Body composition, dietary intake and physical activity of young survivors of childhood cancer

To describe the body composition, dietary intake and physical activity and of paediatric, adolescent and young adult childhood cancer survivors (CCS) and examine the factors that impact body composition after treatment.This prospective cross-sectional study involved 74 subjects who were at least three years post treatment. Measurements included anthropometry, whole body potassium counting, air displacement plethysmography, and three day physical activity and diet diaries.The CCS had significantly reduced body cell mass index Z-scores compared to controls (p\ua0=\ua00.0001), with 59% considered undernourished. The CCS had a significantly higher percent fat (p\ua0=\ua00.002) than the controls, with 27% classified as obese. The intake of 60% of CCS met estimated energy requirements, but the CCS consumed high amount of energy from fat and low amount of energy from carbohydrates. A high percentage of CCS did not meet their dietary requirements for calcium (61%), magnesium (46%), folate (38%) and iodine (38%). The CCS group had a light active lifestyle with 64% spending more than 2\ua0h daily on screen time. Receiving a bone marrow transplant (r\ua0=\ua0-0.27; p\ua0=\ua00.02) and physical activity level (r\ua0=\ua00.49; p\ua0=\ua00.0001) were significantly correlated with body cell mass index.This study demonstrates that increased fat mass and decreased body cell mass is a concern for CCS and that CCS have poor health behaviours including light active lifestyles, excessive screentime, high fat intake, and poor intake of essential nutrients. This study has highlighted that CCS are at risk of both obesity and undernutrition and that increasing body cell mass as well as decreasing fat mass should be a focus of energy balance interventions in survivorship. There is a need for parents and children undergoing treatment for cancer to be educated about diet quality and importance of daily physical activity to ensure healthy habits are established and maintained into survivorship

Addressing the barriers to optimal management of febrile neutropenia in children with cancer

Purpose: Fever and associated neutropenia presentations are frequent occurrences for children with cancer. Prompt treatment is required to prevent adverse outcomes; however, delays are common. In Australia's vast landscape, presentations occur in both tertiary metropolitan sites and smaller regional sites. Management and experiences differ between sites. Our primary aim was to identify the barriers to optimal management of febrile neutropenia in children with cancer from patient/parent and clinician perspectives. Methods: A mixed methods approach was used where quantitative data was supplemented by qualitative data. Data were prospectively collected from parents (n=81) and clinicians (n=42) about all children who presented with fever across multiple diverse hospital locations. A subset of parents (n=9) and clinicians (n=19) completed semi-structured interviews. Results: Delays in assessment and treatment were reported by 31% of parents and up to 36% of clinicians. Four distinct time points where delays occurred were identified: 1) pre-presentation; 2) initial assessment; 3) blood collection and establishing intravenous access, and 4) preparation and administration of antibiotics. Although reasons for delay were diverse, they were primarily related to clinician's knowledge and awareness of fever management, and intravenous access device factors. Interventions were formulated to target these barriers and streamline processes. Conclusion: We identified multifactorial reasons for delays at different time points in care. Regional centres and families have unique needs which require considerations and tailored interventions. Ongoing education, monitoring compliance with initiation of practice changes and identifying and overcoming barriers as they arise are strategies for improving management of the febrile child with cancer

Parental perceptions of the informed consent process in pediatric oncology clinical trials

Background: The integrity of good clinical practice in clinical trials is underpinned by the informed consent process; however the stress of a life threatening diagnosis challenges the absorption of information and may affect the parent’s ability to understand diagnosis, treatment plans and the consent process. Aims: The aim of this study was to explore and describe parental perceptions of the informed consent process in pediatric oncology clinical trials. Methods: A cross-sectional survey was used to collect responses from 50 parents of children aged 8-16 years, enrolled on a clinical trial, one month after diagnosis at an Australian tertiary pediatric oncology centre. Results: The majority of parents (47, 94%) agreed that they understood the diagnosis and information regarding the purpose of the clinical trial. Parents relied primarily on their Oncology consultant for this information. Parents discussed the diagnosis with their children although only 60% (n=30) felt that their child understood the treatment and trial process. Conclusions: Parents indicated that the current process of providing information regarding the clinical trial process met their needs and that they were able to provide informed consent. They were unsure however, of how involved they wanted their children to be in treatment decisions

Body composition of children with cancer during treatment and in survivorship

Background: Malnutrition as assessed with the use of body-composition measurements is a poorly understood short- and long-term complication of childhood cancer

Exposure to diagnostic radiological procedures and the risk of childhood acute lymphoblastic leukemia

Background: Diagnostic irradiation of the mother during pregnancy increases the risk of childhood acute lymphoblastic leukemia (ALL). There is inconsistent evidence on associations between ALL and other parental or childhood diagnostic irradiation. The aim of this analysis is to investigate whether diagnostic X-rays of the mother before birth, of the father before conception, or of the child increased the risk of childhood ALL. Methods: Data from 389 cases and 876 frequency-matched controls were analyzed using unconditional logistic regression, adjusting for study matching factors and potential confounders. A meta-analysis of our findings in relation to paternal X-rays before conception with the published findings of previous studies was also conducted. Results: There was no evidence of an increased risk with maternal abdominal X-rays before the birth of the index child or with the child having any X-rays more than 6 months before the censoring date. The odds ratio (OR) for any paternal abdominal X-ray before conception was 1.17 [95% confidence interval (95% CI), 0.88-1.55], and 1.47 (95% CI, 0.98-2.21) for more than one X-ray. The OR for any paternal intravenous pyelogram before conception was 3.56 (95% CI, 1.59-7.98). The pooled OR for this study with previous studies of any paternal abdominal X-rays before conception was 1.17 (95% CI, 0.92-1.48). Conclusions: There was some evidence of an increased risk of ALL in the offspring if the father had more than one abdominal X-ray before conception or had ever had an intravenous pyelogram. Impact: We plan to repeat this analysis by using pooled data to improve precision