Objective: This study aimed to test the inter-rater reliability, construct validity, and feasibility of the modified “Which Health Approaches and Treatments Are You Using?” (WHAT) questionnaires in pediatric oncology. Methods: A sample of parent-child dyads was invited to complete self- and proxy-report modified WHAT, Pediatric Quality of Life Inventory, demographics, a diary of child recent use of CHA, and a questionnaire assessing aspects of feasibility. Parents were also asked to complete a satisfaction of children’s use of CHA survey. Results: Twenty-four dyads completed the study. The mean weighted kappa showed strong inter-rater reliability (k=0.77, SE=0.056); and strong agreements between the modified WHAT and the diary (self-report [k=0.806, SE=0.046], proxy-report [k=0.894, SE=0.057]). Significant relationships were found only between recent and non-recent CHA users in relation to easy access to CHA (self-report [p=0.02], proxy-report [p<0.001]). The mean scores of the feasibility scale (out of 7.0) for the self- and proxy-report were 5.64 (SD=0.23) and 5.81 (SD=0.22), respectively, indicating the feasibility of the modified WHAT. Conclusions: The findings of this study provide initial evidence of the reliability and validity of the modified WHAT questionnaires and their feasibility in assessing child CHA use and initiating clinical discussions about CHA with children and their parents. Further research is needed to test the theoretical relationships and to further explore the validity and reliability of the modified WHAT.

Differentiating hepatoblastomas (HB) from other congenital benign hepatic tumours prior to surgical management decisions is key. We, herein, present an unusual case of an antenatally diagnosed liver lesion assessed in the neonatal period. Because of its predominantly cystic ultrasound/MRI appearance and borderline alpha-fetoprotein serum levels, the diagnosis of mesenchymal hamartoma was favoured and protocol-based tumor resection was performed. Due to the intra-operative diagnosis of fetal subtype HB with positive resection margins the child had to undergo a second laparotomy. This report raises awareness to an unusual appearance of HB and discusses non-invasive imaging clues to consider atypical appearances of HB pre-operatively as they can have profound implications in patient management.

Abstract Background: Location of cancer care (LOC: pediatric versus adult center) impacts outcomes in adolescents and young adults (AYA) with some cancer types. Data on impact of LOC on survival in AYA with osteogenic sarcoma (OGS) and Ewing sarcoma (EWS) are limited. Objectives: To compare differences in demographics, disease/treatment characteristics, and survival in a population-based cohort of AYA with OGS or EWS treated at pediatric versus adult centers Methods: The IMPACT Cohort captured demographic, disease, and treatment data for all AYA (15-21 years old) diagnosed with OGS and EWS in Ontario, Canada between 1992-2012. Patients were linked to provincial administrative healthcare databases. Outcomes were compared between patients treated in pediatric versus adult centers using appropriate statistical methods. Results: 137 AYA were diagnosed with OGS (LOC: 47 pediatric, 90 adult) and 84 with EWS (LOC: 38 pediatric, 46 adult). AYA treated at pediatric centers were more likely to be enrolled in a clinical trial (OGS 55% vs 1%, [p<0.001]; EWS 53% vs 2%, [p<0.001]) and received higher cumulative chemotherapy doses. Five-year event-free survival (EFS ± Standard Error) in OGS and EWS were 47% ± 4 and 43% ± 5, respectively. In multivariable analysis, the impact of LOC (pediatric vs adult center) on EFS in OGS (adjusted hazard ratio [HR] 1.15, 95% CI 0.58-2.27, P=0.69) and EWS (adjusted HR 1.82, 95% CI 0.97-3.43, P=0.06) were not statistically significant. Conclusion: Outcomes did not differ by LOC suggesting that AYA with bone tumors can be treated at either pediatric or adult centers.

Background: Exercise intolerance is a common side-effect of treatment for childhood leukemia and lymphoma and contributes to adverse health and well-being during survivorship. While central, cardiovascular contributors to fitness have been shown to be impaired, the peripheral muscular factors have not been studied in this population. Therefore, peripheral muscular function in children after leukemia and lymphoma treatment remains unstudied. Procedure: Eleven leukemia and lymphoma patients aged 8-18 years old who completed treatment 6-36 months prior and 11 healthy controls were included in analysis. 31P-MRS was used to characterize muscle bioenergetic metabolism at rest and after in-magnet knee extension exercise. General exercise capacity was assessed using a submaximal graded treadmill test and overall physical activity participation was assessed using the Habitual Activity Estimation Scale (HAES). Results: The patients treated for leukemia and lymphoma exhibited lower anaerobic function (d=0.72), slower metabolic recovery (d=0.93), and lower mechanical muscle power (d=1.09) during in-magnet knee extension exercise compared with the healthy control group. Lower estimated VO2peak (41.61 ± 5.97 vs. 47.71 ± 9.99 ml.min-1.kg-1, d=0.76), lower self-reported minutes of physical activity (58.3 ± 35.3 vs. 114.8 ± 79.3 minutes, d=0.99) and higher minutes of inactivity (107.3 ± 74.0 vs. 43.5 ± 48.3 minutes, d=1.04, p<0.05) were also observed in the patient group. Conclusions: Children treated for leukemia and lymphoma exhibit altered peripheral skeletal muscle energy metabolism in addition to previously reported central cardiovascular limitations during exercise. It is likely that both deconditioning and direct effects of chemotherapy treatment contribute to exercise intolerance in this population.