Hematopoietic cell transplantation (HCT) is an important curative treatment for children with high-risk hematologic malignancies and solid tumors, and increasingly, non-malignant diseases. Given improvements in care, there is a growing number of long-term survivors of pediatric HCT. Compared with non-transplanted childhood cancer survivors, HCT survivors have been shown to have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pre-transplant treatment exposures and organ dysfunction, the transplant conditioning regimen, and any post-transplant graft versus host disease (GVHD). In response, the Children’s Oncology Group (COG) has created Long-Term Follow-Up Guidelines (www.survivorshipguidelines.org) for survivors of childhood, adolescent, and young adult cancer, including those treated with HCT. Guidelines taskforces, consisting of HCT specialists, other pediatric oncologists, radiation oncologists, organ-specific subspecialists, nurses, social workers, other healthcare professionals, and patient advocates have systematically reviewed the literature with regards to late effects after childhood cancer and HCT since 2002, with the most recent review completed in 2013. For the most recent review cycle, over 800 articles from the medical literature relevant to childhood cancer and HCT survivorship were reviewed, including 586 original research articles. Provided here-in is an organ system-based overview that emphasizes the most relevant COG recommendations (with accompanying evidence grade) for the long-term follow-up care of childhood HCT survivors (regardless of current age) based on a rigorous review of the available evidence. These recommendations cover both autologous and allogeneic HCT survivors, those transplanted for non-malignant diseases, and those with a history of chronic GVHD.

Primary productivity, community respiration, chlorophyll a concentration, phytoplankton species composition, and environmental factors were compared in the Yolo Bypass floodplain and adjacent Sacramento River in order to determine if passage of Sacramento River through floodplain habitat enhanced the quantity and quality of phytoplankton carbon available to the aquatic food web and how primary productivity and phytoplankton species composition in these habitats were affected by environmental conditions during the flood season. Greater net primary productivity of Sacramento River water in the floodplain than the main river channel was associated with more frequent autotrophy and a higher P:R ratio, chlorophyll a concentration, and phytoplankton growth efficiency (a B ). Total irradiance and water temperature in the euphotic zone were positively correlated with net primary productivity in winter and early spring but negatively correlated with net primary productivity in the late spring and early summer in the floodplain. In contrast, net primary productivity was correlated with chlorophyll a concentration and streamflow in the Sacramento River. The flood pulse cycle was important for floodplain production because it facilitated the accumulation of chlorophyll a and wide diameter diatom and green algal cells during the drain phase. High chlorophyll a concentration and diatom and green algal biomass enabled the floodplain to export 14-37% of the combined floodplain plus river load of total, diatom and green algal biomass and wide diameter cells to the estuary downstream, even though it had only 3% of the river streamflow. The study suggested the quantity and quality of riverine phytoplankton biomass available to the aquatic food web could be enhanced by passing river water through a floodplain during the flood season.

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Children who receive head, neck, or chest radiotherapy for various primary malignancies have increased risk for secondary thyroid malignancy. Thyroid nodules are difficult to identify by physical examination and/or laboratory tests. Thyroid ultrasound can detect non-palpable nodules without adverse side effects. We performed a retrospective chart review of 36 patients who received radiotherapy and underwent thyroid ultrasound. Forty-seven percent (n = 17) had ≥1 nodule(s) detected. Seven patients underwent thyroidectomy; four of whom were diagnosed with thyroid malignancy. Our study suggests routine use of thyroid ultrasound in high-risk patients detects subclinical thyroid nodules and potential thyroid malignancy post-radiotherapy.

Les fermetures d’hôpitaux et la réduction radicale de l’emploi ne sont que les manifestations les plus visibles de l’actuelle reconfiguration du système de santé au Québec qui affecte profondément la production des soins et l’organisation du travail infirmier dans l’hôpital de courte durée. Largement inspirés de l’expérience américaine, les changements en cours seront analysés en prenant pour exemple la Régie régionale de Québec et le Centre hospitalier universitaire de Québec (CHUQ). Il sera notamment démontré, à partir d’une analyse de l’évolution du travail infirmier dans six unités de soins, que deux évolutions sont possibles, selon que domine la déqualification ou la reprofessionnalisation du travail

6569 Background: The Coleman Supportive Oncology Collaborative for Adolescents and Young Adults (CSOC AYA) is a multi-institution Chicago-based quality improvement collaborative consisting of representation from AYA-focused oncology teams at six hospitals and national patient advocacy organizations. Coping with cancer as an AYA is challenging given their complex and unique phases of life and dichotomy between pediatric and adult care. AYAs with cancer are a recognized underserved population within the cancer community and have unique supportive care needs that are often unmet. The CSOC AYA focuses on improving access to resources for supportive care. Methods: We implemented an online survey across six cancer treatment centers (5 academic, 1 community) engaging 50 AYAs. Participants were newly diagnosed (2), currently on treatment (18), or off treatment (30). Participant age range was representative of AYAs ( < 18years: 2%, 18 – 24: 36%, 25 – 34: 55%, and 35-39: 7%). Reported race was 60% Caucasian, 10% Black, 18% Latino, 8% Asian, 2% American Indian, and 2% other. Questions were asked to inform which supportive resources were desired by patients, when the resources would be most useful during the care continuum, and the preferred methods to receive information. Results: Greater than 54% percent of respondents desire social/emotional resources and peer connection at diagnosis. During treatment and after treatment, > 71% and > 56% respectively, desire guidance regarding nutrition/diet and physical activity/exercise, in addition to social/emotional support and peer connection (See table). Preferred methods to receive information were identified: 72% via email or text, 60% in person, and 45% via a patient portal. Conclusions: The CSOC AYA survey identified the type of supportive care resources AYAs need, when they are wanted, and their preferred methods for receiving them. Optimizing accessibility and availability of supportive care resources can enable AYA self-management and has the potential to improve quality of life. These survey results will serve as the basis for a patient-facing online intervention implemented throughout the care continuum with the intent to improve supportive care access for AYAs with cancer. [Table: see text]

96 Background: 5-year survival rate for childhood cancers significantly improved leading to increased awareness to long-term effects associated with these diseases. Many childhood cancer survivors have significantly lower exercise capacity. The POST (Pediatric Oncology Survivorship in Transition) team at Advocate Children’s Hospital created a 5k Program to encourage survivors to return to physical activity. Participants were childhood cancer survivors who had been off therapy or cleared by their oncologist to participate, and who were greater than 9 years old. The Program had weekly 1 hour supervised training sessions and home physical activity assignments over 8-12 weeks in preparation for the 5K. Each participant invited a friend/family member to partner in training and on race day. Methods: The purpose of this study is to evaluate the strengths and weaknesses of the 5K Program in promoting physical activity and to validate its continuation and expansion. All participants who finished the 5K (n = 68) from 2009-2017 were included in our retrospective chart review. Data collected from the medical records included diagnoses and number of times of participation. An online Qualtrics survey inquired about barriers encountered, subjective experience of having a personal coach and training partner, and additional personal comments. The IRB approved this study. Results: The survey was distributed in October 2017 and complete data collection is anticipated in November 2017. The primary outcome will reflect the effectiveness of the Program in promoting return to physical activity, measured by descriptive survey responses. Secondary outcomes include data collected by retrospective chart review. 44 of 68 (65%) participants completed the 5K multiple times. The majority of these were survivors of leukemia (31) followed by lymphoma (13), solid tumors (9), bone marrow transplant (9), brain tumors (5) and histiocytosis (1). Conclusions: While the 8-12 week program is likely too short to measure physical changes, the high percentage of participants completing multiple 5Ks demonstrates its effectiveness in improving physical endurance. Additional conclusions with full data analysis will be completed by February 2018.