Background and Aims

Every child in Ukraine has realized that new concepts have appeared in life, including "air alarm", "bombing", "war" from February 24, 2022. Children undergoing cancer treatment are forced to hide for weeks with the medical team and parents in basements, storage facilities of the hospital to save their lives. The evacuation of families to safe cities and countries continues, and we are grateful to everyone who has joined this rescue process.

Methods

The supervision group of 10 oncopsychologists, a new questionnaire indicators of well-being and methods of psychological assistance were created.Psychological assistance was provided to 187 children with cancer and 115 parents, during war - 82 and 32 respectively.

Results

70% of psychologists left their homes and moved to safer (conditionally) cities in Ukraine. 85% of children and their parents received crisis psychological assistance. The first states in adults were deceleration, stupor (60%); denial (60%), awareness of the horror of events (50%); anger (20%); fear, felling of irreversibility (20%). In children: anger (50%), fear (43%), sadness for home and family (20%). The most effective steps of self-help to self-stabilization in psychologists: contact with relatives, breathing practices, development of a plan for different cases, actively involved in the identity of the psychologist; in children: art techniques to release emotions, establishing frequent supportive contact in all possible ways with adults. Approximately 77% of children and their families were evacuated to other countries to continue treatment (which was the main fear of parents). 2 children lost their lives, 21 children live in the occupied territories and we haven't contact with them.

Conclusions

Oncology is always a challenge for both parents and children. Being a cancer patient during the war is a double test on resilience, where adult support has an important role. The war should not deny life, especially for those children who are already personally fighting for it.

Background and Aims

Paediatric medical traumatic stress (PMTS) is a set of children’s and their parents’ psychological and physiological responses to pain, injury, serious illnesses, and other experiences with the medical environment. Paediatric cancer patients have the highest prevalence of PMTS as the illness involves a set of stressors that trigger many negative psychological reactions. Posttraumatic stress symptoms (PTSS) are one of the most common psychopathologies among cancer patients. We examined the incidence of PMTS in children with cancer and their parents due to coping with a serious illness and treatment complications. We analysed the following risk factors for PTSS: selected groups of individuals, medical interventions, complications, and treatment modalities.

Methods

The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at Clinical Department of Paediatric Haematology and Oncology of Paediatric Clinic in Ljubljana. We collected the data using The Intensity of treatment rating scale 2.0 [IRT-2], PTSD checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5].

Results

PMTS is frequently present in both, children and their parents, regardless of the cancer type, treatment duration, treatment outcome, and child’s age. Mothers, patients with relapse, patients who were diagnosed after age 5, patients with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post cancer diagnosis and that parents are more traumatized than children.

Conclusions

The systematic prevention of PMTS and endeavour of trauma-informed care are required.

Background and Aims

As childhood cancer survivors (CCSs) may experience psychosocial late effects, we investigated psychosocial distress in a South African cohort.

Methods

CCSs ≥18 years, treated at the Tygerberg hospital paediatric oncology unit 1983 – 2012, completed the Brief Symptom Inventory-18 questionnaire. Cronbach’s alpha values were 0.91 (Global Severity Index (GSI)), 0.85 (depression), 0.83 (somatisation) and 0.75 (anxiety). We compared results utilising GSI T scores of ≥50, ≥57 and ≥63. Data collection included demographic data, socioeconomic status, diagnosis, treatment, and cancer-related late effects.

Results

Forty CCSs (male: female 0.54:1) with a mean age at questionnaire completion of 24.2 years (median 24; 18 - 51 years) were included. The mean follow-up period was 16.6 years; median 7 years. The majority (23/40;58%) completed school or tertiary education; most were unmarried (36/40; 90%). The cancer diagnoses included haematological malignancies (26/40; 65%) and solid tumours (14/40; 35%). Treatment modalities were chemotherapy (13/40; 32.5%), chemotherapy and surgery (8/40;20%), chemo- and radiotherapy (9/40;22.5%), chemotherapy, surgery, and radiotherapy (6/40; 15%), surgery (1/40; 2.5%) and other (3/40;7.5%). Survivors had a mean number of cancer-related late effects of 5.5.

Using a GSI T score of ≥63 identified 4/40 (10%) of survivors with psychological distress, while a score of ≥57 identified 13/40 (32.5%) and ≥50 identified 18/40 (45%). Only radiotherapy (p = 0.035) (odds ratio 4.6) and number of cancer-related late effects per survivor (p=0.039) (odds ratio 1.89) were significantly associated with the presence of psychological distress.

Conclusions

This South African cohort’s level of psychosocial distress was at the higher end of ranges reported in the literature: 45% versus 30% and 44.3% utilising a GSI T score of ≥50 and 32.5% versus 13-31.2% utilising a score ≥57. Significant contributing factors were radiotherapy and the number of cancer-related late effects. Survivors with psychosocial distress on screening should be formally psychologically assessed.

Background and Aims

Measurable residual disease (MRD) at the end of induction therapy (EOI) is a strong survival predictor in childhood acute lymphoblastic leukemia (ALL). In middle-income countries (MIC), validity has not been systematically assessed, which is the first step for MRD routine implementation in clinical practice. We assessed the prognostic capability of MRD evaluation at EOI in a B-ALL cohort in Colombia.

Methods

We prospectively collected data in children (<15 years) with ALL in ten Colombian cities included in VIGICANCER (Childhood Cancer Surveillance System). In Colombia, MRD is performed by multiparametric flow cytometry (FACS), following EuroFlow protocols and performed at different institutions without central review or validation. We assessed the performance of EOI MRD and associated event-free survival (EFS) by using Kaplan-Meier and Cox regression methods.

Results

During the study period (2019-2021), 871 patients with B-ALL were included, with median age of 5.5 years (IQR: 3,10). Fifty-two percent were male and 9% were afro-descendants/native-Colombians. Negative MRD (<0.01%) was reported in 74% of patients, low (0.01-0.09%) in 19%, intermediate (1.00-4.99%) in 4% and high (≥5%) in 3%. MRD results were unavailable in 12% of patients. Six hundred ninety-seven patients with EOI MRD contributed to the survival analysis. Twenty-four-months EFS was 89% (95%CI: 85, 92), 68% (95%CI: 56, 77), 41% (95%CI: 18, 62), and 37% (95% CI: 11, 64) in patients with negative MRD, low MRD, intermediate MRD and high MRD, respectively (P-value <0.001). Adjusted hazard rates were 2.7 (95%CI: 1.7, 4.2) for low MRD, 6.1 (95%CI: 3.1, 12.2) for intermediate, and 3.9 (95%CI: 1.9, 8.4) for high. Cumulative mortality at EOI was 6%.

Conclusions

Despite diagnosis capabilities constraints in Colombia, EOI MRD, as measured with FACS, retains its prognostic significance. Our findings support the development of standardized treatment strategies, that include EOI MRD evaluation for risk stratification of B-ALL, in our country and other MIC.

Background and Aims

Management of malnutrition in children with cancer remains a challenge in Low- Middle Income Countries (LMICs). We describe our paediatric oncology nutrition program and its impact over the past decade.

Methods

We evaluated the impact of our nutrition program in accordance with the International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP-PODC) Nutritional Program Evaluation in the areas of service delivery (number served, increments in delivery, number of trained care providers), patients at-risk (proportion identified with malnutrition at diagnosis/ follow-up) and efficiency of nutritional interventions (proportion assessed, proportion achieved healthy weight, clinicians trained ). We analyzed available data for trends between 2009 and 2020, and comparisons were made using the fisher’s t test. This study was approved by our Institutional Ethics Committee.

Results

From 2010 to 2020, 17749 children treated at our centre were beneficiaries of the nutritional program, including assessment and intervention. During this period, trained paediatric nutritionists increased from 2 to 8; SIOP-PODC level from 2 to 3-4, and nutrition budget increased 15-fold. At diagnosis (n=5618) and 6-month follow-up (n=2674), 59.6% and 51.2% children were undernourished, 34.8% and 43% well-nourished and 4.7% and 5.7% overnourished. From 2016 onwards, fewer children were undernourished at follow-up - 69.5% (2016), 60% (2018), 54% (2019) and 55% (2020, p<0.001). The program helped train over 500 clinicians in nutrition.

Conclusions

Improved financial support and capacity building have helped build and sustain an effective nutrition program. Priority areas include implementation of best practices, early nutritional intervention, continued education and locally relevant research.