Perceptions and attitudes about the contribution of the environment to childhood cancer: a pilot study in a medical guild and undergraduate students.

BACKGROUND: Identifying and recognizing environmental risk factors for childhood cancer is crucial to prevent it. Medical guild are the first contact to monitor children's health. Therefore, courses about the contribution of chemical toxins in the environment and health outcomes such as cancer should be included in their professional training. This study aimed to evaluate the perceptions and attitudes of a medical guild and undergraduate students in health sciences about the contribution of the environment to childhood cancer. METHODS: A pilot study was conducted, an online survey including thirteen questions was shared among medical guild members and undergraduate students in health sciences. Frequencies, percentages, and chi-square homogeneity tests were calculated to compare groups. RESULTS: Genetic factors ranked as the first possible cause of childhood cancer (88.2% medical guild and 97.7% undergraduate students). However, 70.6% of medical guild and 64.6% of undergraduate students reported that they have ever suspected that childhood cancer could be related to the environmental conditions in which children live. More than 95% of the participants reported that they would find it useful to have more knowledge about environmental risks and cancer. When data were analyzed by profession (medical guild) and academic year (undergraduate students), no significant differences were observed. Nonetheless, comparisons by academic discipline between undergraduate students, showed that a higher percentage of medicine and environmental sciences and health (over 98%) reported environmental exposure as risk factors associated with childhood cancer compared to 75% from physiotherapy, (p = 0.001). CONCLUSIONS: In this study, the environmental contribution to childhood cancer is not clear among the medical guild and undergraduate students. They should be trained on the topic of cancer and the environment.

Effectiveness of Family Coping Interventions in Improving Problem-Solving Skills in the Care of Children and Adolescent Cancer Survivors during and after Treatment: A Scoping Review.

(1) Context: Cancer triggers significant changes in family dynamics. It is noteworthy that coping and problem-solving skills, particularly in situations involving cancer in children and adolescents, have not been adequately explored in the context of family adaptation. This study aims to analyze the effectiveness of family interventions in coping to improve problem-solving skills in parents and/or caregivers of children and adolescents during and after oncological treatment. (2) Methods: This is a scoping review following the recommendations of the Joanna Briggs Institute and the Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), from 2014 to 2024, in the databases LILACS, CINAHL, SCOPUS, Web of Science, and PUBMED. (3) Results: Forty-five studies were eligible. Coping strategies were categorized as follows: (1) positive attitudes (including a sense of courage and hope, family support to enhance resilience, and future planning), (2) caregiver empowerment (involving acceptance of diagnosis, emotional distancing, and coping through religiosity), and (3) communication skills (encompassing professional communication, horizontal dialogue with healthcare teams, and sincere communication with friends and family). (4) Conclusions: Over time, families develop coping and problem-solving strategies that influence changes in family functioning patterns, aiding them in accepting, reinterpreting, and reframing ideas and feelings associated with neoplasia.

Use of neutropenic diet in the nutritional care of pediatric cancer patients with neutropenia: a scoping review

Abstract Objective: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. Source of data: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. Summary of the findings: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. Conclusion: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

Environmental Pollution and Risk of Childhood Cancer: A Scoping Review of Evidence from the Last Decade.

The long-term effects of environmental pollution have been of concern as several pollutants are carcinogenic, potentially inducing a variety of cancers, including childhood cancer, which is a leading cause of death around the world and, thus, is a public health issue. The present scoping review aimed to update and summarize the available literature to detect specific environmental pollutants and their association with certain types of childhood cancer. Studies published from 2013 to 2023 regarding environmental pollution and childhood cancer were retrieved from the PubMed database. A total of 174 studies were eligible for this review and were analyzed. Our search strategy brought up most of the articles that evaluated air pollution (29%) and pesticides (28%). Indoor exposure to chemicals (11%), alcohol and tobacco use during pregnancy (16%), electromagnetic fields (12%), and radon (4%) were the subjects of less research. We found a particularly high percentage of positive associations between prenatal and postnatal exposure to indoor (84%) and outdoor (79%) air pollution, as well as to pesticides (82%), and childhood cancer. Positive associations were found between leukemia and pesticides and air pollution (33% and 27%); CNS tumors and neuroblastoma and pesticides (53% and 43%); and Wilms tumor and other rare cancers were found in association with air pollution (50%). Indoor air pollution was mostly reported in studies assessing several types of cancer (26%). Further studies are needed to investigate the mechanisms underlying the potential associations between indoor/outdoor air pollution and pesticide exposure with childhood cancer risk as more preventable measures could be taken.

"Characterization of residential proximity to sources of environmental carcinogens in clusters of Acute Lymphoblastic Leukemia in San Luis Potosi, Mexico".

BACKGROUND: Acute Lymphoblastic Leukemia (ALL) is the most prevalent neoplasia in children and teenagers in Mexico. Although epidemiological data supports that children's residence close to emissions from vehicular traffic or industrial processes increases the risk of ALL; and the IARC states that benzene, PAHs, and PM 2.5 are well-known environmental carcinogens, there is a gap in linking these carcinogenic hazards with the sources and their distribution from scenario perspective. AIM: To identify ALL clusters in the population under 19 years of age and characterize the environment at the neighborhood level by integrating information on sources of carcinogenic exposure using spatial analysis techniques in the Metropolitan Area of San Luis Potosi, Mexico. METHODS: Using the Kernel Density test, we designed an ecological study to identify ALL clusters from incident cases in the population under 19 years of age. A multicriteria analysis was conducted to characterize the risk at the community level from carcinogenic sources. A hierarchical cluster analysis was performed to characterize risk at the individual level based on carcinogenic source count within 1 km for each ALL case. RESULTS: Eight clusters of carcinogenic sources were located within the five identified ALL clusters. The multicriteria analysis showed high-risk areas (by density of carcinogenic source) within ALL clusters. CONCLUSIONS: This study has a limited source and amount of available data on ALL cases, so selection bias is present as well as the inability to rule out residual confounding factors, since covariates were not included. However, in this study, children living in environments with high vehicular density, gas stations, brick kilns, incinerators, commercial establishments burning biomass, or near industrial zones may be at higher risk for ALL.

Navigating the economic challenges in childhood cancer control in low- and middle-income countries: Insights from the CC-BRIDGE tool and the global initiative for childhood cancer.

The increasing incidence of childhood cancer in low- and middle-income countries (LMICs) presents significant economic and logistical challenges, affecting health care provision and equitable treatment access. This editorial explores the economic barriers to pediatric oncology care in LMICs, highlighting resource scarcity, socioeconomic inequities, and health care complexities. It emphasizes the need for detailed cost analysis within health systems complicated by inadequate data and variable treatment protocols. Central to the discussion is the "Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) Tool" from the manuscript by Nancy Bolous et al., who proposed an innovative method to estimate the cost of integrating childhood cancer services into National Cancer Control Plans. This tool aligns with the World Health Organization's Global Initiative for Childhood Cancer to enhance survival rates and advocate for universal health coverage in pediatric oncology. The CC-BRIDGE tool's methodological rigor provides a structured framework for cost analysis. Yet, it is recognized as an initial step requiring further enhancements for comprehensive economic forecasting and societal cost assessments. In conclusion, the editorial highlights the tool's critical role in incorporating childhood cancer care into national strategies in LMICs, contributing to the broader fight against cancer and advocating for comprehensive, equitable health care. It signifies a vital stride toward addressing pediatric oncology's economic challenges and supporting universal health coverage for childhood cancer care.

Use of neutropenic diet in the nutritional care of pediatric cancer patients with neutropenia: a scoping review.

OBJECTIVE: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. SOURCE OF DATA: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. SUMMARY OF THE FINDINGS: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. CONCLUSION: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

Germline mutations in pediatric cancer cohort with mixed-ancestry Mexicans.

BACKGROUND: Childhood cancer is one of the primary causes of disease-related death in 5- to 14-year-old children and currently no prevention strategies exist to reduce the incidence of this disease. Childhood cancer has a larger hereditary component compared with cancer in adults. Few genetic studies have been conducted on children with cancer. Additionally, Latin American populations are underrepresented in genomic studies compared with other populations. Therefore, the aim of this study is to analyze germline mutations in a group of mixed-ancestry Mexican pediatric patients with solid and hematological cancers. METHODS: We analyzed genetic variants from 40 Mexican childhood cancer patients and their relatives. DNA from saliva or blood samples was used for whole-exome sequencing. All variants were identified following GATK best practices. RESULTS: We found that six patients (15%) were carriers of germline mutations in CDKN2A, CHEK2, DICER1, FANCA, MSH6, MUTYH, NF1, and SBDS cancer predisposition genes, and additional new variants predicted to be deleterious by in silico algorithms. A population genetics analysis detected five components consistent with the demographic models assumed for modern mixed-ancestry Mexicans. CONCLUSIONS: This report identifies potential genetic risk factors and provides a better understanding of the underlying mechanisms of childhood cancer in this population.

Palliative care for children with central nervous system tumors: results of a Spanish multicenter study.

BACKGROUND: Brain tumors represent the most common cause of cancer-related death in children. Few studies concerning the palliative phase in children with brain tumors are available. OBJECTIVES: (i) To describe the palliative phase in children with brain tumors; (ii) to determine whether the use of palliative sedation (PS) depends on the place of death, the age of the patient, or if they received specific palliative care (PC). METHODS: Retrospective multicenter study between 2010 and 2021, including children from one month to 18 years, who had died of a brain tumor. RESULTS: 228 patients (59.2% male) from 10 Spanish institutions were included. Median age at diagnosis was 5 years (IQR 2-9) and median age at death was 7 years (IQR 4-11). The most frequent tumors were medulloblastoma (25.4%) and diffuse intrinsic pontine glioma (DIPG) (24.1%). Median number of antineoplastic regimens were 2 (range 0-5 regimens). During palliative phase, 52.2% of the patients were attended by PC teams, while 47.8% were cared exclusively by pediatric oncology teams. Most common concerns included motor deficit (93.4%) and asthenia (87.5%) and communication disorders (89.8%). Most frequently prescribed supportive drugs were antiemetics (83.6%), opioids (81.6%), and dexamethasone (78.5%). PS was administered to 48.7% patients. Most of them died in the hospital (85.6%), while patients who died at home required PS less frequently (14.4%) (p = .01). CONCLUSION: Children dying from CNS tumors have specific needs during palliative phase. The optimal indication of PS depended on the center experience although, in our series, it was also influenced by the place of death.

Cáncer en el paciente pediátrico ¿cuándo sospecharlo? ¿cuándo alarmarse?

Resumen El cáncer infantil se presenta frecuentemente de forma inespecífica, simulando otras enfermedades de curso benigno. Este hecho, asociado a su baja incidencia, dificulta la sospecha y el diagnóstico de cáncer infantil. Si se hace este último de manera precoz junto con la rápida derivación a un centro especializado, se reducen significativamente la morbilidad y la mortalidad, lo que favorece el pronóstico de la enfermedad. Existen muchos signos y síntomas que deben alarmar al médico e incluso a los familiares: palidez, fiebre de larga duración, dolor de cabeza, adenopatías, sangrados o moretones, debilidad marcada, masas, marcha anormal, anormalidades oculares, dolor músculo esquelético, entre otros. Aunque estos tienden a ser inespecíficos, es importante detectar oportunamente los signos de alarma y bandera roja para mejorar la supervivencia en la población pediátrica con esta condición. Con base en la literatura, el objetivo de este artículo de revisión es caracterizar las manifestaciones clínicas en el paciente pediátrico que sugieren una rápida intervención y búsqueda de una neoplasia en él. Metodología de búsqueda Se realizó una búsqueda en la literatura desde el 1 de febrero hasta el 31 de marzo de 2022, en PUBMED, GOOGLE SCHOLAR, MEDLINE, UPTODE con los términos MESH "Neoplasias", "Cáncer infantil", "Signos y síntomas", "Alarma". Los criterios de inclusión fueron artículos que trataran como tema central el cáncer infantil, sus síntomas y signos de alarma, así mismo, se incluyeron libros, artículos de revista, revisiones de tema y reportes de caso publicados en los últimos 20 años en inglés y español; obteniéndose inicialmente 40 artículos. Se excluyeron los relacionados a cáncer en adultos. Aquellos duplicados o con contenido insuficiente o no relevante para desarrollar el tema, tampoco fueron tenidos en cuenta. Finalmente, resultaron 35 publicaciones, de las cuales 22 fueron considerados acordes al objetivo del presente estudio.

Abstract Childhood cancer frequently presents in a non-specific manner, simulating other benign diseases. This fact, associated with its low incidence, difficults the suspicion and diagnosis of childhood cancer. Early diagnosis and prompt referral to a specialized center significantly reduce morbidity and mortality, improving the prognosis of the disease. There are many signs and symptoms that should alarm the physician and even family members, which are: pallor, long-lasting fever, headache, lymphadenopathy, bleeding, or bruising, marked weakness, masses, abnormal gait, ocular abnormalities, skeletal muscle pain, among others. Although these are usually nonspecific, it is important to detect early warning signs and red flags to improve survival in the pediatric population with this condition. Based on the literature, the objective of this review article is to characterize the clinical manifestations in the pediatric patient that suggest a rapid intervention and search for a neoplasm in the child.

Development and Implementation of Educational Material by Nurses for Parents/Caregivers of Children With Cancer: A Peruvian National Study.

Background: Education for parents and caregivers of children with cancer is one of the fundamental roles of nurses to avoid complications, provide quality care, promote adherence to treatment and maintain basic standards of care. This study aimed to design educational material for parents and caregivers of children with cancer in Peru on general information about childhood cancer and its care. Method: Within the framework of the WHO Global Initiative for Childhood Cancer in Peru, a multicenter working group was convened by the Peruvian Ministry of Health. A comprehensive needs assessment of parents and caregivers of children with cancer was performed through a survey in June and July 2020. The survey was conducted online (via Google Forms) and in person at nine hospitals to examine the preferred method of delivery and content of information. Results: Based on the findings from the parent needs assessment, a national nursing working group developed Spanish-language audiovisual materials (i.e., diagnosis and treatment videos for nurses to educate parents and caregivers). A total of 365 parents and caregivers were included. Most respondents (56.9%) were parents of children receiving treatment. Main topics were childhood cancer overview and side effects (85%), food and nutrition (75%), and palliative care (67%); most (70.9%) preferred information through talks and videos (64.7%). Twenty-three videos were developed with support by the Pan American Health Organization and the Ministry of Health. Discussion: Assessing the educational needs of parents and caregivers of children with cancer provides a starting point in the design of targeted strategies.

Neurotoxidad inducida por ifosfamida / Ifosfamide-induced neurotoxicity

Introducción: La ifosfamida es un agente alquilante utilizado para el tratamiento de enfermedades oncohematológicas. Entre sus eventos adversos agudos se encuentra la neurotoxicidad. Esta puede presentarse desde el inicio de la infusión hasta tres días después. El tratamiento consiste en suspender la administración y asegurar una adecuada hidratación. Objetivo: Describir eventos neurológicos asociados al uso de ifosfamida en pacientes pediátricos con enfermedades oncohematológicas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y transversal. Los datos se obtuvieron de historias clínicas de pacientes internados en el Hospital Garrahan que infundieron ifosfamida y desarrollaron síntomas neurológicos. Se analizaron edad, diagnóstico de base, dosis de ifosfamida, síntomas neurológicos y su relación con la infusión, tratamiento instaurado, exámenes complementarios y posibles factores de riesgo asociados. Resultados: Se registraron un total de catorce eventos neurológicos en doce pacientes, sin diferencia de sexo, con una mediana de edad de 9,5 años. La enfermedad de base más prevalente fue osteosarcoma. Las convulsiones fueron el síntoma más frecuente (50%), seguido de somnolencia y paresias. La combinación de ifosfamida y etopósido con/sin carboplatino se asoció en un 36% cada uno. El 64% desarrolló neurotoxicidad dentro de las primeras cuatro horas. Ningún paciente presentó alteraciones en los exámenes complementarios. Todos presentaron recuperación ad integrum. Conclusión: Este estudio brinda información acerca del tiempo de aparición de esta complicación, lo cual facilitará su detección precoz y tratamiento oportuno (AU)

Introduction: Ifosfamide is an alkylating agent used for the treatment of cancer. Among its acute adverse events is neurotoxicity. This can occur from the beginning of the infusion up to three days afterwards. Treatment consists of discontinuing administration and ensuring adequate hydration. Objective: To describe neurological events associated with the use of ifosfamide in children with cancer. Materials and methods: Observational, descriptive, retrospective, and cross-sectional study. Data were obtained from clinical records of patients admitted to the Garrahan Hospital who received ifosfamide infusion and developed neurological symptoms. Age, baseline diagnosis, ifosfamide dose, neurological symptoms and their relationship with the infusion, treatment, complementary tests, and possible associated risk factors were analyzed. Results: A total of fourteen neurological events were recorded in twelve patients, without difference in sex and with a median age of 9.5 years. The most prevalent underlying disease was osteosarcoma. Seizures were the most frequent symptom (50%), followed by drowsiness and paresis. The combination of ifosfamide and etoposide with/without carboplatin was associated in 36% each. Sixty-four percent developed neurotoxicity within the first four hours. None of the patients presented with abnormalities in the complementary examinations. All recovered ad integrum. Conclusion: This study provides information about the time of onset of this complication, which will facilitate its early detection and timely treatment (AU)

Estilos de humor, afrontamiento y soporte social en padres de niños con cáncer

Objetivo: Analizar el rol predictivo de las estrategias de afrontamiento y el soporte social percibido, sobre los estilos de humor en padres migrantes de niños con cáncer. Método: Se empleó un diseño cuantitativo transaccional-correlacional y un muestreo no probabilístico por conveniencia. Participaron 62 progenitores (11 hombres y 51 mujeres) entre los 20 y 61 años, quienes respondieron la Escala del Sentido del Humor (HSQ), el Cuestionario de Estimación del Afrontamiento (COPE) y el Medical Outcomes Study Social Support Survey (MOS-SSS). Resultados: Se establecieron modelos de regresión para el humor afiliativo (R²=0,19, p<0,001) y agresivo (R²=0,25, p<0,001), ambos considerados estilos de humor orientados a los demás. Respecto a los estilos orientados a uno mismo, para el humor de mejoramiento personal se desarrollaron dos modelos, el primero considera el soporte social global (R²=0,25, p< 0,001) y el segundo el soporte afectivo (R²=0,27, p< 0,001); y de la misma forma para el humor de descalificación personal, un modelo incluye el soporte social global (R²=0,28, p< 0,001) y el segundo el soporte instrumental (R²=0,27, p< 0,001). Conclusión: Las estrategias de afrontamiento y el soporte social en relación con los estilos de humor en contexto de enfermedad y migración demuestra la efectividad de ciertas estrategias y estilos considerados desadaptativos ante una situación altamente estresante.

Objective: To analyze the predictive role of coping strategies and social support over humor styles in parents who migrate along with children with cancer. Method: A transactional-correlational quantitative design and non-probabilistic convenience sampling were used. It involved 62 parents (11 men and 51 women) between 20 and 61 years. They answered the Humor Styles Questionnaire (HSQ), COPE Inventory (COPE) and the Medical Outcomes Study Social Support Survey (MOS-SSS). Results: Regression models were developed for affiliative (R²=0,19, p<0,001) and aggressive humor (R²=0,25, p<0,001), both considered humor styles towards others. For self-oriented humor styles, two models were built to predict self-enhancing humor. The first model considers global social support (R²=0,25, p<0,001), while the second model, affective support (R²=0,27, p<0,001). Likewise, the first model explaining self-defeating humor considers global social support (R²=0,28, p<0,001) and the second, instrumental support (R²=0,27, p<0,001). Discussion: Coping strategies and social support in relation to humor styles in the context of illness and migration demonstrate the effectiveness of certain strategies and styles considered maladaptive in face of a highly stressful situation.

Drugging Hijacked Kinase Pathways in Pediatric Oncology: Opportunities and Current Scenario.

Childhood cancer is considered rare, corresponding to ~3% of all malignant neoplasms in the human population. The World Health Organization (WHO) reports a universal occurrence of more than 15 cases per 100,000 inhabitants around the globe, and despite improvements in diagnosis, treatment and supportive care, one child dies of cancer every 3 min. Consequently, more efficient, selective and affordable therapeutics are still needed in order to improve outcomes and avoid long-term sequelae. Alterations in kinases' functionality is a trademark of cancer and the concept of exploiting them as drug targets has burgeoned in academia and in the pharmaceutical industry of the 21st century. Consequently, an increasing plethora of inhibitors has emerged. In the present study, the expression patterns of a selected group of kinases (including tyrosine receptors, members of the PI3K/AKT/mTOR and MAPK pathways, coordinators of cell cycle progression, and chromosome segregation) and their correlation with clinical outcomes in pediatric solid tumors were accessed through the R2: Genomics Analysis and Visualization Platform and by a thorough search of published literature. To further illustrate the importance of kinase dysregulation in the pathophysiology of pediatric cancer, we analyzed the vulnerability of different cancer cell lines against their inhibition through the Cancer Dependency Map portal, and performed a search for kinase-targeted compounds with approval and clinical applicability through the CanSAR knowledgebase. Finally, we provide a detailed literature review of a considerable set of small molecules that mitigate kinase activity under experimental testing and clinical trials for the treatment of pediatric tumors, while discuss critical challenges that must be overcome before translation into clinical options, including the absence of compounds designed specifically for childhood tumors which often show differential mutational burdens, intrinsic and acquired resistance, lack of selectivity and adverse effects on a growing organism.

Physical activity of children with cancer during the COVID-19 pandemic: what were the most relevant studies published from August 2019 to July 2021? / Actividad física em niños con cáncer durante la covid-19: ¿cuáles fueron las publicaciones más relevantes entre agosto de 2019 y julio de 2021? / Atividade física de crianças com câncer durante a covid-19: o que foi publicado de mais relevante entre agosto de 2019 e julho de 2021?

ABSTRACT This study aims to investigate up-to-date scientific information about physical activity, COVID-19, and childhood cancer. This study is an integrative review. Research was conducted in the Science Direct database, using keywords in three different combinations. In total, 50 publications classified as the most relevant of each keyword combination were selected, 26 eligible publications were reached from August 2019 to July 2021, of which nine were duplicates. When exclusion criteria were applied, 11 complete studies were selected. The level of physical activity (PA) of children diagnosed with cancer or those who survived cancer is low. Changes due to the COVID-19 pandemic include the decrease in the level of PA and the increase in the use of technological devices. The minimum PA recommendations for this population vary but some evidence supports its importance and benefits in minimizing the adverse effects arising from cancer and from the performed medical treatment. Exercise-based interventions should be chosen and carried out considering the type of cancer and the stage of treatment the child is in due to the evidence of its effectiveness.

RESUMEN Este estudio tiene como objetivo investigar, en la base de datos ScienceDirect, la información científica actualizada sobre actividad física, COVID-19 y cáncer infantil, mediante una revisión integradora, en la cual se utilizaron las palabras clave en tres combinaciones diferentes. Se seleccionaron cincuenta publicaciones clasificadas como las más relevantes de cada combinación, y se alcanzaron 26 publicaciones elegibles en el periodo entre agosto de 2019 y julio de 2021, de las cuales nueve fueron textos duplicados. Al aplicar los criterios de exclusión, se seleccionaron 11 artículos completos. El nivel de actividad física (AF) de los niños diagnosticados de cáncer o supervivientes de cáncer es bajo, y entre los cambios provocados por la pandemia de la COVID-19 se encuentran la disminución del nivel de AF y el aumento en el uso de dispositivos tecnológicos. Las recomendaciones mínimas de AF para esta población varían entre sí, sin embargo, existe evidencia que respalda su importancia y los beneficios en la minimización de los efectos adversos derivados del propio cáncer y del tratamiento médico realizado. Las intervenciones basadas en ejercicios, para la cual ya existe evidencia de efectividad, deben elegirse y llevarse a cabo teniendo en cuenta el tipo de cáncer y la etapa de tratamiento en la que se encuentra el niño.

RESUMO O objetivo deste trabalho é investigar, na base de dados Science Direct, informações científicas sobre atividade física, covid-19 e câncer infantojuvenil, através de uma revisão integrativa, utilizando três combinações de palavras-chave. Cinquenta publicações mais relevantes de cada combinação de palavras-chave foram selecionadas, e chegou-se a 26 artigos elegíveis no período compreendido entre agosto de 2019 e julho de 2021, dos quais nove eram textos duplicados. Aplicando-se os critérios de exclusão, foram selecionados 11 estudos completos. Constatou-se que o nível de atividade física (AF) de crianças com câncer ou sobreviventes do câncer é baixo e que entre as mudanças causadas pela pandemia de covid-19 estão a diminuição do nível de AF e o aumento do uso de dispositivos tecnológicos. As recomendações mínimas de AF para essa população variam, entretanto há evidências que sustentam sua importância e seus benefícios ao minimizar os efeitos adversos oriundos do próprio câncer e do tratamento médico realizado. As intervenções baseadas em exercícios, para as quais já há evidência de eficácia, devem ser escolhidas e realizadas a partir do tipo de câncer e na fase do tratamento em que a criança está.

Cáncer infantil: lo que debemos saber / Childhood cáncer: What we should know

Introducción: el cáncer representa una de las principales causas de muerte en niños, niñas y adolescentes a nivel global, el cual es superado escasamente por los accidentes. Las neoplasias más frecuentes son, en primer lugar, las leucemias; segundo, los tumores del Sistema Nervioso Central; y, tercero, los linfomas. Es importante destacar que no existe prevención, sin embargo, hay signos de alarma que si se logran identificar a tiempo pueden verse traducidos en una enfermedad más manejable con una sobrevida más alta y un mejor pronóstico. Objetivo: realizar una actualización académica sobre la importancia de los signos y síntomas de alarma del cáncer infantil. Método: se realizó una investigación documental y se utilizó como buscador de información científica Google Académico. Se evaluaron artículos de investigación y revisión de diferentes bases de datos, como: site de la Organización Mundial de la Salud, site de la Oficina Panamericana de la Salud, Revista de Pediatría Integral, American Cáncer Society y publicaciones periodísticas locales, entre otros. Conclusiones: el cáncer en la infancia y adolescencia no puede prevenirse; sin embargo, si los médicos de los distintos niveles de atención en salud pueden reconocer los signos de alarma ante un probable caso de malignidad, se lograrán referimientos oportunos, diagnósticos tempranos y una mejor tasa de curabilidad y sobrevida en los niños.

Introduction: Cancer represents one of the main causes of death in children and adolescents globally, which is barely surpassed by accidents. The most frequent neoplasms are leukemias first, Central Nervous System tumors second, and lymphomas third. It is important to note that there is no prevention, however, there are warning signs that, if identified in time, can be translated into a more manageable disease with higher survival and a better prognosis. Objective: To carry out an academic update on the importance of warning signs and symptoms of childhood cancer. Method: A documentary research was carried out and Google Scholar was used as a search engine for scientific information. Research and review articles from different databases were evaluated, such as: the World Health Organization site, the Pan American Health Office site, the Comprehensive Pediatrics Review, the American Cancer Society, local journalistic publications, among others. Conclusions: Cancer in childhood and adolescence cannot be prevented, however, if doctors at the different levels of health care can recognize the warning signs in the event of a probable case of malignancy, timely referrals, early diagnoses and a better curability rate will be achieved and survival in children.

Fear of cancer recurrence in informal caregivers of childhood cancer survivors / Miedo a la recurrencia del cáncer en cuidadores de supervivientes de cáncer infantil

Abstract Background Fear of cancer recurrence is one of the most distressing psychological consequences in cancer survivors and their informal primary caregivers (IPC). IPC of childhood cancer survivors (CCS) are often their mothers, which could intensify fear of cancer recurrence (FCR) and its impact on both IPC and CCS. However, the phenomenon has not been widely described in this specific population. Objective To summarize and analyze current evidence on the evaluation and management of FCR among IPC of CCS. Method A narrative review of studies included in four databases (PsycInfo, Medline, CINALH, and Web of Science) with no language or year of publication restrictions. Results Measures specifically developed to assess FCR among IPC of CCS comprising an interview and a questionnaire with initial psychometric evaluations and two short, online intervention programs based on cognitive-behavioral-contextual therapy were identified (ENGAGE and CASCAdE). Both have demonstrated acceptability in parents of CCS in high-income countries; preliminary evidence also exists of the effectivity of CASCAdE in reducing FCR. Discussion and conclusion Given the limitations of this area of psychological evaluation, the Fear of Cancer Recurrence Inventory, originally developed for adult cancer survivors, constitutes the most suitable tool for evaluating FCR among IPC of CCS. The CASCAdE program seems a promising intervention for IPC of CSS, although cultural adaptations, evaluations of its acceptability in low- and middle-income countries, and controlled studies in large samples are still required.

Resumen Antecedentes El miedo a la recurrencia del cáncer es una de las consecuencias psicológicas más angustiantes en los supervivientes y sus cuidadores primarios informales (CPI). Los CPI de supervivientes de cáncer infantil (SCI) a menudo son sus madres, lo que podría intensificar el miedo a la recurrencia (MR) y su impacto tanto a los CPI como a los SCI. Sin embargo, el fenómeno no se ha descrito ampliamente en esta población específica. Objetivo Resumir y analizar la evidencia actual sobre la evaluación y manejo del MR entre CPI de SCI. Método Se realizó una revisión narrativa de los estudios incluidos en cuatro bases de datos (PsycInfo, Medline, CINALH y Web of Science) sin restricciones de idioma o año de publicación. Resultados Se identificaron instrumentos desarrollados específicamente para evaluar MR entre CPI de SCI que comprenden una entrevista y un cuestionario, además de dos programas de intervención en línea basados en terapia cognitivo-conductual-contextual (ENAGE y CASCAdE). Ambos demostraron aceptabilidad en los padres de SCI en países de ingresos altos. También existe evidencia preliminar de la efectividad de CASCAdE en la disminución del MR. Discusión y conclusión Dadas las limitaciones de esta área de evaluación psicológica, el Inventario del Miedo a la Recurrencia del Cáncer, desarrollado originalmente para supervivientes adultos, constituye la herramienta más adecuada para evaluar MR en los CPI de SCI. El programa CASCAdE parece una intervención prometedora para CPI de SCI, aunque aún requiere adaptaciones culturales, evaluaciones de aceptabilidad en países de ingresos medio-bajos y estudios controlados con nuestras más grandes.

Exploring knowledge of parents and caregivers on cancer symptoms in children: an observational study regarding the need for educational tools and health promotion in low- and middle-income countries.

BACKGROUND: Although most cases of childhood cancer are unlikely to be prevented, by today's standards, most children with cancer can now be cured. However, disparities about survival exist among countries; in Mexico, the overall survival is 49.6%, with 70% of childhood cancers diagnosed at advanced stages. Therefore, parents and caregivers must have optimal knowledge of the early signs and symptoms of childhood malignancies as they are largely non-specific. This study was designed to explore the current knowledge of childhood cancer among parents and caregivers in Mexico and identify the need for education and health promotion in low- and middle-income countries. METHODS: An online survey of 112 parents and caregivers was performed to assess their knowledge of childhood cancer, focusing on the signs and symptoms and early diagnostic strategies. RESULTS: Sixty-nine (61.6%) mothers, 23 (20.5%) fathers, 17 (15.2%) familiar caregivers, and 3 (2.7%) non-familiar caregivers responded. Forty-six (41.1%) respondents said that they knew a child diagnosed with cancer, 92.9% mentioned leukemia as the most common type of cancer among children, the most highly ranked option when asked which sign/symptom they considered as a warning for suspicion was growth/lump in any part of the body, 97.3% considered that an early diagnosis is related to a higher cure rate, and 92.9% expressed the desire to receive reliable information about childhood cancer. CONCLUSIONS: Although parents and caregivers have some knowledge of childhood cancer, there are concepts that should be reinforced to improve their understanding of this group of diseases, as they are the frontline for children to seek medical attention. In the future, the use of tools that help educate more caregivers will strengthen knowledge and contribution regarding this issue and promote the generation of public policies that support the early diagnosis of childhood cancer.

P2X7 receptor isoform B is a key drug resistance mediator for neuroblastoma.

Drug resistance is a major challenge for all oncological treatments that involve the use of cytotoxic agents. Recent therapeutic alternatives cannot circumvent the ability of cancer cells to adapt or alter the natural selection of resistant cells, so the problem persists. In neuroblastoma, recurrence can occur in up to 50% of high-risk patients. Therefore, the identification of novel therapeutic targets capable of modulating survival or death following classical antitumor interventions is crucial to address this problem. In this study, we investigated the role of the P2X7 receptor in chemoresistance. Here, we elucidated the contributions of P2X7 receptor A and B isoforms to neuroblastoma chemoresistance, demonstrating that the B isoform favors resistance through a combination of mechanisms involving drug efflux via MRP-type transporters, resistance to retinoids, retaining cells in a stem-like phenotype, suppression of autophagy, and EMT induction, while the A isoform has opposite and complementary roles.

Análisis de conglomerado de cáncer infantil y su relación con proximidad a fuentes de contaminación industrial en el Área Metropolitana del Valle de Aburrá, 2000-2015

Objetivo: Este estudio evaluó el efecto de la proximidad a fuentes industriales de contaminación del aire sobre la aparición de clústeres de casos de cáncer infantil en el Área Metropolitana del Valle de Aburrá, del departamento de Antioquia, durante el período 2000-2015. Metodología: La información de casos de cáncer infantil en menores de 15 años residentes del área metropolitana se obtuvo del Registro Poblacional de Cáncer de Antioquia, de dicho periodo. Se identificaron 32 conglomerados industriales, a partir del inventario de la autoridad ambiental local. Se realizaron pruebas de escaneo circular de Kulldorf locales y focalizadas, para detectar clústeres de cáncer infantil en los municipios y alrededor de los conglomerados industriales respectivamente. Se usó un modelo de regresión multivariable ajustado por estrato socioeconómico, para evaluar el efecto de las variables espaciales. Resultados: La tasa de incidencia específica en el Valle de Aburrá para el periodo evaluado fue de 117,13 casos por millón de niños menores de 15 años. Las tasas de incidencia más altas se presentaron en los municipios de Medellín y Sabaneta. La prueba de Kulldorf identificó 12 clústeres espaciales y 8 espacio-temporales con significación estadística en 7 de los municipios, particularmente en Bello y Medellín. Las pruebas focalizadas identificaron clústeres alrededor de 20 conglomerados industriales. En los modelos multivariables, un conglomerado en Bello evidenció asociación estadísticamente significativa e inversa entre la incidencia y la distancia al conglomerado con direccionalidad sureste. Conclusión: Algunos conglomerados espacio-temporales de cáncer infantil en el Área Metropolitana del Valle de Aburrá entre 2000 y 2015 están relacionados con proximidad a fuentes industriales de contaminación del aire.

Objective: This study evaluated the effect of proximity to industrial sources of air pollution on the occurrence of clusters of childhood cancer cases in the Aburrá Valley Metropolitan Area, Department of Antioquia, during the 2000-2015 period. Methodology: The information on childhood cancer cases in children under 15 years of age residing in the metropolitan area was obtained from the Registro Poblacional de Cáncer de Antioquia (Antioquia Cancer Population Registry) for that period. 32 industrial clusters were identified based on the local environmental authority's inventory. Local and targeted Kulldorff's circular scan tests were performed to detect childhood cancer clusters in the municipalities and surrounding the industrial clusters, respectively. We used a multivariate regression model adjusted for socioeconomic strata to assess the effect of spatial variables. Results: The specific incidence rate in the Aburrá Valley for the evaluated period was 117.13 cases per million children under 15 years of age. The highest incidence rates occurred in the municipalities of Medellín and Sabaneta. The Kulldorff test identified 12 spatial clusters and 8 space-time clusters that were statistically significant in 7 municipalities, particularly in Bello and Medellín. The targeted tests identified childhood cancer clusters surrounding 20 industrial clusters. In multivariate models, an industrial cluster in Bello showed a statistically significant inverse association between incidence and distance from the industrial cluster toward the southeast. Conclusion: Some space-time childhood cancer clusters in the Aburrá Valley Metropolitan Area between 2000 and 2015 are related to proximity to industrial sources of air pollution.

Objetivo: Este estudo avaliou o efeito da proximidade a fontes industriais de poluição do ar sobre a aparição de agrupações de casos de câncer infantil na Área Metropolitana do Valle de Aburrá, do departamento de Antioquia, durante o período 2000-2015. Metodología: A informação de casos de câncer infantil em menores de 15 anos residentes da área metropolitana foi obtida do Registro Populacional de Câncer de Antioquia, de tal período. Foram identificados 32 conglomerados industriais, a partir do inventário da autoridade ambiental local. Foram realizados testes de varredura circular de Kulldorf locais e focalizados, para detectar agrupações de casos de câncer infantil nos municípios e ao redor dos conglomerados industriais, respectivamente. Foi usado um modelo de regressão multivariável ajustado por nivel socioeconômico, para avaliar o efeito das variáveis espaciais. Resultados: A taxa de incidência específica no Valle de Aburrá para o período avaliado foi de 117,13 casos por milhão de crianças menores de 15 anos. As maiores taxas de incidencia apresentaram-se nos municípios de Medellín e Sabaneta. O teste de Kulldorf identificou 12 agrupações de casos espaciais e 8 espaço-temporais com significação estatística em 7 dos municípios, particularmente em Bello e Medellín. As provas focalizadas identificaram agrupações de casos ao redor de 20 conglomerados industriais. Nos modelos multivariáveis, um conglomerado em Bello evidenciou associação estatisticamente significativa e inversa entre a incidência e a distância com o conglomerado orientado ao sudeste. Conclusão: Algumas agrupações de casos espaço-temporais de câncer infantil na Área Metropolitana do Valle del Aburrá entre 2000 e 2015 estão relacionadas com a proximidade a fontes industriais de poluição do ar.