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Purpose We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies. Methods Using the Childhood Cancer Survivor Study cohort and a case–control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns. Results Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR = 1.72, CI 1.27–2.34), being underweight (OR = 2.58, CI 1.55–4.28), increased medical care utilization ( P  < 0.001), and self-reported fair to poor health ( P  < 0.001). Physical activity was associated with a higher risk of death among males (OR = 3.26, CI 1.90–5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR = 0.61, CI 0.41–0.89) and other nonexternal causes of death (OR = 0.40, CI 0.20–0.79). Concerns/worries about future health (OR = 1.54, CI 1.10–2.71) were associated with increased all-cause mortality. Conclusions Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer. Implications for Cancer Survivors Continued cohort observation may inform interventions to reduce mortality.

To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors. The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee. Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram. Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores. Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.

OBJECTIVES: To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors, SAMPLE & SETTING: The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St, Jude Children's Research Hospital in Memphis, Tennessee, METHODS & VARIABLES: Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram. RESULTS: Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores. IMPLICATIONS FOR NURSING: Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.

Introduction Female childhood cancer survivors experience adverse health events secondary to cancer treatment. In healthy women, breastfeeding provides protection against many of these complications. Breastfeeding may be beneficial for mothers surviving childhood cancer by decreasing risks of, or ameliorating adverse late effects. Healthcare providers and survivors should be aware that successful lactation may be affected by previous cancer treatment. Methods The literature addressing lactation outcomes in cancer patients is reviewed, and processes that may disrupt breastfeeding are discussed. A summary of common late effects experienced by women is provided, and arguments are made for the potential amelioration of these complications by breastfeeding. Results Findings demonstrate that breastfeeding is beneficial for healthy mothers in regard to specific health conditions. There are limited data addressing breastfeeding outcomes among cancer survivors. Preliminary findings suggest that lactation is adversely affected among mothers treated for childhood cancer. Conclusions Fundamental research is needed to determine rates of breastfeeding in childhood cancer survivors, identify specific cancer therapies and their effects on lactation, examine the efficacy of breastfeeding in risk reduction and/or amelioration of late effects, and develop interventions to increase breastfeeding among survivors of childhood cancer. Implications for cancer survivors As female childhood cancer survivors transition into adult medical care, it is important each patient be aware of her past medical history and the impact of treatment on her ability to successfully lactate. If lactation is possible, these women can choose to breastfeed their children, thereby engaging in a health behavior that may help protect them against many late effects of cancer treatment.