Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.

A B S T R A C TDifficulties with negotiating and achieving desired social outcomes in life may be exacerbated by the experience of childhood cancer, including adverse effects from therapies used to achieve a cure. This review of previous publications from the Childhood Cancer Survivor Study (CCSS) and other relevant literature provides insight into the prevalence of, and risk factors for, poor educational attainment, less than optimal employment status, and interpersonal relationship issues among long-term survivors of childhood cancer. The impacts of emotional health and physical disability on social outcomes are also examined. Study results suggest that childhood cancer survivors generally have similar high school graduation rates, but are more likely to require special education services than sibling comparison groups. Survivors are slightly less likely than expected to attend college, and are more likely to be unemployed and not married as young adults. Cancers and treatments that result in impairment to the CNS, particularly brain tumors, or that impact sensory functioning, such as hearing loss, are associated with greater risk for undesirable social outcomes, as are emotional health problems and physical disability. This review of relevant data from CCSS and other studies provides information on risk factors for social problems into adulthood. A greater understanding of the long-term social impacts from the diagnosis and treatment of childhood cancer is critically important for developing targeted interventions to prevent or ameliorate adverse psychosocial effects.

Background-Among survivors of childhood cancer, those with Central Nervous System (CNS) malignancies have been found to be at greatest risk for neuropsychological dysfunction in the first few years following diagnosis and treatment. This study follows survivors to adulthood to assess the long term impact of childhood CNS malignancy and its treatment on neurocognitive functioning.

Important knowledge deficits exist among adult survivors of childhood cancer regarding basic aspects of their diagnosis and treatment. Such deficits could impair survivors' ability to seek and receive appropriate long-term follow-up care.

Schritt für Schritt: Im „molekularen“ Ansatz zur Bildung von Graphen werden Vorstufenmoleküle zu zweidimensionalen Zwischenstufen vernetzt und diese anschließend zu Graphen pyrolysiert. Damit werden qualitativ hochwertige Graphenprodukte, wie sie für technische Anwendungen dringend benötigt werden, zugänglich.

CUTE LYMPHOBLASTIC LEUKEmia (ALL) is the most common childhood malignancy in the United States, comprising 25% of all cancers in individuals younger than 20 years. 1 Over the past several decades, ALL has been transformed from a uniformly fatal disease to one that is associated with a 5-year survival probability of greater than 80%. 2 This remarkable progress is largely because of the adoption of risk-based therapy determined by patient characteristics and leukemia phenotype at disease presentation. Characteristics consistently identified from epidemiological studies to infer higher risk and require more intensive therapy include age at diagnosis (Ͻ1 year or Ն10 years), peripheral white blood cell (WBC) count greater than 50000/µL, T-cell immunophenotype, hypodiploidy, and certain chromosomal abnormalities. 3 Variability in survival outcome across racial and ethnic groups (hereafter referred to as race/ethnicity) also has been identified in some, but not all, clinical research. 4-13 Based on a study of St Jude's Children's Research Hospital data, Pui et al 4 concluded that survival in black children with ALL was comparable with that of white children with ALL in recent treatment eras, which are associated with more intensive, risk-based therapy. In contrast, Bhatia et al 5 reported that black and Hispanic children enrolled in Chil-dren's Cancer Group cooperative trials in the modern treatment era had worse survival than did white children, who in turn had worse survival than children of Asian decent, even after adjusting for other risk factors. The conclusions by Bhatia et al are similar to those of Pollock et al, 8 who found that black children and children with a Spanish surname enrolled in Pediatric Oncology Group cooperative trials had worse outcomes than white children. Population-based studies are needed to further delineate the role of race/ ethnicity in the risk classification of children with ALL. Past clinical studies were vulnerable to participation bias because they were restricted to children at a single medical center or those

BACKGROUND Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer. METHODS This was a cross‐sectional, multi‐institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age ≥20 years, stamina for the interview, English or Spanish‐speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM‐IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post‐Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization. RESULTS Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90–41.50) and non‐Hispanic white patients (OR = 2.7; 95% CI, 1.01–7.43) were more likely to receive mental health services in adjusted analysis. CONCLUSIONS Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients. Cancer 2005. © 2005 American Cancer Society.

Purpose-Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers. Results-Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services. Methods-TwoConclusion-Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.