Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.

A B S T R A C TChildhood cancer survivors are at risk for medical and psychosocial late effects as a result of their cancer and its therapy. Promotion of healthy lifestyle behaviors and provision of regular risk-based medical care and surveillance may modify the evolution of these late effects. This manuscript summarizes publications from the Childhood Cancer Survivor Study (CCSS) that have examined health behaviors, risk-based health care, and interventions to promote healthy lifestyle practices. Long-term survivors use tobacco and alcohol and have inactive lifestyles at higher rates than is ideal given their increased risk of cardiac, pulmonary, and metabolic late effects. Nearly 90% of survivors report receiving some form of medical care. However, only 18% report medical visits related to their prior cancer that include discussion or ordering of screening tests or counseling on how to reduce the specific risks arising from their cancer. One low-cost, peer-driven intervention trial has been successful in improving smoking cessation within the CCSS cohort. On the basis of data from CCSS investigations, several trials to promote improved medical surveillance among high-risk groups within the cohort are underway. Despite their long-term risks, many survivors of childhood cancer engage in risky health behaviors and do not receive adequate risk-based medical care.

Aims-This study describes alcohol consumption among adult survivors of pediatric cancer compared to sibling controls and a national sample of healthy peers. Risk factors for heavy drinking among survivors are described.Design, Setting and Participants-Cross-sectional data were utilized from the Childhood Cancer Survivor Study including adult survivors of pediatric cancer (N=10,398), and a sibling cohort (n=3,034). Comparison data were drawn from the National Alcohol Survey (n=4,774).Measurement-Alcohol consumption, demographic, cancer diagnosis, treatment and psychosocial factors were measured.Findings-Compared to peers, survivors were slightly less likely to be risky (OR adj =0.9; CI 0.8-1.0) and heavy drinkers (OR adj =0.8; CI 0.7-0.9) and more likely to be current drinkers. Compared to siblings, survivors were less likely to be current, risky and heavy drinkers. Risk factors for survivors' heavy drinking included being age 18-21 (OR adj =2.0; 95% CI 1.5-2.6), male (OR adj =2.1; 95% CI 1.8-2.6), having high school education or less (OR adj =3.4; 95% CI 2.7-4.4), and drinking initiation before age 14 (OR adj =6.9; 95% CI 4.4-10.8). Among survivors, symptoms of depression, anxiety, or somatization, activity limitations and anxiety about cancer were associated with heavy drinking. Cognitively compromising treatment, brain tumors and older age at diagnosis were protective.Conclusions-Adult survivors of childhood cancer show only a modest reduction in alcohol consumption compared to peers despite their more vulnerable health status. Distress and poorer health are associated with survivor heavy drinking. Screening for alcohol consumption should be instituted in long-term follow-up care and interventions among survivors and siblings should be established to reduce risk for early drinking.

Childhood cancer survivors (CCS) have a high risk of medical late effects following cancer therapy. Psychosocial late effects are less often recognized. Many CCS do not receive long-term follow-up (LTFU) care, and those who do are rarely screened for psychosocial late effects. An interdisciplinary team conducted a systematic review of qualitative and quantitative studies to assess social, educational, vocational, psychological, and behavioral outcomes along with factors related to receipt of LTFU care. We propose that psychosocial screening be considered a standard of care in long-term follow-up care and that education be provided to promote the use LTFU care starting early in the treatment trajectory.

Physical or sexual IPV was associated with poorer self-assessed health and many health symptoms among this culturally distinctive Mexican American population.

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Background. Pediatric hematopoietic cell transplant (HCT) is a lifesaving treatment that often results in physical and psychological discomfort. An acupressure-massage intervention may improve symptom management in this setting. Methods. This randomized controlled pilot trial compared a combined massage-acupressure intervention to usual care. Children were offered three practitioner-provided sessions per week throughout hospitalization. Parents were trained to provide additional acupressure as needed. Symptoms were assessed using nurses' reports and two questionnaires, the behavioral affective and somatic experiences scale and the Peds quality of life cancer module. Results. We enrolled 23 children, ages 5 to 18. Children receiving the intervention reported fewer days of mucositis (Hedges' g effect size ES = 0.63), lower overall symptom burden (ES = 0.26), feeling less tired and run-down (ES = 0.86), having fewer moderate/severe symptoms of pain, nausea, and fatigue (ES = 0.62), and less pain (ES = 0.42). The intervention group showed trends toward increasing contentness/serenity (ES = +0.50) and decreasing depression (ES = −0.45), but not decreased anxiety (ES = +0.42). Differences were not statistically significant. Discussion. Feasibility of studying massage-acupressure was established in children undergoing HCT. Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children.

Background Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHB co-occur. Limited information describes how RHBs cluster among childhood cancer survivors and siblings and the risk factors for co-occurring RHBs. Methods Latent class analysis was used to identify RHB clusters using longitudinal survey data on smoking, alcohol use, and physical activity from adult survivors (N=4184) and siblings (N=1598) in the Childhood Cancer Survivor Study (CCSS). Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership. Results We identified three RHB clusters: a low risk cluster; an insufficiently active cluster; and a high-risk cluster (tobacco and risky alcohol use and insufficient activity). Compared to siblings, survivors were more likely to be in the insufficiently active cluster (ORadj=1.17; 95% CI 1.06–1.27) and less likely to be in the high-risk cluster (ORadj=0.79; 95% CI 0.69–0.88). Risk factors for high-risk cluster membership included psychological distress, (ORadj=2.76; 95% CI 1.98–3.86) low educational attainment, (ORadj=7.49; 95% CI 5.15–10.88) income <$20,000, (ORadj=2.62; 95% CI 1.93–3.57) being divorced/separated or widowed, (ORadj=1.36; 95% CI 1.03–1.79) and limb amputation (ORadj=1.52; 95% CI 1.03–2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, non-white race/ethnicity, single marital status, cranial radiation, and cisplatin exposure. Conclusions RHB co-occur in childhood cancer survivors and siblings. Economic and educational disadvantage and psychological distress should be considered in screening and interventions to reduce RHB.