Eating behavior and BMI in adolescent survivors of brain tumor and acute lymphoblastic leukemia.

OBJECTIVES: Elevated body mass index (BMI) has been reported in pediatric cancer survivors. It is unclear whether this is related to altered energy intake (via disordered eating), decreased energy expenditure (via limited exercise), or treatment-related direct/indirect changes. The aims of this study are to describe the occurrence of overweight and obesity, exercise frequency, and the extent of disordered eating patterns in this sample of survivors, and to examine relationships among BMI, eating patterns, exercise frequency, and demographic and disease and treatment-related variables to identify those survivors most at risk for overweight/obesity. METHODS: This cross-sectional study recruited 98 cancer survivors (50 acute lymphoblastic leukemia [ALL], 48 brain tumor [BT]), aged 12 to 17 years and ≥12 months posttreatment from a large pediatric oncology hospital. Survivors completed health behavior measures assessing disordered eating patterns and physical activity. Clinical variables were obtained through medical record review. Univariate analyses were conducted to make comparisons on health behaviors by diagnosis, gender, treatment history, and BMI category. RESULTS: Fifty-two percent of ALL survivors and 41.7% of BT survivors were classified as overweight/obese. Overweight/obesity status was associated with higher cognitive restraint (odds ratio = 1.0; 95% confidence interval = 1.0-1.1). Only 12% of ALL survivors and 8.3% of BT survivors met Centers for Disease Control and Prevention guidelines for physical activity. Males reported more physical activity, t(96) = 2.2, P < .05. CONCLUSIONS: Overweight/obese survivors may attempt to purposefully restrict their food intake and rely less on physiological cues to regulate consumption. Survivors should be screened at follow-up for weight-related concerns.

Paternal involvement in pediatric Type 1 diabetes: fathers' and mothers' psychological functioning and disease management.

Psychological functioning in fathers of children with Type 1 diabetes has received relatively little attention compared to mothers. This study examined fathers' perceived involvement in their children's diabetes care as it related to mothers' and fathers' pediatric parenting stress, depression, anxiety, marital satisfaction, and sleep, and to their children's diabetes regimen adherence and glycemic control. Eighty-two mothers and 43 fathers completed questionnaires. Multivariate linear regressions were conducted separately for mothers and fathers to determine the relationships between the perceived amount and the perceived helpfulness of father involvement in child diabetes care on parental psychosocial functioning and child diabetes control. Maternal perceptions of father helpfulness and amount of involvement in illness care were related to improved marital satisfaction and fewer depressive symptoms in mothers. In fathers, perception of their own amount of involvement was related to increased pediatric parenting stress and anxiety. Better child regimen adherence was associated with maternal perceptions of father helpfulness but not the amount of their involvement, while paternal perceptions of their own helpfulness were related to poorer glycemic control. These findings suggest that fathers and mothers may react differently to their roles in childhood illness and that perceptions of their involvement may be differently associated with children's glycemic control and regimen adherence.

It's not over when it's over: long-term symptoms in cancer survivors--a systematic review.

BACKGROUND: The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal). METHODS: A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions. RESULTS: Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors. CONCLUSIONS: Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.

Breast cancer survivors at work.

INTRODUCTION: Residual symptoms such as fatigue, cognitive limitations, and emotional distress can be experienced by cancer survivors. These symptoms may impact their abilities at work. It is unclear to what degree these symptoms are associated with work in occupationally active breast cancer survivors, the most prevalent cancer survivor group. METHODS: A sample of 100 women working part- or full-time with a history of breast cancer and a noncancer comparison group (n = 103) completed questionnaires related to physical fatigue, depression, anxiety, and cognitive limitations. Demographic variables, job stress, type of job, stage at diagnosis, treatment exposure, and health behaviors were also measured as potential confounders. RESULTS: Four years postdiagnosis breast cancer survivors reported higher levels of age-adjusted work limitations (F = 32.708, P < 0.001). Significant group by fatigue (beta = -0.311, 95% CI = -0.545 to -0.076) and group by depression (beta = 0.331, 95% CI = 0.024 to 0.638) interactions were observed. Fatigue was more strongly related to work limitations in the cancer survivor group whereas depressive symptoms were more strongly related to limitations at work in the noncancer group. Although fatigue accounted for 22% of the variance in the model, it explained 71% of the contribution of symptom burden to the overall model. CONCLUSIONS: Fatigue was more strongly related to work in the breast cancer survivor group after accounting for many potential confounders. There is a pressing need to better understand and effectively manage fatigue in the workplace in occupationally active breast cancer survivors.

Work productivity in brain tumor survivors.

OBJECTIVE: To determine the association of symptom burden to work limitation among working survivors of malignant brain tumors. METHODS: Working adults with malignant brain tumors (n = 95) and a non-cancer comparison (n = 131) group completed a web-based questionnaire. Measures of demographics, tumor type and treatment, fatigue, emotional distress, cognitive limitations, and factors that can positively impact work, including health behaviors and problem solving, were obtained. RESULTS: Survivors of malignant brain tumors reported higher levels of work limitations and time off from work than the non-cancer group. Higher levels of symptom burden, lower levels of health behaviors, and more negative problem solving orientation were characteristic of the brain tumor survivor group. These variables were not differentially associated with work limitations among brain cancer survivors or the comparison group. Depressive symptoms, fatigue, cognitive limitations, sleep, and negative problem solving orientation were independently associated with work limitations, accounting for 65% of the variance in work limitations. CONCLUSIONS: Despite higher levels of burden, poorer health behaviors, and negative problem solving coping style, modifiable factors account for most of the variance in work limitations for both groups. Efforts to modify these variables should be evaluated.

Pediatric quality of life in transitioning to the insulin pump: does prior regimen make a difference?

A shift in conventional diabetes management has graduated to basal (glargine) and bolus (rapid-acting analogue) therapy via multiple daily injections or continuous subcutaneous insulin infusion (CSII). Continuous subcutaneous insulin infusion is considered the most intensive type of diabetes management, and before transitioning, consideration of regimen benefits should include lifestyle and quality-of-life issues in addition to medical benefits. Short-term and long-term changes in children's quality of life, as a function of their pre-CSII diabetes regimen, was assessed in 52 children before their transition to CSII from a conventional or multiple daily injection regimen. Results demonstrated significant improvement in quality of life only for those children transitioning to CSII from conventional vs multiple daily injection regimens; results were maintained at 6 months following pump initiation. Quality of life is an important consideration as children transition from more traditional to intensive regimens, and CSII devices may not necessarily improve satisfaction with diabetes control in all pediatric patients. Risks and benefits of both intensive regimens should be discussed before making the transition.