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ObjectivesHealth status (HS)/ health-related quality of life measures, completed by self or proxy, are important outcome indicators. Most HS literature on children born preterm includes adolescents and adults with limited data at preschool age. This study aimed to describe parent-reported HS in a large national cohort of extreme preterm children at preschool age and to identify clinical and sociodemographic variables associated with HS.MethodsInfants born before 29 weeks’ gestation between 2009 and 2011 were enrolled in a prospective longitudinal national cohort study through the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-Up Network (CNFUN). HS, at 36 months’ corrected age (CA), was measured with the Health Status Classification System for Pre-School Children tool completed by parents. Information about HS predictors was extracted from the CNN and CNFUN databases.ResultsOf 811 children included, there were 79, 309 and 423 participants in 23–24, 25–26 and 27–28 weeks’ gestational age groups, respectively. At 36 months’ CA, 78% had a parent-reported health concern, mild in >50% and severe in 7%. Most affected HS attributes were speech (52.1%) and self-care (41.4%). Independent predictors of HS included substance use during pregnancy, infant male sex, Score for Neonatal Acute Physiology-II, bronchopulmonary dysplasia, severe retinopathy of prematurity, caregiver employment and single caregiver.ConclusionMost parents expressed no or mild health concerns for their children at 36 months’ CA. Factors associated with health concerns included initial severity of illness, complications of prematurity and social factors.

Arm anthropometry is a more sensitive measure of nutritional status than body mass index for age (BMI) in children with cancer, but the added utility of serum albumin remains uncertain. Concordance was determined among four forms of classifying nutritional status in a cohort of undernourished children with cancer: method 1: BMI-for-age Z score; method 2: method 1 + mid-upper arm circumference (MUAC) percentile; method 3: method 2 + triceps skinfold thickness (TSFT) percentile; and method 4: method 3 + serum albumin. Concordance was highest between methods 2 and 3, followed closely by 3 and 4, indicating that addition of arm anthropometry, but not serum albumin, to BMI increased the sensitivity of baseline nutritional assessment.

Health Utilities Preschool (HuPS) was developed to fill the need for a generic preference-based measure (GPM) applicable in early childhood. A GPM has all the properties for higher-order summary measures, such as quality-adjusted life-years, required to inform important policy decisions regarding health and healthcare services.Development was in accordance with published standards for a GPM, statistical procedures, and modeling. HuPS incorporates key components of 2 existing measurement systems: Health Status Classification System for Preschool Children and Health Utilities Index Mark 3 (HUI3). The study included a series of 4 measurement surveys: definitional, adaptational, quantificational, and evaluational health-related quality of life (HRQL). HuPS measurements were evaluated for reliability, validity, interpretability, and acceptability.Definitional measurements identified 8 Health Status Classification System for Preschool Children attributes in common with HUI3 (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain and discomfort), making the HUI3 scoring equation commensurate with HuPS health states. Adaptational measurements informed the content of attribute-level descriptions (n = 35). Quantificational measurements determined level scoring coefficients. HRQL scoring inter-rater reliability (intraclass correlation coefficient = 0.79) was excellent. Continuity of HRQL scoring with HUI3 was reliable (intraclass correlation coefficient = 0.80, P.001) and valid (mean absolute difference = 0.016, P = .396).HuPS is an acceptable, reliable, and valid GPM. HRQL scoring is continuous with HUI3. Continuity expands the applicability of GPM (HUI3) scoring to include subjects as young as 2 years of age. Widespread applications of HuPS would inform important health policy and management decisions as HUI3 does for older subjects.

Background. Low bone mineral density (osteopenia) is encountered in children with acute lymphoblastic leukemia (ALL) before, during and after treatment. Prior experience with alendronate, an oral bisphosphonate, demonstrated high tolerability and evident clinical efficacy. However, concerns have been expressed about the long-term safety and utility of such agents in children. Procedure. Of 217 children with ALL treated on Dana Farber Cancer Institute protocols 69 received alendronate for a mean of 87 weeks after dual energy X ray absorptiometry (DXA). DXA was repeated following completion of alendronate, and again 5-9 years later in a subgroup of 32 children. Lumbar spine areal bone mineral (LS aBMD) Z scores were obtained and values corrected for height, age and weight (HAW) were calculated for subjects 3-18 years of age. Results. Almost 80% (N=172) of the children remain in continuous complete remission at a mean of 14.5 years from diagnosis. Of those who receive alendronate, which was almost uniformly well tolerated, 7/69 (10.3%) relapsed compared to 19/89 (21.3%) who did not receive the drug. The mean unmodified LS aBMD Z score rose from -1.78 to -0.47. This gain was statistically significant for both unmodified (p

Families of children with cancer are confronted with unexpected out-of-pocket expenses and productivity costs associated with the diagnosis. One productivity cost that falls on children is the impact of cancer on children’s school attendance, performance, and activities (eg, play, friendships, and socialization). Nested within the Childhood Cancer Cost Study, this qualitative descriptive study used convenience sampling to recruit and interview parents of children newly diagnosed with cancer. Content analysis techniques were used to inductively descriptive the semistructured interview data. Sixty-six parents of 65 children with cancer and of 73 siblings participated. The most commonly reported productivity loss in children with cancer was school absenteeism mainly due to cancer treatment. Children fell behind their classmates academically and lost important social time with peers. A few siblings also fell behind their peers primarily due to limited parental attention. Parents adopted various strategies to lessen the impact of the diagnosis on their children’s school attendance, performance, and activities. Providing parents with additional resources and support may optimize their children’s academic and social reintegration into school.

This manuscript proves maturity of GaN-on-Si technology for the world’s first highly reliable 650V GaN HEMT [2],[3],[4],[5],[6],[7],[8] by demonstrating three years of manufacturing data of since ramp. This technology was initially developed in a pilot line in Transphorm Goleta, CA and then later ported into a Si-CMOS compatible 6-inch foundry at AFSW(Aizu Fujitsu Semiconductor Wafers Solution Ltd). Data set generated from over three thousand wafers worth of data spread over three generations of technology nodes covering multiple products and packages post qualification is presented Silicon manufacturing processes are employed including gold- free, and avoiding the use of evaporation/liftoff typical to compound semiconductors. Best practice of defect detection, failure analysis and process control methods from Si manufacturing industry have been employed to maintain and improve yield for this new technology. Probe yield and line yield for the GaN process now matches that of mature Si-CMOS process running in the same fabrication facility[1]. Wide bandgap high-speed and high- voltage GaN devices significantly reduce the system size and improve energy efficiency of power conversion in all areas of electricity conversion, ranging from PV inverters to electric vehicles. The results below demonstrates that GaN high volume production is now a reality.

Gallium Nitride (GaN) is now a popular choice for power conversion. High voltage (HV) GaN HEMTs (GaN FETs) in the range of 650–900 volts are emerging as the next standard for power conversion. This paper highlights key successes in efficient and compact converters/inverters ranging from high performance gaming/crypto-mining power supplies, titanium class server power, servo drives, PV inverters, and automotive OBCs, dc-dc converters, pole charges. The reasons for market success including unmatched quality & reliability, high volume GaN on Si manufacturing, robust performance in applications as well as challenges to achieve the full potential of GaN FETs are presented.

After successful qualification under JEDEC requirements as well as Automotive (Q101) requirements [1], [2], along with the establishment of intrinsic lifetimes with associated failure modes [2], high voltage GaN is now ramping in converter/inverter applications. Among the key applications, compact & high efficiency (including Titanium class) Power supplies for uses such as high performance gaming & cryptocurrency mining as well as data center power are leading the way [3]. Automotive uses including onboard chargers (uni/bi-directional), dc-dc converters and pole chargers are being designed in. Finally industrial users have adopted GaN for compact Servo drives and PV inverters [4]. This paper will review the design, performance and manufacturability of high voltage GaN, establishment of the highest level of quality and reliability standards and key features that led to market ramp.

Adoption of any semiconductor technology by the power conversion market requires the understanding of fundamental failure modes, acceleration factors and reliability statistics. This study shows how GaN products from Transphorm can meet this challenge, especially in the critical High Voltage Off State (HVOS) reliability stress test. The anticipated failure rate during a product's first 10 to 20 years of use is of particular interest as it has direct impact on warranty costs. This market requirement can be addressed by testing to failure statistically significant samples of devices, and analyzing the data with appropriate models. The methods developed for measuring GaN reliability on large samples will be discussed, which are wholly based on existing industrial and automotive standards. The resulting data can be used to supplement qualification testing results when the failure modes and acceleration factors are well understood.

Osteoporotic fractures are a significant cause of morbidity in acute lymphoblastic leukemia (ALL). Our objective was to determine the incidence and predictors of fractures and recovery from osteoporosis in pediatric ALL over 6 years following glucocorticoid initiation. Vertebral fractures (VF) and vertebral body reshaping were assessed on annual spine radiographs, low-trauma non-VF were recorded at regular intervals and spine bone mineral density (BMD) was captured every 6 months for 4 years and then annually. A total of 186 children with ALL were enrolled (median age 5.3 years; range, 1.3 to 17.0 years). The cumulative fracture incidence was 32.5% for VF and 23.0% for non-VF; 39.0% of children with VF were asymptomatic. No fractures occurred in the sixth year and 71.3% of incident fractures occurred in the first 2 years. Baseline VF, cumulative glucocorticoid dose, and baseline lumbar spine (LS) BMD Z-score predicted both VF and non-VF. Vertebral body reshaping following VF was incomplete or absent in 22.7% of children. Those with residual vertebral deformity following VF were older compared to those without (median age 8.0 years at baseline [interquartile range {IQR}, 5.5 to 9.4] versus 4.8 years [IQR, 3.6 to 6.2], p = 0.04) and had more severe vertebral collapse (median maximum spinal deformity index 3.5 [IQR, 1.0 to 8.0] versus 0.5 [IQR, 0.0 to 1.0], p = 0.01). VF and low LS BMD Z-score at baseline as well as glucocorticoid exposure predicted incident VF and non-VF. Nearly 25% of children had persistent vertebral deformity following VF, more frequent in older children, and in those with more severe collapse. These results suggest the need for trials addressing interventions in the first 2 years of chemotherapy, targeting older children and children with more severe vertebral collapse, because these children are at greatest risk for incident VF and subsequent residual vertebral deformity. © 2018 American Society for Bone and Mineral Research.

Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.

Objectives: The purpose of this article was to determine the incidence and predictors of vertebral fractures (VF) during the 4 years after diagnosis in pediatric acute lymphoblastic leukemia (ALL). Patients and Methods: Children were enrolled within 30 days of chemotherapy initiation, with incident VF assessed annually on lateral spine radiographs according to the Genant method. Extended Cox models were used to assess the association between incident VF and clinical predictors. Results:Atotal of 186 children with ALL completed the baseline evaluation (median age, 5.3 years; interquartile range, 3.4 -9.7 years; 58% boys). The VF incidence rate was 8.7 per 100 person-years, with a 4-year cumulative incidence of 26.4%. The highest annual incidence occurred at 12 months (16.1%; 95% confidence interval [CI], 11.2-22.7), falling to 2.9% at 4 years (95% CI, 1.1-7.3). Half of the children with incident VF had a moderate or severe VF, and 39% of those with incident VF were asymptomatic. Every 10 mg/m2 increase in average daily glucocorticoid dose (prednisone equivalents) was associated with a 5.9-fold increased VF risk (95% CI, 3.0 -11.8; P < .01). Other predictors of increased VF risk included VF at diagnosis, younger age, and lower spine bone mineral density Z-scores at baseline and each annual assessment. Conclusions: One quarter of children with ALL developed incident VF in the 4 years after diagnosis; most of the VF burden was in the first year. Over one third of children with incident VF were asymptomatic. Discrete clinical predictors of a VF were evident early in the patient's clinical course, including a VF at diagnosis.

Renal cell carcinoma (RCC) is an uncommon tumor in childhood and adolescence, and is exceptionally rare as a secondary neoplasm related to prior anti-neoplastic therapy. We report a case of RCC with Xp11.2 translocation in a 17 year old boy who is a survivor of stage 4 neuroblastoma 13 years earlier.

Manufacturing readiness of the world's first highly reliable 650V GaN HEMT is demonstrated with high process capability (CpK>1.6) for leakage and on resistance. This technology was developed in a Si-CMOS compatible 6-inch foundry and has been demonstrated with over one thousand wafers worth of data spread over two generations of technology nodes covering multiple products and packages collected during ramp up post qualification. Silicon manufacturing processes are employed including gold-free processes that avoid the use of evaporation/liftoff typical to compound semiconductors. Probe yield and Line yield for the GaN process now matches mature Si-CMOS process running in the same fabrication facility. Extended qualification results beyond JEDEC standard are also shown for GaN products for the first time. Products in cascode configuration were tested. Wide bandgap high speed and high voltage GaN devices significantly reduce the system size and improve energy efficiency of power conversion in all areas of electricity conversion, ranging from PV inverters to electric vehicles making the above results significant and making GaN high volume production a reality.

Forty years ago, a group of physicians gathered in Nice, France, with a shared optimism for the promise of systemic therapies to treat cancer. This conference became the inaugural meeting of what is now the European Society for Medical Oncology (ESMO) , which today convenes nearly 20,000 individuals from around the world. At that time, in 1975, it was becoming clear that contemporary scientific discoveries related to the properties of chemotherapeutic agents were spring-loading the oncologist's ability to address malignancies. Clinicians were able to employ adjuvant chemotherapy for the treatment of early-stage breast cancer, and combination chemotherapy for patients with testicular cancer, both of which would soon lead to marked improvements in overall survival. Medicines such as cyclophosphamide, cisplatin, bleomycin and others—which we often take for granted in our practices today—were then new instruments in the clinician's anticancer toolkit. The number of systemic therapies and treatment approaches we currently have to address the needs of our patients with cancer is vast. With advanced techniques in radiology, pathology, radiation oncology, surgical oncology and other subspecialties, the benefit of medicines can be further augmented for certain types of cancer. A woman diagnosed with early-stage breast cancer in Europe today has an 80% chance of long-term survival. Similarly, a child diagnosed in Europe with acute lymphoblastic leukaemia has a nearly 90% chance to live a long and relatively healthy life after treatment. Overall, the notion that cancer is a universal death sentence has shifted from reality to fallacy in wealthy parts of the world. Yet, as these tremendous gains in advanced economies have resulted in improvements in life expectancy, and undoubtedly economic gains from productivity life-years (not to mention the social and moral imperatives implicit in cancer care), the conception of cancer as a death sentence is not a fallacy in many impoverished …

Purpose A great proportion of the world's cancer burden resides in low- and middle-income countries where cancer care infrastructure is often weak or absent. Although treatment of cancer is multidisciplinary, involving surgery, radiation, systemic therapies, pathology, radiology, and other specialties, selection of medicines that have impact and are affordable has been particularly challenging in resource-constrained settings. In 2014, at the invitation of the WHO, the Union for International Cancer Control convened experts to develop an approach to propose essential cancer medicines to be included in the WHO Model Essential Medicines Lists (EML) for Adults and for Children, as well as a resulting new list of cancer medicines. Methods Experts identified 29 cancer types with potential for maximal treatment impact, on the basis of incidence and benefit of systemic therapies. More than 90 oncology experts from all continents drafted and reviewed disease-based documents outlining epidemiology, diagnostic needs, treatment options, and benefits and toxicities. Results Briefing documents were created for each disease, along with associated standard treatment regimens, resulting in a list of 52 cancer medicines. A comprehensive application was submitted as a revision to the existing cancer medicines on the WHO Model Lists. In May 2015, the WHO announced the addition of 16 medicines to the Adult EML and nine medicines to the Children's EML. Conclusion The list of medications proposed, and the ability to link each recommended medicine to specific diseases, should allow public officials to apply resources most effectively in developing and supporting nascent or growing cancer treatment programs.

The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries.Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined.Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0-18) in low income countries (n = 26) and 14 in lower-middle (n = 42), upper-middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0-8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000).There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries.

The reliability of 600 V GaN power switches, fabricated in a silicon CMOS foundry, has been demonstrated. JEDEC qualification of cascode packages and the long term reliability of GaN power switches has been estimated for the first and shown to be greater than a million hours. Excellent switched/dynamic on-resistance up to 1000 V and breakdown voltage over 1500 V indicate the suitability of these devices for switching up to 480 V. Detailed data of high temperature reverse bias (HTRB) test is shown. High temperature DC stress test and high voltage off-state stress tests also corroborate the high reliability of these devices. This suite of initial, JEDEC & accelerated stress tests show that GaN-on-silicon power switches are ready for many commercial and industrial applications, would significantly reduce switching losses and system size and will impact all areas of electricity conversion, ranging from tablet chargers to photovoltaic inverters and electric vehicles.

A systematic review was conducted of studies (2001-2013) about therapeutic recreation/camp for children with cancer and/or their family which measured either process or outcome variables qualitatively or quantitatively. Of 581 titles, 20 met the inclusion criteria. Research demonstrates positive impacts of camp on: cancer knowledge, mood, self-concept, empathy, and friendship, quality of life, and emotional well-being. This recent decade of research illuminates nuances in camp outcomes, which previously were unexplored. For instance, changes following camp do not necessarily occur in a linear, positive fashion and varying outcomes were observed by camper subgroup depending on age, culture, and treatment status.

Industry's first 600-V GaN-on-Si switching transistors have passed qualification based on Jedec standards and entered commercial market. Although far from being optimized, these 1st generation GaN devices exhibit properties superior to matured Si counterparts including lower on-resistance, much reduced input/output charges, and much higher switching speed. Application examples show significant loss reduction at high frequencies and markedly simplified hard-switched bridge circuits, offering a new means for designing more compact and efficient power systems. Extended SOA tests revealed a large margin in blocking voltage even at 175 °C, ability to deliver 99% peak efficiency at 187°C case temperature and high power operation at 215°C junction temperature with a very-low degradation rate.

The psychosocial outcomes of young adult survivors of childhood bone tumors are not well known. This study: (a) examined perceived social support (SS) and benefit-finding (BF) with respect to surgical intervention, gender, and age; (b) compared SS and psychological outcomes to normative values; and (c) examined the relationship between these social and psychological outcomes and sexual functioning.Twenty-eight participants (18-32 years) completed outcome-specific questionnaires for SS, BF, depression, self-worth, and sexual functioning. Surgical intervention was grouped into limb sparing (LS; allograft-fusion and endoprosthesis) and ablative procedures (AMP; amputation or Van Nes rotationplasty). Age at study was grouped into ≤25 or ≥26 years of age.Compared to normative values, survivors reported significantly less depressive symptoms (P = 0.005), and higher self-evaluations of intellectual capabilities (P = 0.009). No significant differences in SS and BF were found between surgical and age groups. Males perceived significantly higher SS than females (P = 0.027). Significant positive correlations were found between perceived SS and sexual functioning (r = 0.397), sexual experiences (r = 0.423), and satisfaction with sexual relationships (r = 0.408). Negative correlation was found between global SS and depression scores (r = -0.397). Similar correlations were found with the subscales of the SS, depression, and self-worth measures. BF was significantly positively correlated only to SS (r = 0.552).Bone tumor survivors, particularly males, demonstrated remarkable psychosocial resiliency with SS possibly serving as a protective factor for survivors' psychological and sexual functioning.

Families of children with cancer are confronted with a broad range of direct costs (out-of-pocket expenses), but the nature of these costs is poorly understood. This study aimed to disaggregate and describe these costs.A prospective, mixed method, cost-of-illness design was utilized. Starting in the fourth week following their child's diagnosis, parents recorded resources consumed, and costs incurred for 1 week per month for 3 consecutive months. Any additional costs not captured in this typical 1 week period were added for the remainder of the month. Parents also discussed their costs in an audio-taped interview at the end of the 3 months. Descriptive statistics and qualitative content analyses were performed to disaggregate and describe families' costs.In total, 99 families reported utilizing 16 cost categories and 74 cost items. Nearly three quarters of these costs were attributed to travel (56%) and food (18%). Costly items included acquisition of a car ($CAD35,000), relocation of a family ($CAD6,000), and purchase of a wheelchair ($CAD6,800). Parents described facing significant out-of-pocket expenses to ensure that their children had access to cancer treatment, to cope with the clinical treatment side effects of treatment, and to maintain the family household.Families of children with cancer experience a wide range of costs. Our understanding of the nature of their costs and resource use may formulate the basis for future cost assessments and provide insight into practice and policy changes aimed at lessening the economic impact of this burden.

A diagnosis of cancer in childhood places a considerable economic burden on families, although costs are not well described. The objectives of this study were to identify and determine independent predictors of the direct and time costs incurred by such families.A prospective, cost-of-illness study was conducted in families of children newly diagnosed with cancer. Parents recorded the resources consumed and costs incurred during 1 week per month for three consecutive months beginning the fourth week following diagnosis and listed any additional costs incurred since then. Descriptive and multiple regression analyses were performed to describe families' costs (expressed in 2007 Canadian dollars) and to determine direct and time cost predictors.In total, 28 fathers and 71 mothers participated. The median total direct and time costs in 3 months were $CAD3503 and $CAD23 130, respectively, per family. The largest component of direct costs was travel and of time costs was time allocated previously for unpaid activities. There were no statistically significant predictors of direct costs. Six per cent of the variance for time costs was explained by language spoken at home.Families of children with cancer are confronted with a wide range of direct and time costs, the largest being travel and time allocated previously for unpaid activities.

Dramatic increases in survival rates have led to increased interest regarding the health related quality of life (HRQOL) of adolescent and young adult survivors of bone tumors. This study investigated HRQOL and physical disability in adolescent and young adult survivors of lower extremity bone tumors as a function of type of surgical intervention, gender, and age at assessment.Twenty-eight participants (age range 18-32 years) completed three generic and one disease-specific measures of HRQOL and a measure of physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and ablative surgeries (AMP; amputation or Van Nes rotationplasty). Age at study was grouped into ≤ 25 years of age and ≥ 26 years of age. The MOS-SF-36, HUI2, HUI3, and EORTC-QLQ-C30 were used to measure HRQOL and the TESS was used to assess physical disability.Survivors reported HRQOL equivalent to the general population, with the exception of physical functioning. LS reported poorer HRQOL than AMP participants for emotional functioning and fatigue. Males reported better HRQOL compared with females for overall HRQOL, general health, physical functioning, and social functioning. Finally, younger participants generally reported better HRQOL than older participants for overall HRQOL and physical functioning.This study identifies LS surgical intervention, female gender and older age as risk factors for reduced HRQOL in adolescent and young adult survivors of lower extremity bone tumors. This study also provides information about what instrument may be most useful in identifying these specific difficulties and subgroups.

The treatment of non-Hodgkin lymphoma (NHL) is an example of the successful therapy of cancer in children; the cure rate overall at approximately 80%. Unfortunately, relapsed NHL has a dismal prognosis, and the customary treatment is highly toxic chemotherapy followed by hematopoietic stem cell transplantation (HSCT). A child with relapsed T-cell rich B-NHL was treated with rituximab alone. This was delivered in eight doses after the recurrence of disease after high-dose chemotherapy and allogenic HSCT that was undertaken for the first relapse. Eight years after the last dose of rituximab he remains in complete remission.

More than 80% of children who have been recently diagnosed with cancer will survive for five years or more. A majority of these survivors are at risk for developing one or more long-term sequelae of their therapy. Thus, they all require specialized medical care that is focused on their specific risks.A survey of informants from all 17 paediatric cancer programs in Canada was conducted to determine the care offered to survivors of childhood cancer, both during their paediatric and adolescent years, as well as after they transition to adulthood.Sixteen informants representing all 17 centres responded to the survey by telephone or e-mail. Twelve of the 17 centres (71%) had a formal program or clinic dedicated to the care of survivors during their paediatric and adolescent years, while the remaining centres cared for survivors in their acute care oncology clinics. However, only six of 17 centres (35%) had access to a formal program for survivors once they reach adulthood. Fifteen of the 17 centres (88%) adhered to published long-term follow-up guidelines, and 13 of 17 centres (76%) provided a treatment summary and/or a survivorship care plan to each survivor before their transfer out of paediatric care.Despite the centralization of paediatric oncology care within 17 specialist centres and the availability of universal health care, many Canadian survivors of childhood cancer do not have access to clinics specializing in long-term risk-based survivor care, and this access further decreases once they reach adulthood.

PURPOSE: To improve efficacy and reduce toxic- ity of treatment for children with acute lymphoblas- tic leukemia. PATIENTS AND METHODS: Patients from all risk groups, including infants and those with T-cell disease, were treated between 1987 and 1991. Standard-risk (SR) patients did not receive cranial irradiation, whereas high-risk (HR) and very high-risk (VHR) patients participated in a randomized comparison of 18 Gy of cranial irradiation conventionally fractionated versus two fractions per day (hyperfractionated). RESULTS: At a median follow-up of 9.2 years, the 9-year event-free survival (EFS ± SE) was 75% ± 2% for all 369 patients, 77% ± 4% for the 142 SR patients, and 73% ± 3% for the 227 HR/VHR patients (P = .37 comparing SR and HR/VHR). The CNS, with or without concomitant bone marrow involvement, was the first site of relapse in 19 (13%) of the 142 SR patients: 16 (20%) of 79 SR boys and three (5%) of 63 SR girls. This high incidence of relapses necessitated a recall of SR boys for additional therapy. CNS relapse occurred in only two (1%) of 227 HR and VHR patients. There were no outcome differences found among randomized treatment groups. Nine-year overall survival was 84% ± 2% for the entire population, 93% ± 2% for SR children, and 79% ± 3% for HR and VHR children (P < .01 comparing SR and HR/VHR). CONCLUSION: A high overall survival outcome was obtained for SR patients despite the high risk of CNS relapse for SR boys, which was presumed to be associated with eliminating cranial radiation without intensifying systemic or intrathecal chemotherapy. For HR/VHR patients, inability to salvage after relapse (nearly all of which were in the bone marrow) remains a significant clinical problem.