Educational and occupational outcomes among survivors of childhood cancer during the transition to emerging adulthood.

PURPOSE: To examine educational and occupational outcomes among survivors of childhood cancer and peers during the transition from adolescence to emerging adulthood. METHODS: Families were recruited when children with cancer were 8 to 15 years old and receiving initial treatment for a malignancy that did not primarily affect the central nervous system (CNS). At that time, each child with cancer was matched to a classmate of similar age, gender, and race for inclusion in a comparison group. For the current follow-up (7.29 years postdiagnosis), 56 survivors, 60 peers, and their parents completed questionnaires soon after the youth's 18th birthday. Severity of treatment and late effects were rated by healthcare providers. RESULTS: Survivors and peers were similar on a variety of outcomes, including family background, scholastic and occupational self-concept, and academic competence. However, survivors were more likely to report repeating a grade and having more school absences. The proportion of participants who graduated from high school, were working, and expressed plans to attend postsecondary education or seek employment were similar between groups. Initial treatment intensity, time since diagnosis, and severity of late effects were associated with several indices of educational and occupational attainment. CONCLUSIONS: Despite being more likely to repeat a grade and miss school, survivors of nonCNS cancer were similar to peers on most educational and occupational outcomes during the transition from adolescence to emerging adulthood. Interventions to assist academic or occupational functioning may not be necessary for all survivors, but additional research is needed to identify subgroups at risk for difficulties.

Brief report: post-traumatic stress during emerging adulthood in survivors of pediatric cancer.

OBJECTIVE: To examine post-traumatic stress symptoms (PTSS) and disorder (PTSD) among survivors of childhood cancer and comparison peers during the transition to emerging adulthood. METHOD: From elementary and middle school, we prospectively followed a cohort of 56 cancer survivors, 60 comparison peers, and their parents. Assessments were completed after the youth's 18th birthday using questionnaires and a semi-structured psychiatric interview. Healthcare providers rated treatment severity and late effects. RESULTS: Survivors and comparison peers did not differ on rates of PTSS or PTSD, but comparison peers reported more dissociative experiences than survivors. Late effects were associated with a greater number of past PTSS. Of the 16 cancer survivors who reported a traumatic event, five (31%) were cancer-related. CONCLUSIONS: Levels of PTSS were similar for survivors and comparison peers. Research with other potentially traumatic diseases or treatments (e.g., amputations, brain tumors) is needed. The role of methodology and contextual factors in the assessment of PTSS/PTSD is discussed.

Social and romantic outcomes in emerging adulthood among survivors of childhood cancer.

PURPOSE: To examine social and romantic outcomes among survivors of childhood cancer and comparison peers during the transition from adolescence to emerging adulthood. METHODS: Families were recruited when the children with cancer were 8-15-years-old and on initial treatment for a malignancy that did not primarily affect the central nervous system (i.e., non-CNS). At that time, each child with cancer was matched to a classmate of similar age, gender, and race for inclusion in a comparison group. For the current follow-up (7.29 years post-diagnosis), 56 survivors, 60 comparison peers, and their parents completed questionnaires after the youth's 18th birthday. Severity of treatment and late effects were rated by health care providers. RESULTS: Survivors and comparison peers were similar on a variety of outcomes, including family background, social self-concept, social competence, family relationships, friendships, and romantic relationships. Mothers reported that survivors engaged in fewer activities than comparison peers. The proportion of participants who lived with their parents, were dating, and expressed plans to marry or have children was similar between groups. Initial treatment intensity, time since diagnosis, and severity of late effects were associated with some indices of social adjustment. CONCLUSIONS: The social and romantic outcomes of survivors of non-CNS cancer were similar to comparison peers during the transition from adolescence to emerging adulthood. Disease and treatment factors had limited associations with outcomes. Clinical interventions to assist social development may not be necessary for all survivors, but additional research is needed to identify subgroups at risk for difficulties.

Relationship between feeding difficulties, medical complexity, and gestational age.

BACKGROUND: This study examined feeding skills differences in medically complex children born prematurely and full term and sought to determine whether later feeding difficulties within this medically complicated sample were related to medical factors or factors related to preterm status. METHODS: A total of 143 pediatric patients referred to an outpatient clinic for feeding, nutrition, or growth problems were compared by their gestational age at birth across a variety of dependent variables related to feeding development and behaviors. RESULTS: Full-term and preterm children did not demonstrate significant differences in feeding difficulties at first oral feeding. By the time of introduction to solid (cereal) feeding, however, preterm children more often continued to demonstrate difficulty than full-term children. Regression analyses indicated that medical factors, primarily the need for breathing assistance, accounted for more of the variance than prematurity alone. CONCLUSIONS: Medically complex children, especially those with an early need for respiratory support, will benefit from ongoing oral-motor feeding intervention.