A protective effect of childhood vaccinations on leukemia risk, particularly acute lymphoblastic leukemia (ALL), has been hypothesized, though findings are inconsistent. We used a nationwide cohort of Danish children born 1997-2018 (n = 1,360,230), to examine associations between childhood vaccinations and leukemia (<20 years) using registry data (follow-up: December 31, 2018). Cox proportional hazard models with age as the underlying time estimated hazard ratios (HRs) for leukemia (any, ALL, acute myeloid [AML], and other), comparing vaccinated with unvaccinated children. We also accessed the effect of each additional vaccine dose. During 14,536,819 person-years, 771 children were diagnosed with leukemia (74% ALL, 16% AML, and 10% other). Any vaccination was associated with an increased HR for ALL (HR: 2.76; 95% CI: 0.66-11.58), compared to unvaccinated children, with a change in HR of 1.01 (95% CI: 0.96-1.05) per dose. The corresponding HRs for any leukemia, AML, and other leukemia were 1.04 (95% CI: 0.50-2.17), 0.67 (95% CI: 0.18-2.59) and 0.29 (95% CI: 0.09-0.99), with a change in HR of 0.97 (95% CI: 0.94-1.02), 0.92 (95% CI: 0.84-1.00, p = .062) and 0.88 (95% CI: 0.78-1.00, p = .044) per dose. No significant associations were found for vaccination types, except for the pneumococcal vaccine which was associated with a decreased risk of other leukemia (HR: 0.32; 95% CI: 0.14-0.74). In six-months lag analyses, no significant associations were observed, and decreased risks were attenuated. The results provide no strong evidence that childhood vaccinations reduce leukemia risk. The limited number of unvaccinated cases and wide confidence intervals suggest cautious interpretation of some findings.

The International Agency for Research on Cancer (IARC) Regional Hub in Mumbai provides technical support to population-based cancer registries (PBCRs) in South and South-East Asian (SSEA) countries. For data management and incidence rate table generation, the Hub recommends CanReg5, an open-source registry software developed by IARC, to all PBCRs seeking support from it. However, CanReg5 is limited in generating mortality and paediatric cancer incidence tables. Several SSEA cancer registries requested the Hub to develop practical solutions to facilitate the generation of cancer rates statistics. The IARC Regional Hub, in Mumbai, subsequently developed Nirmiti, an innovative web application which is capable of generating incidence, mortality, and paediatric cancer rates based on provided input data. The application accepts registry data in a specific format and generates required tables according to the selected options; users can input data from CanReg5 or other software into Nirmiti for processing. Nirmiti generates childhood cancer rates for age-groups 0-14 and 0-19, based on the 12 main groups and 47 subgroups of the International Incidence of Childhood Cancer, Volume 3, and is freely available to cancer registries upon request. The application has been successfully utilized by PBCRs in India, Sri Lanka, and Bhutan.

Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications.

This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event-free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes.

Eighty-two patients (median [interquartile range] 3.9 (1.9-8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000-1.002, p = 0.032). Higher ferritin was associated with increased number of treatment-related complications (B = 7.3E-5, 95% CI = 1.5E-5-0.000, p = 0.013). Folate status showed significant association with body mass index category (χ2 = 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (F(2.9); p = 0.06; -2LL (1381)). Haematological malignancies (F(2.8); p = 0.05; -2LL (4244)) and medium and high treatment intensity (F(2.4); p = 0.09; -2LL 4262)) were associated with higher ferritin levels over 18 months.

Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large-scale population-based studies and clinical trials are now warranted.

Malnutrition in pediatric oncology patients is a serious clinical condition. There is a need for standardized nutrition screening in pediatric oncology patients, as nutrition screening can offer a simple method to identify children with cancer at risk of malnutrition. This study aimed to determine the validity of a Turkish version of nutrition screening tool for childhood cancer (SCAN) in identifying the risk of malnutrition among children with cancer.

A cross-sectional study was conducted with 78 children with cancer admitted to the pediatric hematology-oncology unit of a university hospital. In the first stage of this study, SCAN was translated into Turkish, and in the second stage, the validity of SCAN against pediatric Subjective Global Nutritional Assessment (SGNA) and Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) malnutrition criteria were evaluated.

Patients had a median age of 8.0 years (range, 2-18 years; IQR, 5-14 years), 61.5% were male, and 60.3% were diagnosed with leukemia. According to SCAN, 53.8% had high risk of malnutrition. Validation of SCAN against pediatric SGNA showed that SCAN has a sensitivity of 97.5%, specificity of 94.5%, and accuracy of 96.1%.

The risk of malnutrition is common in children with cancer. The Turkish version of the SCAN is a simple, quick, and valid tool to determine the risk of malnutrition in children with cancer. Further research is needed to understand the impact of nutrition interventions on clinical outcomes in children at risk for malnutrition based on SCAN.

Many childhood cancer survivors (CCS) do not receive long-term follow-up care. We investigated the association of patient characteristics and neighborhood-level social determinants of health (SDOH) with follow-up.

CCS (N = 354) diagnosed 2013-2022 at age <18 years were identified from cancer registries at two urban hospitals. Demographics and cancer history were abstracted from the cancer registries, supplemented by electronic health record data. Vital status was ascertained from the National Death Index. Neighborhood-level SDOH was measured with social vulnerability index, childhood opportunity index, and area deprivation index. Outcomes included survivorship clinic attendance ≥ 2 years posttherapy and any ambulatory visit ≥3 and ≥5 years posttherapy at the hospitals.

Survivorship clinic attendance was 52% ≥2 years posttherapy. Nonattendance was associated with adolescent age at diagnosis (42% for 11-17 vs. 65% for 6-10 years; p = 0.012), non-Hispanic Black race and ethnicity versus non-Hispanic White (32 vs. 57%, p = 0.048), and central nervous system (CNS) versus hematologic cancer (19 vs. 54%, p = 0.0005). The frequency of any ambulatory visit declined from 60% ≥3 years posttherapy to 40% ≥5 years posttherapy. Although 60% of CNS cancer survivors remained in ambulatory follow-up ≥5 years posttherapy, only 19% attended survivorship clinic. In multivariate analyses, neighborhood-level SDOH measures were not associated with follow-up.

There was a substantial drop in follow-up among CCS from 3 to 5 years posttherapy. Future studies of follow-up should focus on engagement of CNS cancer survivors, patients diagnosed during adolescence, and minority groups.

Cancer and its treatments can affect dental health of childhood cancer survivors. We aimed to evaluate the prevalence of dental problems in survivors, compare them to their siblings, and investigate cancer-related risk factors.

As part of the population-based Swiss Childhood Cancer Survivor Study, we sent questionnaires inquiring about dental problems to survivors aged 5-19 years and their siblings. We retrieved cancer-relevant information from the Swiss Childhood Cancer Registry and used logistic regressions to compare dental problems between survivors and siblings and to investigate cancer-related risk factors.

We included 735 survivors and 144 siblings. Almost half of survivors and siblings reported at least one dental problem. Compared to siblings, CCS might be more likely to have hypo- or microdontia (odds ratio [OR] 1.7; 95% CI: 0.9-3.2) and enamel hypoplasia (2.2; 0.8-6.0), but seem to be similarly likely to have cavities or cavity-related tooth loss (0.8; 0.6-1.3). Chemotherapy was associated with enamel hypoplasia (3.0; 1.2-10.4), cavities or cavity-related tooth loss (1.5; 1.0-2.3), and gum problems during (23.0; 9.4-76.2) and after (4.6; 2.0-13.5) treatment. Hematopoietic stem cell transplantation (HSCT) was related to hypo- or microdontia (5.4; 2.6-10.7), cavities or cavity-related tooth loss (2.1; 1.2-3.6), and gum problems during treatment (2.0; 1.2-3.6). For hypo- or microdontia and cavities, associations with treatment were driven by patients diagnosed before the age of 5 years.

Childhood cancer survivors treated with chemotherapy or HSCT, especially at a young age, might be more likely to have dental problems. Regular dental check-ups guided by healthcare teams and dental hygiene habits can mitigate risks and promote survivor's long-term dental health.

Background/Objectives: This population-based study examined epidemiological trends of primary cancers in adolescents and young adults (AYAs) to enhance the understanding of the specific spectrum of cancers impacting AYAs in Belgium. Methods: Data on incidence, prevalence, mortality, and survival were obtained from the Belgian Cancer Registry (2004-2020, N = 43,535). (A)APC statistics were compared with children (5-14 years) and adults (40-49 years). Results: Cancer incidence increased by 0.4% annually from 66 to 80 per 100,000 person-years (ESR2013) but stabilised after 2015, except for Hodgkin lymphoma, chronic myeloid neoplasms, and testicular and breast cancer, which continued to rise. Mortality decreased by 1% annually, from 10 to 7 per 100,000 person-years (2004-2019). Five-year relative survival (RS) was 87% but remained low for certain cancers, including ovary (78%), central nervous system (67%), precursor haematopoietic neoplasms (64%), gastrointestinal (excl. colorectal) (49%), and lung-bronchus-trachea cancers (42%). Conclusions: From 2004-2020, the cancer burden among AYAs in Belgium increased due to improved survival, while incidence stabilised after 2015. Five-year RS exceeds 80% overall but remains lower for some cancers compared to children (e.g., precursor haematopoietic neoplasms) or older adults (e.g., breast cancer, sarcoma). The Belgian epidemiological trends align with those in neighbouring countries (Netherlands, France, Germany).

Childhood cancer survivors (CCS) are at risk of pulmonary dysfunction due to cancer treatments, but evidence on prevalence and risk factors remains limited. Most previous studies had small sample sizes or retrospective study designs, little information about treatments, or a lack of standardization of pulmonary function tests (PFTs) or limited their investigation to certain PFTs. Since spirometry mainly assesses the large airways but cancer therapy also affects peripheral airways, additional functional tests are needed. The nitrogen multiple breath washout test (N2MBW) is sensitive to peripheral airway damage in other patient populations, but its benefit in CCS is unknown. Therefore, comprehensive and standardized evaluation of pulmonary function after cancer treatment in childhood, using different PFTs that include N2MBW, is needed to address these knowledge gaps and provide insights into possible early stages of pulmonary dysfunction.

In the Swiss Childhood Cancer Survivor Study (SCCSS) FollowUp-Pulmo, we will comprehensively assess lung function in children and adolescents after treatment for cancer to identify risk factors for pulmonary dysfunction, assess the ability of N2MBW to detect pulmonary dysfunction compared to other PFTs, and investigate the association of functional outcomes from PFTs with self-reported respiratory symptoms.

SCCSS FollowUp-Pulmo is a prospective multicenter longitudinal cohort study embedded in routine clinical care that enrolls CCS aged 6-20 years for whom at least 1 year has passed since a childhood cancer diagnosis, who have completed treatment, and who attend regular pediatric oncological follow-up care. Inclusion criteria comprise any of the following: systemic anticancer treatment (chemotherapy, immunotherapy, or targeted agents), thoracic surgery, thoracic radiotherapy, or hematopoietic stem cell transplantation (HSCT). CCS undergo a standardized pulmonary assessment, including spirometry, body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), and N2MBW, and complete a questionnaire on respiratory symptoms and lifestyle. Data from previous and subsequent routine care PFTs will be included in this study.

Recruitment started in June 2022 at the University Children's Hospital Bern, Switzerland. Subsequently, patient recruitment expanded to the University Children's Hospitals in Basel and Geneva, Switzerland. By October 2024, we had invited 220 patients, of which 201 have already participated in this study, resulting in a response rate of 91%. Their median age at the time of the study was 14 years (IQR 10-17), and the median time since diagnosis was 7 years (IQR 4-10). The study will continuously enroll new CCS.

This study will contribute to a comprehensive understanding of pulmonary function in CCS and assess related risk factors, as well as the utility of N2MBW compared to other PFTs. The results will assist in the development of more targeted screening and risk-stratified follow-up care.

ClinicalTrials.gov NCT04732273; https://clinicaltrials.gov/study/NCT04732273.

DERR1-10.2196/69743.

To evaluate the reliability, construct, and criterion validity of the screening tool for childhood cancer (SCAN), stratified by age in oncology patients admitted to a tertiary referral hospital.

Hospitalized children from birth to 18 years old, with an oncological diagnosis and expected length of stay (LOS) of >24 hours were included. Interrater and intrarrater agreements were used to evaluate the reliability of SCAN. Construct validity and criterion validity were explored in SCAN. Also, predictive validity was explored by comparing SCAN risk categories against LOS.

Three hundred ninety-four children were included in the study. The scores obtained after dietitians and physicians used SCAN showed good agreement (ICC = 0.80, 95%CI 0.71-0.86, P < 0.001). The intrarrater agreement within the evaluation of the same dietitian to the same group of patients was also good (ICC = 0.83, 95%CI 0.75-0.88, P < 0.001). After applying SCAN, 66.2% of participants scored >3 points, classified as at risk of malnutrition. The agreement observed when comparing the risk classification given by the tool with the malnutrition assessment using anthropometry variables as the criterion reference was fair (κ = 0.22, 95%CI 0.15-0.29, P < 0.001). Predictive validity indicated a slight agreement (κ = 0.16, 95%CI 0.08-0.25, P < 0.001) between malnutrition risk by SCAN and LOS. When assessing construct validity, comparing the scores given by SCAN with those provided by STRONGkids, a fair agreement was found (κ = 0.21, 95%CI 0.15-0.26, P < 0.001).

Our results show that SCAN is a reliable and valid tool for detecting malnutrition in oncology pediatric patients upon hospital admission.

Having a child with cancer can profoundly impact parents' health-related quality of life (HRQOL). However, there is a lack of knowledge about the long-term effects of childhood cancer on parents' well-being. The current study aimed to (1) describe the HRQOL of parents of long-term childhood cancer survivors (CCS) and compare it with that of parents from the general population in Switzerland, and (2) investigate sociodemographic and cancer-related determinants of lower HRQOL in parents of CCS.

In this cross-sectional study, a total of 751 parents of CCS (mean time since diagnosis = 23.7 years, SD = 6.7 years) and 454 parents from the general population reported their HRQOL by completing the Short Form-36 (SF-36v2). Sociodemographic and cancer-related characteristics were also collected.

Multilevel regression analyses showed that parents of CCS and parents from the general population had similar physical and mental HRQOL. When comparing mothers and fathers separately, there were no differences between the samples, except for higher HRQOL in the domain of physical functioning in mothers of CCS. Cancer-related characteristics were not associated with HRQOL in parents of CCS. Several sociodemographic characteristics such as being female, being from the French or Italian-speaking part of Switzerland, having a lower education, having a chronic condition, and having a migration background were associated with lower HRQOL.

Parents of CCS are doing well a long time after their child's cancer diagnosis. Nevertheless, tailored support should be provided for at-risk demographic groups.

Background In the context of the digital era, the deep integration of the Internet and the medical field has shown two sides in the treatment and rehabilitation of children with malignant tumors. However, the problem of Internet addiction (IA) behind Internet use in these children - and its potential threat to their health status - has not yet attracted widespread attention. The main objective of this study was to investigate the impact of IA on patient-reported outcomes (PROs) in Chinese children aged 8 to 18 years with malignant tumors. Methods From October 2023 to May 2024, a continuous sampling of 300 children aged 8 to 18 with malignant tumors was conducted at the National Clinical Medical Research Center for Child Health and Diseases in Chongqing. IA was assessed using the Internet addiction test (IAT). In contrast, the Chinese version of the Pediatric Patient-Reported Outcome Measurement Information System (C-Ped-PROMIS) was used to evaluate the PROs. The relationship between these variables was analyzed using Spearman rank correlation analysis and multiple linear regression models. Results Out of 300 children, 87 (29.0%) showed signs of IA, with elementary school students having a significantly lower rate than students in middle school and above (p = 0.005). IA was positively correlated with depression (r = 0.127, p < 0.05), anger (r = 0.130, p < 0.05), anxiety (r = 0.158, p < 0.01), and fatigue (r = 0.129, p < 0.05) scores. Multiple linear regression analysis showed that elevated IAT scores were significant negative predictors of depression, anger, anxiety, and fatigue (all p < 0.05). Conclusion Children aged 8 to 18 years with malignant tumors face a higher risk of IA, which is closely related to some self-reported outcomes. Healthcare professionals should pay attention to the Internet usage issues of children with malignant tumors, guiding them to use the Internet wisely to improve their mental health and overall well-being.

Medical tourism is defined as travel outside one's home country to seek medical care. International travel for medical care can have financial, logistical, and ethical implications for patients, families, and accepting institutions. Data on medical tourism in pediatrics are sparse, especially for care of rare or life-threatening diseases such as cancer. To our knowledge, this study provides the first description of international patients seeking medical care in the United States for oncologic and hematologic diseases.

We performed a retrospective review of international patients seen at St Jude Children's Research Hospital from August 2, 2009, through June 30, 2019. These included patients with acceptance obtained through the referral process and those who arrived without approval (walk-in patients). Demographic and clinical data were collected and analyzed using descriptive statistics.

Of the 372 international patients seen, most identified as White (n = 258; 69.4%) and not Hispanic (n = 232; 62.4%). A minority (n = 23; 6.2%) arrived as walk-in patients. The highest number of patients was from the Latin America and Caribbean region (n = 181; 48.7%) and from upper-middle-income countries (UMICs) (n = 182; 48.9%). Six patients (1.6%) were from low-income countries (LICs). Oncologic diagnoses were the most common reason for referral, with a similar distribution of accepted patients across hematologic, CNS, and non-CNS solid tumors although hematologic malignancies predominated among walk-in patients (n = 17; 81%).

International patients came to the United States from across the world, mostly through formal acceptance. However, there were more patients from UMICs at our institution than from low- and middle-income countries and LICs. Additional studies are needed to investigate this observation which supports the continuous need for global capacity-building collaborations in pediatric oncology.

Diabetes is a potential late consequence of childhood and young adult cancer (CYAC) treatment. Causative treatments associated with diabetes have been identified in retrospective cohort studies but have not been validated in population-based cohorts. Our aim was to define the extent of diabetes risk and explore contributory factors for its development in survivors of CYAC in the U.K.

Cancer registration data (n = 4,238) were linked to electronic health care databases to identify cases of diabetes through clinical coding or HbA1c values. Total effect of prespecified treatment exposures on diabetes risk was estimated using flexible parametric modeling and standardized cause-specific cumulative incidence functions (CIFs).

After median follow-up of 14.4 years, 163 individuals (3.8%) were identified with diabetes. Total body irradiation (TBI) increases diabetes risk over time, with a 40-year CIF reaching 21.0% (95% CI 13.8-31.9) compared with 8.4% (95% CI 6.1-11.5) without TBI. Survivors treated with corticosteroids had a 7.7% increased risk at 40 years after cancer diagnosis. Hematopoietic stem cell transplant (HSCT) survivors had markedly higher risk, with a 40-year CIF of 19.6% (95% CI 13.4-28.6) versus 8.2% (95% CI 6.0-11.3) for patients who had not undergone HSCT. Among patients who received allogeneic HSCT, the 40-year CIF of diabetes was 25.7% (95% CI 17.4-38.0), compared with 7.9% (95% CI 3.3-19.1) in patients who received autologous transplants.

This evaluation of a hospital-based cohort of patients with CYAC identifies these patients' increased long-term risk of developing diabetes and how this varies temporally according to treatment modalities. Notable contrasts in risk by treatment were detected as early as 10 years after cancer diagnosis. Findings should inform the development of risk-stratified evidence-based screening.

The epidemiology of childhood cancer in Afro-descendant (AD) populations is poorly described. We performed a descriptive study of the distribution, incidence, and survival of children with cancer in the French West Indies (FWI) and French Guiana (FG).

We included all patients aged 0-17 diagnosed with cancer or benign intracranial tumor between January 2011 and December 2021 and living in the FWI/FG area at time of diagnosis. The cases were identified from the French national registry of childhood cancer and cross-referenced with local sources. Incidence rates were calculated, and compared to that of mainland France by standardized incidence ratios (SIR). Vital status was completed up to the 31st of December 2023 (date of point). Relapses were identified and documented in pediatric reference centers in mainland France and local centers. The 5-year overall survival (5yOS) and event-free survival (5yEFS) were estimated using Kaplan-Meier method.

We identified 368 patients (26% leukemias, 21% central nervous system tumors, 12% lymphomas, and 41% others). The average age at diagnosis was 8.8 years (Range: 0.1-17.8), with 52% boys. The median follow-up was 4.4 years (Range: 0.1-12.3). The age standardized rates for all cancers was lower than in mainland France (124.9 vs 162.6 per million-year for children under 18 years old, SIR = 0.77 [95% CI: 0.69-0.85]). The 5yOS was 78.9% [95% CI: 73.9-83.0] and 5yEFS was 69.3% [95% CI: 63.9-74.0]. The 5yOS for the 0-14 age group was 81.2% [95% CI: 76.9-85.5].

This first registry-based study of childhood cancer in the FWI and FG shows that our patients with childhood cancer, treated in a country with a high standard of health care, has resulted in overall survival comparable to that of European and North American children.

The authors received no financial support.

The VersKiK-study is based on a record-linkage between the German Childhood Cancer Registry (GCCR) and claims data from statutory health insurances (SHI) in order to investigate the frequency of late effects and long-term medical care among pediatric cancer survivors.GCCR defined a basic population of approximately 50,000 former patients with cancer in childhood or adolescence (years of diagnosis 1991-2021) who survived until 1.1.2017. Encrypted GCCR identity data were stochastically linked with encrypted identity data from 13 SHI. For those cancer patients who could be identified in SHI records (study population), claims data covering 2017-2021 were added and combined with basic GCCR information on cancer diagnosis. A comparison between identified cancer patients and those who were not identified in SHI records was made to evaluate the representativeness of the study population for quantitative analyses.A total of 26,127 former childhood cancer patients were identified in SHI data. Since the participating SHI represent approximately two-thirds of the German population, the record linkage could be judged as satisfactory (84% matching rate). We found no significant differences between the study population and the non-matched group regarding age, sex, primary cancer diagnosis, and year of diagnosis.The identified study population is considered representative for survivors of childhood cancer in Germany.

Purpose: Cardiovascular risk factors (CVRFs) later in life potentiate risk for late cardiovascular disease (CVD) from cardiotoxic treatment among survivors. This study evaluated the association of baseline CVRFs and CVD in the early survivorship period. Methods: This analysis included patients ages 0-29 at initial diagnosis and reported in the institutional cancer registry between 2010 and 2017 (n = 1228). Patients who died within 5 years (n = 168), those not seen in the oncology clinic (n = 312), and those with CVD within one year of diagnosis (n = 17) were excluded. CVRFs (hypertension, diabetes, dyslipidemia, and obesity) within 1 year of initial diagnosis were constructed and extracted from the electronic health record based on discrete observations, ICD9/10 codes, and RxNorm codes for antihypertensives. Results: Among survivors (n = 731), 10 incident cases (1.4%) of CVD were observed between 1 and 5 years after the initial diagnosis. Public health insurance (p = 0.04) and late effects risk strata (p = 0.01) were positively associated with CVD. Among survivors with public insurance (n = 495), two additional cases of CVD were identified from claims data with an incidence of 2.4%. Survivors from rural areas had a 4.1 times greater risk of CVD compared with survivors from urban areas (95% CI: 1.1-15.3), despite adjustment for late effects risk strata. Conclusion: Clinically computable phenotypes for CVRFs among survivors through informatics methods were feasible. Although CVRFs were not associated with CVD in the early survivorship period, survivors from rural areas were more likely to develop CVD.

Childhood cancer survivors (CCS) experience an elevated burden of health complications, underscoring the importance of understanding the patterns of multimorbidity to guide the management of survivors with complex medical needs.

We examined the patterns of hospitalisations with multimorbidity in 5-year CCS (n = 2938) and age- and sex-matched non-cancer comparisons (n = 24,792) using statewide records of inpatient admissions in Western Australia from 1987 to 2019.

Multimorbidity rates were higher for CCS (10.6, 95%CI 10.2-10.9) than for non-cancer comparisons (3.2, 95%CI 3.2-3.3). CCS exhibited a significantly higher adjusted hazard ratio of multimorbidity, particularly when admitted for neoplasms (14.6, 95%CI 11.2-19.1), as well as blood (7.3, 95%CI 4.9-10.7), neurological and sensory (5.2, 95%CI 4.2-6.6), and cardiovascular (3.6, 95%CI 2.6-4.8) diseases. By the age of 55 years, chronic multimorbidity was more prevalent in survivors than in comparisons (14.5% vs. 5.3%). Psychiatric disorders were common comorbidities, particularly in those admitted for neurological and sensory (71.1%), endocrine (61.5%), and digestive (59.3%) diseases. Multimorbidity during hospitalisation increased the length of hospital stay (p < 0.05). Key condition clusters included (1) psychoactive substance  dependence, alcohol misuse, and other mental disorders; (2) hypertension, diabetes, kidney disease, and musculoskeletal diseases; (3) epilepsy, hypothyroidism, and other liver diseases; and (4) hypertension, kidney disease, and other liver diseases.

These findings suggest that exposure to cancer in childhood elevates the risk of multimorbidity. The reconfiguration of healthcare delivery to enhance personalised care and clinical integration is essential for effectively managing multimorbidity in this population.

Central nervous system (CNS) tumors are the leading cause of cancer-related deaths in children. Although most cases come from low- and middle-income countries (LMIC) where their prognosis is worse, few epidemiologic studies are conducted in these regions.

We conducted a registry-based cohort study for childhood CNS tumors at Children's Cancer Hospital, Egypt, over 15 years. Unified treatment protocols were implemented. Survival analyses were conducted using the Kaplan-Meier function. Cases were additionally annotated using the International Classification of Childhood Cancer-3 classification.

In total, 5,051 children ≤18 years of age were identified, accounting for 20% of all childhood cancers treated at Children's Cancer Hospital, Egypt. The most common tumor sites were the posterior fossa (36.8%) and brainstem (17.7%). Pathologies were predominantly astrocytic (n = 1,360; 26.9%) and embryonal (n = 1,003; 19.9%) in origin. The 5-year overall survival (OS) and event-free survival for all cases were 64.6% and 51.8%, respectively. More specifically, 1,421 low-grade gliomas were identified, with a 5-year OS of 91.1%. Medulloblastoma (n = 801) recorded a 5-year OS of 66%. The entity with the worst prognosis was diffuse intrinsic pontine glioma (n = 633), with a 5-year OS of 3.2%.

We report on a large number of childhood CNS tumors from an LMIC. This study underscores the need to understand the burden of childhood brain tumors and its outcomes in resource-constrained settings.

This study reports on the epidemiology and clinical outcomes of 5,000+ children with CNS tumors from a specialized LMIC center. Despite the lack of many sophisticated and advanced facilities, LMICs can improve the clinical end-results with experience and augmented efforts.

A cancer diagnosis early in life can leave a legacy in terms of compromised Quality of Life (QoL). There is a lack of clarity regarding the impact on QoL according to age at diagnosis, with childhood cancer survivors (CCS) and adolescents and young adult cancer survivors (AYACS) often combined. As part of an EORTC Quality of Life Group study, this umbrella review aims to (1) identify the QoL outcomes reported in the literature for both CCS and AYACS, and (2) investigate the similarities and differences in QoL challenges between both groups.

A systematic literature search of systematic reviews and meta-analyses was conducted in December 2023 using PubMed, PsychInfo, and CINAHL. Methodological quality was evaluated using the AMSTAR tool.

Overall, 1457 articles were assessed, and 39 systematic reviews and meta-analyses met the inclusion criteria. QoL outcomes were categorized into eight QoL domains, all of which were reported in both groups of young survivors. However, reviews on CCS often focused on outcomes relating to emotional functioning, cognitive difficulties, social challenges, school functioning, body image and overall happiness, whereas AYACS reviews had a greater focus on depressive symptoms, outcomes related to sexual health and reproductive health, employment, financial difficulties, self-image and identity and the impact of cancer.

This umbrella review comprehensively explores QoL outcomes among CCS and AYACS, revealing both shared and distinct challenges. Future research should focus on developing tailored questionnaires, emphasizing transition periods and incorporating a life perspective to capture unique developmental tasks of young survivors.

Despite most childhood cancer cases being diagnosed in low- and middle-income countries, there is a significant deficit of population-based childhood cancer registries (PBCCRs) in these regions. To address this critical gap, we established India's first dedicated PBCCR in Chennai on October 4, 2022, covering children aged 0-19. This study aims to identify the barriers and enablers to implementing the Chennai PBCCR.

Between April 2023 and March 2024, a sequential explanatory mixed-method study was conducted across 10 of the 16 centers in Chennai that agreed to support the PBCCR. A total of 25 professionals agreed to participate in the quantitative phase utilizing a structured questionnaire. For the qualitative phase, in-depth interviews were conducted with 23 participants, including 16 from the quantitative phase, two stakeholders, and five caregivers. The interview guide was constructed, and the responses were analyzed using the Consolidated Framework for Implementation Research.

Themes from the qualitative analysis revealed technological constraints, poor record-keeping, insufficient details captured in case records, and inadequate human resources as impediments. At the same time, factors such as knowledge, belief in sharing high-resolution data, the requirement and advantages of implementing a childhood cancer registry, professional self-efficacy, work infrastructure, and collaborative networks emerged as facilitators to the successful implementation of PBCCR.

Our experience and the findings of this study serve as a model for successfully implementing and operating PBCCRs in India and other countries. Registry data are vital to improving the understanding of childhood cancer burden and offer hope to children and their families.

Enhancing therapy outcomes in pediatric oncology and hematology relies on robust epidemiological surveillance. This study aimed to estimate cancer stage-related survival in pediatric patients with lymphoma and solid tumors by assessing changes over time and identifying spatial clustering of patients diagnosed at advanced stages.

This retrospective observational cohort study included pediatric cancer patients treated in a single Greater Poland center, constituting 9% of Polish children from 2004 to 2017. The incidence, cancer stage, and patient coordinates were analyzed. The follow-up period ranged from 5 to 18 years. Survival differences across tumor stages were evaluated using Kaplan‒Meier curves, log-rank tests, and trend analysis. Geographical analysis was performed with Kulldorff's scan statistics and the Bernoulli model.

Among 1094 diagnosed patients, 511 with lymphoma and solid tumors were eligible. There was a decreasing trend in advanced-stage diagnoses (p = 0.0001), with a nearly twofold increase in low-stage diagnoses (OR = 1.98 [1.22; 3.24], p = 0.0061) from 2009-2011 to 2015-2017. Hazard ratios for neuroblastoma and sarcoma patients were more than fourfold greater, while survival differences were not significant for patients with nephroblastoma, germ cell tumors, or lymphoma.

This study shows cancer stage-related survival dynamics. A substantial decrease in advanced-stage diagnoses over time emphasizes improved early detection. Geographical analysis pinpointed clusters with prevalent late-stage diagnoses, offering a practical tool for targeted educational interventions. The study underscores the pivotal impact of cancer stage on survival outcomes, emphasizing the need for ongoing surveillance and tailored interventions to further optimize pediatric oncology and hematology care.

Childhood cancer is an important contributor to childhood mortality in high-income countries. Information on associations between childhood cancer and in-utero exposure is absent or limited for most medications. Signal detection methods identify medications where research should be focused but have not been applied to datasets containing prenatal medication exposures and childhood cancers.

The aim of this study was to apply and evaluate four signal detection methods - odds ratios (OR), the information component (IC), sequential probability ratio testing (SPRT), and Bayesian hierarchical models (BHM) - for identification of associations between medications dispensed during pregnancy and subsequent, incident diagnosis of childhood cancer <10 years, using linked Nordic registry data. Signal detection results were compared to propensity score adjusted odds ratios from generalized linear models.

Analysis was performed for 117 medication-cancer pairs with 5 or more observations. The OR had the greatest sensitivity (0.75). The IC had a greater specificity (0.98) than the OR (0.95).

The IC may be the most appropriate method for identifying signals within this type of data. Reported signals should not be considered sufficient evidence of causal association and must be followed-up by tailored investigations that consider confounding by indication.

The registry-based collection of detailed cancer and late effect (LE) data in childhood and adolescent cancer (CAC) is rarely explored.

We aimed to provide an overview of CAC registration practices in Europe and share a Slovenian example.

We distributed a questionnaire among European cancer registries on disease, treatment and LE registration and present the system at the Slovenian Cancer Registry along with an example of retrospectively collected LE data from a cohort of central nervous system tumour survivors from 1983 to 2000. Kaplan-Meier and Cox regression were used to calculate the LE incidence.

Out of 27 responding registries, over 80% registered cancer type, vital status, death and second primary cancer data. Less than 20% registered cumulative doses of radiation and systemic therapy or progressions. Only three registered LEs. The obstacles in setting up LE collection in registries are a lack of standardization in the variable sets, definitions and methods of collection. In the retrospective cohort, neurological and endocrine LEs were most common. Females had a higher risk of endocrine LEs (HR of 1.89; 95% CI of 1.08-3.31), while patients treated with radiotherapy had higher risks of endocrine (3.47; 1.80-6.69), musculoskeletal and skin LEs (3.16; 1.60-6.26) and second primary cancers (2.85; 1.18-6.75).

Standardization and harmonization are necessary to promote detailed CAC and LE registration.

Auditory complications are potential side effects from childhood cancer treatment. Yet, limited evidence exists about the impact of auditory complications-particularly tinnitus-on health-related quality of life (HRQoL) among childhood cancer survivors (CCS). We determined the prevalence of hearing loss and tinnitus in the European PanCareLIFE cohort of CCS and examined its effect on HRQoL.

We included CCS from four European countries who were diagnosed at age ≤ 18 years; survived ≥ 5 years; and aged 25-44 years at study. We assessed HRQoL (Short Form 36), hearing loss, and tinnitus using questionnaires. We used multivariable linear regression to examine associations between these two auditory complications and HRQoL adjusting for socio-demographic and clinical factors.

Our study population consisted of 6,318 CCS (53% female; median age at cancer diagnosis 9 years interquartile range [IQR] 5-13 years) with median age at survey of 31 years (IQR 28-35 years). Prevalence was 7.5% (476/6,318; confidence interval [CI]: 6.9-8.2) for hearing loss and 7.6% (127/1,668; CI: 6.4-9.0) for tinnitus. CCS with hearing loss had impaired physical (coefficient [coef.] -4.3, CI: -7.0 to -1.6) and mental (coef. -3.2, CI: -5.5 to -0.8) HRQoL when compared with CCS with normal hearing. Tinnitus was associated with impaired physical (coef. -8.2, CI: -11.8 to -4.7) and mental (coef. -5.9, CI: -8.8 to -3.1) HRQoL.

We observed reduced HRQoL among CCS with hearing loss and tinnitus. Our findings indicate timely treatment of hearing loss and tinnitus may contribute to quality of life of survivors.

CCS who experience auditory complications should be counseled about possible therapeutic and supportive measures during follow-up care.

There is much interest in the perinatal period in relation to childhood cancer aetiology, with most studies focussing on childhood leukaemia. This work aimed to investigate the associations between pregnancy-related and perinatal factors and childhood lymphoma.

We conducted a pooled analysis of two French nationwide population-based case-control studies. Data on sociodemographic, perinatal and lifestyle factors were collected through maternal interviews. Odds ratios (OR) and 95% confidence intervals (CIs) were computed using adjusted logistic regression models, separately for non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Specific analyses also investigated Burkitt NHL and nodular sclerosis HL, two most common histological types in children.

We included 305 NHL, 328 HL and 2415 controls in this study. No associations were observed with gestational age, foetal growth indicators, folic acid supplementation, factors related to maternal fertility and reproductive history, or maternal smoking during pregnancy. Maternal coffee consumption during pregnancy was associated with NHL (>2 cups/day, OR = 1.5 [95% CI: 1.1-2.1]), with a dose-response relationship; while maternal alcohol consumption was associated with Burkitt NHL (OR = 1.5 [1.1-2.2]). Paternal smoking during preconception/pregnancy was associated with NHL (OR = 1.4 [1.1-1.8]). Breastfeeding (ever/never) was not significantly associated with NHL and HL, but an inverse log-linear trend was observed with the duration of breastfeeding for NHL (p = 0.04).

Maternal coffee and alcohol consumptions during pregnancy and paternal smoking during preconception/pregnancy might increase the risk of childhood NHL. While warranting replication, these findings could help us better understand the aetiology of childhood lymphoma.

The number of patients with childhood cancer (CC) in sub-Saharan Africa is expected to rise over the coming years. According to the WHO Initiative for Childhood Cancer, access to care is crucial and must be guided by the needs of patients and their families. Our study explored barriers to CC treatment from a patient's perspective to guide the health care providers.

From February to September 2021, we conducted a multinational cross-sectional study with a sample from nine population-based cancer registries in nine sub-Saharan countries. Inclusion criteria comprised a cancer diagnosis according to the International Classification of Childhood Cancer, age 0-19 years, and year of diagnosis 2017-2019. A questionnaire was administered asking families about self-perceived barriers accessing surgery, radiotherapy, and chemotherapy. To assess associated factors, we conducted a multivariable regression analysis presenting the results as odds ratios (ORs).

A total of 224 patients with CC was included. The fear of treatment effects and the perceived (poor) health of the child were named most frequently as barriers for all treatment modalities (78.9% and 75.5%, respectively). For chemotherapy, respondents who indicated themselves as rich had lower odds of perceiving the (poor) health of the child as a barrier (OR, 0.06 [95% CI, 0.01 to 0.36]). For radiotherapy, long waiting time and (limited) availability in the country were more commonly barriers (OR, 7.53 [95% CI, 3.38 to 16.78]; OR, 11.11 [95% CI, 2.04 to 60.46], respectively) than for chemotherapy.

Despite known barriers such as the availability of therapy, our study additionally indicates the importance of the patients' and families' perceptions of the disease and its treatment. Further expanding measures of social support for affected families should be regarded as one of the main pillars to assure access to care.

International variation in childhood cancer survival might be explained by differences in stage at diagnosis, among other factors. As part of the BENCHISTA project, we aimed to assess geographical variation in tumour stage at diagnosis through the application, by population-based cancer registries working with clinicians, of the international consensus Toronto Childhood Cancer Stage Guidelines.

This population-based, retrospective cohort study involved 67 cancer registries from 23 European countries, Australia, Brazil, Japan, and Canada. Participating cancer registries applied the Toronto Guidelines to stage all incident cases of six childhood solid tumours-neuroblastoma, medulloblastoma, and Wilms tumour (age 0-14 years) and Ewing sarcoma, rhabdomyosarcoma, and osteosarcoma (age ≤19 years)-diagnosed between Jan 1, 2014, and Dec 31, 2017. Eligible cancer registries were those able to assign stage according to the Toronto Guidelines; information on the staging investigations conducted was collected where available. European countries were grouped by geographical area and non-European countries were considered individually. We used χ2 tests to compare stage distribution across these geographical areas and multivariable logistic models to estimate odds ratios (ORs) for metastatic stage at diagnosis, using central Europe (Austria, Belgium, France, Germany, the Netherlands, and Switzerland) as the comparison. Sensitivity analyses were conducted to overcome potential bias from non-random missing stage information for some geographical areas and cancer types.

Data from 10 937 patients with cancer (6031 [55·1%] male and 4906 [44·9%] female) were analysed. Tumour staging was complete for 93·1% (10 180 of 10 937) of patients, ranging from 88·7% (1347 of 1518 patients) with medulloblastoma to 96·5% (1083 of 1122 patients) with Ewing sarcoma. Stage distribution differed statistically by geographical area for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma, but not for Ewing sarcoma or medulloblastoma. After excluding patients with missing stage information and, for the sarcomas, patients aged 18-19 years, the proportions of patients with metastases detected at diagnosis were 50·3% with neuroblastoma (1435 of 2852 patients; including 1159 [40·6%] stage M and 276 [9·7%] stage MS), 35·1% with medulloblastoma (473 of 1347 patients; stages M1-M4), 32·6% with Ewing sarcoma (335 of 1028 patients), 29·0% with rhabdomyosarcoma (368 of 1267 patients), 25·5% with osteosarcoma (345 of 1353 patients), and 18·2% with Wilms tumour (384 of 2114 patients). After adjusting by age group, significant differences in the proportions of patients with metastases detected at diagnosis were found between geographical areas for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma.

Assessed at a population level, the stage at diagnosis shows significant variation between geographical areas for several childhood tumours. This finding highlights the need for earlier diagnosis and standardisation of investigations for distant metastases. To enable ongoing comparisons, further cooperation efforts are required between cancer registries and clinicians regarding the sustainable and standardised use of the Toronto Guidelines at diagnosis.

Children with Cancer UK and Associazione Italiana per la Ricerca sul Cancro.

Over the past decades, childhood cancer survival has increased substantially in Europe, including Denmark. However, families with fewer social resources may have benefitted less from these improvements. In this nationwide register-based study, we assessed associations between parental socioeconomic position (SEP) and 5-year relapse-free survival (RFS) and overall survival (OS) in childhood cancer patients.

All children aged <16 years diagnosed with cancer in Denmark between 1998 and 2017 were identified in the Danish Childhood Cancer Registry (N = 3245). Parents, with whom the children resided, were identified, and data on the parents' education, cohabitation status, affiliation to work market, country of origin, and vital status of the children were obtained through individual-level linkage across Danish nationwide registries. Cox proportional hazards models were used to estimate the association between SEP indicators and 5-year RFS and OS.

Tendencies towards lower 5-year RFS and OS were observed among children whose parents were unemployed/not in workforce (RFS: HR [hazard ratio] = 1.14, 95% CI [confidence interval]: 0.90-1.45, OS: HR = 1.28, 95% CI: 0.95-1.71) or from non-Western countries (RFS: HR = 1.21 95% CI: 0.96-1.52, OS: HR = 1.44, 95% CI: 1.09-1.90). Results by diagnostic groups revealed particularly low OS for children with non-central nervous system tumors whose parents were from non-Western countries (HR = 1.92, 95% CI: 1.24-2.97). Targeted strategies are needed to promote social equity and ensure optimal diagnosis, care, and management of childhood cancer across social groups.

Caring for children with solid tumors (STs) can impact caregiver's physical and mental health. Caregiver mastery, which influences psychological well-being, is vital in improving outcomes for both caregivers and children. The study aimed to investigate the relationship between caregiver mastery, anxiety, depression, fear of disease progression (FoP), caregiver burden, and the quality of life (QOL) of children with ST.

This cross-sectional study was conducted from June 2022 to April 2023 at a Grade A tertiary hospital in Shandong. Family caregivers of children with ST completed several validated measures, including the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module, the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR), the Zarit Burden Interview Scale (ZBI), the hospital anxiety and depression scale (HADS), and the Caregiver Mastery Scale. Multiple linear regression analyses assessed the relationships between FoP, caregiver burden, anxiety, depression, caregiver mastery, and children's QOL. Results were expressed as β and 95% confidence intervals (CIs).

A total of 454 caregivers participated. Caregiver mastery was positively correlated with children's QOL (β = 0.80, 95% CI: 0.20 to 1.39). Depression (β = -0.64, 95% CI: -0.83 to -0.45), anxiety (β = -0.67, 95% CI: -0.85 to -0.49), caregiver burden (β = -1.20, 95% CI: -1.60 to -0.80), and FoP (β = -0.04, 95% CI: -0.05 to -0.03) were negatively related to children's QOL. Caregiver mastery moderated the associations between depression, caregiver burden, FoP, and children's QOL, while also improving the effect of mild anxiety on QOL.

The study underscores the importance of fostering caregiver mastery to mitigate the negative impact of caregiver distress on children's QOL and improve outcomes for both caregivers and children with solid tumors.

Caregiver mastery moderates the effects of anxiety, depression, FoP, and caregiver burdenon children's QOL. Supporting caregiver mastery can alleviate caregiver burden and enhance both caregiver and child well-being.

Recent decades have witnessed tangible improvements in childhood cancer survival. However, the prognosis for children with congenital heart disease (CHD), the most prevalent birth defect, remains unclear. Due to improved survival of CHD and childhood cancer, evaluating outcomes within this intersection is important for clinical practice. We aimed to assess mortality post-cancer diagnosis among children with CHD.

We conducted a study on the population of Denmark and Sweden, born 1970-2014, with a cancer diagnosis before age 20 in the national cancer registers (end of follow-up 2015; n = 20,665). CHD diagnoses (n = 397) and recorded deaths were retrieved from national health registers. We evaluated the effect of CHD on five-year mortality post-cancer diagnosis fitting Cox proportional hazards regression.

When excluding children with Down syndrome, children with CHD had a higher five-year mortality post-cancer diagnosis compared to children without (HR 1.48, 95% CI 1.18-1.86). This was particularly notable in children with lymphoma (HR 2.17, 95% CI 1.11-4.25) and neuroblastoma (HR 2.39, 95% CI 1.11-5.15). In more recent decades (post-1990), children with CHD had similar five-year mortality as their counterparts without, except for children diagnosed with lymphoma, where mortality remained elevated (HR 3.37, 95% CI 1.65-6.89).

In this large, register-based cohort study, children with CHD fared worse post-cancer diagnosis-particularly lymphoma and neuroblastoma. While a more positive trend emerged in recent years, lymphoma-related mortality remained disproportionately high among children with CHD, underscoring the need for continued research and interventions to improve outcomes for this vulnerable group.

Childhood obesity can result in adverse health outcomes. The objectives of this study were to describe the prevalence of obesity and determine the association between obesity at cancer diagnosis and event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada.

The authors conducted a retrospective cohort study using the Cancer in Young People in Canada database, including all children with newly diagnosed cancer aged 2-18 years across Canada from 2001 to 2020. Obesity was defined as age-adjusted and sex-adjusted body mass index greater than or equal to the 95th percentile. Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity at diagnosis.

In total, 11,291 patients were included, of whom 10.5% were obese at diagnosis. In multivariable models controlling for age, sex, ethnicity, neighborhood income quintile, treatment era, and cancer categories, obesity at diagnosis was independently associated with inferior EFS (adjusted hazard ratio [aHR], 1.16; 95% confidence interval [CI], 1.02-1.32; p = .02) and OS (aHR, 1.29; 95% CI, 1.11-1.49; p = .001). The adverse prognostic impact of obesity was particularly notable for acute lymphoblastic leukemia (ALL) and central nervous system (CNS) tumors. In children with ALL (n = 3458), obesity remained associated with inferior EFS (aHR, 1.55; p = .002) and OS (aHR, 1.75; p = .002) in multivariable analysis. In patients with CNS tumors (n = 2458), obesity was also associated with inferior EFS (aHR, 1.38; p = .008) and OS (aHR, 1.47; p = .004).

In this population-based study, obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, and prominently in children with ALL and CNS tumors.

This study aims to analyze the epidemiological characteristics and clinical features of childhood malignant solid tumors in a single center in southwest China, thereby providing a reliable basis for formulating prevention and control strategies and rational allocation of resources for these tumors.

Children less than 15 years old and under-diagnosed with malignant solid tumors for the first time at Children's Hospital of Chongqing Medical University (Children's Medical Center of Southwest China) from 2000 to 2023 were selected. They were classified according to the International Classification of Childhood Cancer, Third Edition (ICCC-3). A retrospective analysis was conducted on the disease spectrum composition and trends, distribution among different age groups and genders, and hospitalization characteristics of the patients.

Over 24 years, there were a total of 4,777 cases of initial diagnosis of childhood malignant solid tumors, with a male-to-female ratio of 1.33:1. The median age was 4 years old, with 12.6% in the 0-year-old group, 41.6% in the 1 to 4-year-old group, 27.3% in the 5 to 9-year-old group, and 18.5% in the 10 to 14-year-old group. The top 3 malignant solid tumors by incidence rate were central nervous system (CNS) tumors (21.8%), neuroblastoma (17.8%), and lymphoma (13.9%). The ratio of pediatric malignant solid tumor patients to total hospital admissions rose from 0.14% in 2000 to 0.52% in 2021 but showed a declining trend after 2021. Childhood malignant solid tumors were primarily diagnosed due to the discovery of mass/occupancy (34.9%), abdominal pain/bloating (21.1%), or fever (6.3%). 74.4% of neuroblastomas and 54.7% of nephroblastomas were diagnosed at an advanced stage. 84.4% of patients underwent surgery, and 71.9% received chemotherapy, with chemotherapy rates showing an upward trend.

This study provides reliable information on the incidence characteristics and trends of childhood malignant solid tumors.

The survival of paediatric oncology patients has improved substantially in the past decades due to advances in the field of oncology. Modern cancer treatments often come with life-threatening complications, of which infection is one of the most common causes in this patient population. This study aims to investigate the prevalence and outcomes of common infections in haemato-oncology patients during their stay in paediatric intensive care unit (PICU) and to identify any factors associated with these infections.

A retrospective observational study was conducted on all children with a haemato-oncology diagnosis or who underwent haematopoietic stem cell transplantation (HSCT) and who were admitted to the Hong Kong Children's Hospital PICU over a one-year period. Infection characteristics and patient outcomes were evaluated and compared between different sub-groups. Univariable and multi-variable analyses were employed to identify risk factors associated with the development of active infection.

Forty-five (36.3%) of 124 critically ill haemato-oncology admissions to PICU were associated with infections, of which 31 (25%) admissions involved bacterial infections, 26 (20.9%) involved viral infections and 6 (4.8%) involved fungal infections. Bloodstream infection was the most common type of infection. More than half (61.3%) of the bacterial infections were due to an antibiotic-resistant strain. After adjusting for confounding variables, post-HSCT status and neutropenia were significantly associated with active infections.

Infections in critically-ill haemato-oncological patients are associated with post haematopoietic stem cell transplant status and neutropenia. Further study is warranted to review effective strategies that may mitigate the likelihood of infection in this patient population.

Spirometry-based assessment of pulmonary function has limitations in detecting pulmonary toxicity following cancer treatment with chemotherapy, haematopoietic stem cell transplantation, radiotherapy or thoracic surgery. Nitrogen single and multiple breath washout tests are sensitive in assessing peripheral airway function, and lung imaging detects structural abnormalities, but little is known about their use in paediatric cancer patients and survivors. We aimed to 1) identify studies using nitrogen single or multiple breath washout tests and/or lung imaging to assess pulmonary toxicity in paediatric cancer patients and survivors, and 2) describe reported abnormalities.

We systematically searched MEDLINE, Embase and the Cochrane Library for studies published in 1995‒2023. Eligible studies included paediatric cancer patients and survivors under 22 years of age receiving haematopoietic stem cell transplantation, chemotherapy, radiotherapy and/or thoracic surgery who underwent nitrogen single or multiple breath washout tests or lung imaging for detecting pulmonary toxicity. Two independent reviewers identified the studies, performed data extraction and assessed risk of bias.

We included 12 of 6544 publications. Three studies used nitrogen single or multiple breath washout tests, seven conducted lung imaging using computed tomography and two used both nitrogen single or multiple breath washout tests and lung imaging. Abnormal test results for nitrogen single and multiple breath washout tests and lung imaging were mainly reported following haematopoietic stem cell transplantation (67%). All studies performing lung imaging reported structural abnormalities. Study results were heterogeneous due to varying patient and methodological characteristics.

We identified a limited number of studies, mainly after haematopoietic stem cell transplantation, reporting functional and structural lung abnormalities in paediatric cancer patients and survivors. Longitudinal studies with standardised assessments using nitrogen single or multiple breath washout tests and lung imaging are needed to improve our understanding of treatment-related pulmonary toxicity.