.2018.1503647DOI Listing
May 2019

Patient factors associated with sperm cryopreservation among at-risk adolescents newly diagnosed with cancer.

Cancer 2018 09 5;124(17):3567-3575. Epub 2018 Jul 5.

Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas (retired).

Background: Although survivors of adolescent-onset cancers are at risk of infertility, the majority desire children. Fertility preservation options are available for adolescents, but sperm banking remains underused. To the authors' knowledge, patient factors that influence decisions to bank sperm are poorly understood.

Methods: A cross-sectional study of 146 adolescent males who were newly diagnosed with cancer and who completed surveys within 1 week of treatment initiation was performed. Participants, 65% of whom were white, were aged 13 to 21 years (mean, 16.49 years; standard deviation, 2.02 years) and were at risk of infertility secondary to impending gonadotoxic treatment. Participating institutions included 8 leading pediatric oncology centers across the United States and Canada.

Results: Of the patients approached, approximately 80.6% participated. Parent recommendation to bank (odds ratio [OR], 4.88; 95% confidence interval [95% CI], 1.15-20.71 [P = .03]), higher Tanner stage (OR, 4.25; 95% CI, 1.60-11.27 [P < .01]), greater perceived benefits (OR, 1.41; 95% CI, 1.12-1.77 [P < .01]), and lower social barriers to banking (OR, 0.88; 95% CI, 0.81-0.96 [P < .01]) were found to be associated with adolescent collection attempts, whereas meeting with a fertility specialist (OR, 3.44; 95% CI, 1.00-11.83 [P = .05]), parent (OR, 3.02; 95% CI, 1.12-8.10 [P = .03]) or provider (OR, 2.67; 95% CI, 1.05-6.77 [P = .04]) recommendation to bank, and greater adolescent self-efficacy to bank (OR, 1.16; 95% CI, 1.01-1.33 [P = .03]) were found to be associated with successful sperm banking.

Conclusions: Adolescents' perceived benefits of sperm banking, higher Tanner stage, and parent recommendation were associated with collection attempts, whereas perceived social barriers decreased this likelihood. Successful banking was associated with greater adolescent self-efficacy, parent and provider recommendation to bank, and consultation with a fertility specialist. Providers should consult with both adolescents and parents regarding fertility preservation, and interventions should be tailored to address barriers to sperm banking while promoting its benefits.
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http://dx.doi.org/10.1002/cncr.31596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191330PMC
September 2018

Youth and parent perceptions of parenting in childhood cancer survivors and healthy peers.

Support Care Cancer 2018 Dec 3;26(12):4143-4149. Epub 2018 Jun 3.

Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.

Purpose: Having a child diagnosed with cancer may have a long-term impact on parenting practices. The aims of this study were to (a) examine possible differences in youth and parent perceptions of parenting between childhood cancer survivors and healthy comparisons, (b) determine the concordance between youth and parent perceptions of parenting, and (c) explore differences in parent-youth concordance between survivors and healthy comparisons.

Methods: Participants were youth aged 8-18 years (N = 170 childhood cancer survivors, N = 114 healthy comparisons) and one of their parents. All patients were ≥ 3 years from diagnosis (M = 6.52, SD = 3.60). Both youth (Parental Bonding Instrument (PBI)) and parents (Parenting Relationship Questionnaire (PRQ)) reported on their perceptions of parenting. Two separate MANCOVA's (PBI and PRQ) were conducted to determine possible differences between childhood cancer survivors and healthy peers. Concordance between youth and parent perceptions of parenting was examined.

Results: Survivors did not differ from healthy peers in their perception of parental care and overprotection (p = .890). Likewise, parents in the survivor and healthy peer groups did not differ in their perceptions of involvement, attachment, communication, confidence, or relational frustration (p = .360). Youth's report of a caring parent-child relationship was positively associated with parent-reported involvement, attachment, communication, and parenting confidence and negatively associated with parent-reported relational frustration. Youth-perceived overprotection was positively associated with parent-reported relational frustration. No differences were found in parent-youth concordance between survivors and healthy comparisons.

Conclusion: A history of childhood cancer does not appear to adversely influence parenting behavior, as perceived by both youth and their parents.
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http://dx.doi.org/10.1007/s00520-018-4285-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204097PMC
December 2018

Surgical outcomes of pancreaticoduodenal injuries in children.

Pediatr Surg Int 2018 Jun 5;34(6):641-645. Epub 2018 Apr 5.

Division of Pediatric Surgery, Department of Surgery, Primary Children's Hospital, University of Utah School of Medicine, 100 N. Mario Cappechi Drive, Suite 3800, Salt Lake City, UT, 84113, USA.

Purpose: To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center.

Methods: We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.1.0.

Results: 170 children presented with pancreatic and/or duodenal injury. 13 (7.7%) suffered a combined injury and this group forms the basis for this report with mean ISS of 22.8 (± 15.1), RTS2 of 6.4(± 2.1), and median age of 6.6 (1.3-13.5) years. Child abuse (31%) and bicycle injuries (23%) were the most common mechanisms. 8/13 (61.5%) required operative intervention. Higher AAST pancreatic and duodenal injury grade (2.9 vs. 1.2, p = 0.05 and 3.6 vs. 1.4, p = < 0.01), lower RTS2 (7.84 vs. 5.49, p < 0.01), and lower GCS (9.6 vs. 15, p = 0.03) predicted operative intervention. 6/8 (75%) undergoing surgery survived to discharge with only (2/6) survivors suffering postoperative complications. Both mortalities were secondary to severe traumatic brain injury.

Conclusion: Surgical management of complex pancreaticoduodenal injury is an uncommon traumatic event that is associated with high injury severity, but survival occurs in most scenarios.
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http://dx.doi.org/10.1007/s00383-018-4249-xDOI Listing
June 2018

Accurate understanding of infertility risk among families of adolescent males newly diagnosed with cancer.

Psychooncology 2018 04 20;27(4):1193-1199. Epub 2018 Feb 20.

Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.

Objective: To examine patient and parent understanding of infertility risk (relative to oncologists' risk ratings) among adolescents newly diagnosed with cancer, and to identify background factors related to inaccurate reporting/estimating.

Methods: Male patients (N = 137; aged 13-21) and their parents completed self-report questionnaires. Those who reported a fertility-related conversation with their provider (N = 102 adolescents, N = 74 parents) reported their infertility risk (ie, what oncologist had communicated) and all participants' estimated risk (ie, personal belief). Reports/estimates were compared with oncologists' ratings to assess relative accuracy, and regression analyses assessed potentially related background factors.

Results: Participants' agreement of their risk reports with the oncologist was poor (κ = .079/.122 for adolescents/parents), resulting in most adolescents (59.8%) and parents (58.7%) inaccurately reporting risk. Older adolescents were less likely to overreport risk (OR = 0.69; 95% CI, 0.49-0.97) and parents of sons with the highest Tanner stage were less likely to underreport (OR = 0.28; 95% CI, 0.08-0.92). Risk estimates were also in poor agreement with oncologists' ratings among adolescents (κ = .040) and parents (κ = .088). Accordingly, incongruent estimates occurred in most adolescents (63.7%) and parents (62.2%), although all reported fertility-related conversations with their providers.

Conclusions: Most adolescents and parents inaccurately reported infertility risk, and more poorly estimated risk. Research is needed to identify additional factors associated with accurate understanding of cancer-related infertility risk. Providers should be supported with user-friendly educational tools to promote awareness of infertility risk.
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http://dx.doi.org/10.1002/pon.4646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392008PMC
April 2018

Parental influences on sperm banking attempts among adolescent males newly diagnosed with cancer.

Fertil Steril 2017 12;108(6):1043-1049

Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, Texas.

Objective: To investigate the influence of parental sociodemographic, communication, and psychological factors on sperm collection attempts among at-risk adolescent males newly diagnosed with cancer.

Design: Prospective, single group, observational study design.

Setting: Pediatric oncology centers.

Patient(s): Parents (N = 144) of 122 newly diagnosed adolescent males at increased risk for infertility secondary to cancer therapy.

Intervention(s): Survey-based assessment of parent factors associated with adolescent collection attempts.

Main Outcome Measure(s): Attempt of manual collection of sperm.

Result(s): Parental recommendation to bank sperm (odds ratio [OR] 3.72; 95% confidence interval [CI] 1.18-11.76) and perceived self-efficacy to facilitate banking (OR 1.20; 95% CI 1.02-1.41) were associated with an increased likelihood of making a collection attempt.

Conclusion(s): Parental recommendation to bank is a critical influence for sperm banking among adolescent males newly diagnosed with cancer. These findings highlight the importance of effective communication between parents, patients, and health-care teams when discussing preservation options. Parent perceptions of their ability to facilitate sperm banking at the time of diagnosis should also be targeted in future interventions.

Clinical Trial Registration Number: NCT01152268.
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http://dx.doi.org/10.1016/j.fertnstert.2017.08.039DOI Listing
December 2017

Prevalence and Predictors of Sperm Banking in Adolescents Newly Diagnosed With Cancer: Examination of Adolescent, Parent, and Provider Factors Influencing Fertility Preservation Outcomes.

J Clin Oncol 2017 Dec 4;35(34):3830-3836. Epub 2017 Oct 4.

James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children's Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children's Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children's Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children's Hospital, Salt Lake City, UT.

Purpose To estimate the prevalence of sperm banking among adolescent males newly diagnosed with cancer and to identify factors associated with banking outcomes. Patients and Methods A prospective, single-group, observational study design was used to test the contribution of sociodemographic, medical, psychological/health belief, communication, and developmental factors to fertility preservation outcomes. At-risk adolescent males (N = 146; age 13.00 to 21.99 years; Tanner stage ≥ 3), their parents, and medical providers from eight leading pediatric oncology centers across the United States and Canada completed self-report questionnaires within 1 week of treatment initiation. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs for specified banking outcomes (collection attempt v no attempt and successful completion of banking v no banking). Results Among adolescents (mean age, 16.49 years; standard deviation, 2.02 years), 53.4% (78 of 146) made a collection attempt, with 43.8% (64 of 146) successfully banking sperm (82.1% of attempters). The overall attempt model revealed adolescent consultation with a fertility specialist (OR, 29.96; 95% CI, 2.48 to 361.41; P = .007), parent recommendation to bank (OR, 12.30; 95% CI, 2.01 to 75.94; P = .007), and higher Tanner stage (OR, 5.42; 95% CI, 1.75 to 16.78; P = .003) were associated with an increased likelihood of a collection attempt. Adolescent history of masturbation (OR, 5.99; 95% CI, 1.25 to 28.50; P = .025), banking self-efficacy (OR, 1.23; 95% CI, 1.05 to 1.45; P = .012), and parent (OR, 4.62; 95% CI, 1.46 to 14.73; P = .010) or medical team (OR, 4.26; 95% CI, 1.45 to 12.43; P = .008) recommendation to bank were associated with increased likelihood of sperm banking completion. Conclusion Although findings suggest that banking is underutilized, modifiable adolescent, parent, and provider factors associated with banking outcomes were identified and should be targeted in future intervention efforts.
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http://dx.doi.org/10.1200/JCO.2016.70.4767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707206PMC
December 2017

Cognitive and Psychosocial Functioning of Preschool-Aged Children with Cancer.

J Dev Behav Pediatr 2017 Oct;38(8):638-645

*Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN; †Department of Psychology, University of Memphis, Memphis, TN.

Objective: Most children with cancer are diagnosed in early childhood, potentially resulting in missed developmental opportunities. The most common diagnoses-brain tumors, leukemia-are also associated with increased risk of neurocognitive deficits. Unfortunately, research regarding the functioning of preschool-aged children with cancer is limited. Our objective is to describe the cognitive and psychosocial functioning of preschool-aged children with cancer who completed a clinical evaluation at a hospital-based psychology clinic.

Methods: Assessment data from 98 preschool-aged children with cancer (M = 5.17 years old, SD = 0.54; 54.1% male) who completed clinically referred evaluations from 2011 to 2015 were abstracted. Because of variability in assessment measures used across clinicians, indicators of cognitive, adaptive, preacademic, and emotional/behavioral functioning were collapsed before analyses.

Results: Children were 2.56 years from diagnosis (SD = 1.46, range 0-5.25 years) and most were off therapy (79.6%). Primary diagnostic categories were represented: brain tumor (68.4%), solid tumor (15.3%), and leukemia (16.3%). Mean IQ scores were significantly below expectations (t[80] = -7.95, p < .001). There were no differences based on diagnostic category, treatment status, or sex. Adaptive functioning (t[73] = -8.42, p < .001) and preacademic skills (t[77] = -6.20, p < .001) were also significantly below expectations. Mean scores on a measure of parent-reported emotional/behavioral functioning were in the average range.

Conclusion: Young children with cancer may be at significant risk of deficits in intellectual, adaptive, and preacademic functioning. Although our sample is biased by those who were referred for clinical evaluations, the severity of deficits highlights the potential vulnerability of young patients, even before most have entered formal school. Interventions-such as hospital-based preschool programs to increase preacademic skills-should be designed that explicitly target preschool-aged children and focus on a wide range of domains.
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http://dx.doi.org/10.1097/DBP.0000000000000512DOI Listing
October 2017

Human Papillomavirus Vaccination Rates in Young Cancer Survivors.

J Clin Oncol 2017 Nov 24;35(31):3582-3590. Epub 2017 Aug 24.

James L. Klosky, Melissa M. Hudson, Kathryn M. Russell, Gina Sabbatini, Jessica S. Flynn, and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; Yanjun Chen, Liton Francisco, Jocelyn M. York, Smita Bhatia, and Wendy Landier, University of Alabama-Birmingham, Birmingham, AL; James A. Connelly, University of Michigan, Ann Arbor, MI and Vanderbilt University, Nashville, TN; Karen Wasilewski-Masker, Emory University and Children's Healthcare of Atlanta, Atlanta, GA; Can-Lan Sun, Laura Gustafson, and F. Lennie Wong, City of Hope, Duarte, CA; and Anna R. Giuliano, Moffitt Cancer Center, Tampa, FL.

Purpose Cancer survivors are at high risk for human papillomavirus (HPV)-related morbidities; we estimated the prevalence of HPV vaccine initiation in cancer survivors versus the US population and examined predictors of noninitiation. Methods Participants included 982 cancer survivors (9 to 26 years of age; 1 to 5 years postcompletion of therapy); we assessed HPV vaccine initiation, sociodemographic and clinical characteristics, and vaccine-specific health beliefs; age-, sex-, and year-matched US population comparisons were from the National Immunization Survey-Teen and the National Health Interview Survey (2012-2015). Results The mean age at the time of the study was 16.3 ± 4.7 years; the mean time off therapy was 2.7 ± 1.2 years; participants were 55% male and 66% non-Hispanic white; 59% had leukemia/lymphoma. Vaccine initiation rates were significantly lower in cancer survivors versus the general population (23.8%; 95% CI, 20.6% to 27.0% v 40.5%; 95% CI, 40.2% to 40.7%; P < .001); survivors were more likely to be HPV vaccine-naïve than general population peers (odds ratio [OR], 1.72; 95% CI, 1.41 to 2.09; P < .001). Initiation in adolescent survivors (ages 13 to 17 years) was 22.0% (95% CI, 17.3% to 26.7%), significantly lower than population peers (42.5%; 95% CI, 42.2% to 42.8%; P < .001). Initiation in young adult survivors and peers (ages 18 to 26 years) was comparably low (25.3%; 95% CI, 20.9% to 29.7% v 24.2%; 95% CI, 23.6% to 24.9%). Predictors of noninitiation included lack of provider recommendation (OR, 10.8; 95% CI, 6.5 to 18.0; P < .001), survivors' perceived lack of insurance coverage for HPV vaccine (OR, 6.6; 95% CI, 3.9 to 11.0; P < .001), male sex (OR, 2.9; 95% CI, 1.7 to 4.8; P < .001), endorsement of vaccine-related barriers (OR, 2.7; 95% CI, 1.6 to 4.6; P < .001), and younger age (9 to 12 years; OR, 3.7; 95% CI, 1.8-7.6; P < .001; comparison, 13 to 17 years). Conclusion HPV vaccine initiation rates in cancer survivors are low. Lack of provider recommendation and barriers to vaccine receipt should be targeted in vaccine promotion efforts.
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http://dx.doi.org/10.1200/JCO.2017.74.1843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662846PMC
November 2017

Provider Influences on Sperm Banking Outcomes Among Adolescent Males Newly Diagnosed With Cancer.

J Adolesc Health 2017 Mar 18;60(3):277-283. Epub 2016 Dec 18.

Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Fertility Associates of Memphis, Memphis, Tennessee.

Purpose: The purpose of this study was to examine provider communication and sociodemographic factors which associate with sperm banking outcomes in at-risk adolescents newly diagnosed with cancer.

Methods: A prospective single-group quasi-experimental study design was used to test the contributions of provider factors on sperm banking outcomes. Medical providers (N = 52, 86.5% oncologists) and 99 of their at-risk adolescent patients from eight leading pediatric oncology centers in North America completed questionnaires querying provider factors and patient sperm banking outcomes. Logistic regression with single covariates was used to test each provider factor as a potential correlate of the two binary sperm banking study outcomes (collection attempt/no attempt and successful sperm bank/no bank). Multicovariate logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for specified banking outcomes.

Results: Fertility referral (OR, 9.01; 95% CI, 2.54-31.90; p < .001) and provider comfort/skills in negotiating barriers to sperm banking with families (OR, 1.94; 95% CI, 1.03-3.63; p < .04) were associated with collection attempts. Adolescents who were referred for a specialized fertility consultation were also almost five times more likely to successfully bank (OR, 4.96; 95% CI, 1.54-16.00; p < .01) compared to those who were not.

Conclusions: Provider training in communicating/managing adolescents and their families about sperm banking, and increasing utilization of fertility preservation referrals, should increase the proportion of at-risk males preserving fertility before treatment initiation.
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http://dx.doi.org/10.1016/j.jadohealth.2016.10.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674772PMC
March 2017