The number of cancer survivors living in the U.S. is dramatically increasing. Cognitive decline is a commonly reported and burdensome symptom of cancer survivors. In addition, many cancer survivors experience difficulty maintaining employment. This dissertation addresses gaps in the literature of cognitive and occupational function of cancer survivors, with particular emphasis on the understudied population of cancer survivors diagnosed as an adolescent or young adult (AYA). For this dissertation, a series of studies were conducted to 1) explore the association between occupation and symptom burden in breast cancer survivors, 2) synthesize the evidence of cognitive outcomes in survivors of AYA cancer, and 3) describe cognitive and occupational function in survivors of adolescent cancer compared to healthy controls.To address aim one, a secondary analysis of data from early-stage breast cancer survivors explored the relationship between occupation and symptom burden. Breast cancer survivors employed in lower skill level jobs reported greater symptom burden over the first year of anastrozole treatment than women employed at the higher skill level. Survivors employed at lower skill levels had higher levels of fatigue and worse depressive, musculoskeletal, vasomotor, and gastrointestinal symptoms.To address aim two, an integrative review synthesized the current state of science in terms of cognitive outcomes of those diagnosed with cancer as an AYA. Survivors of AYA cancer tended to experience cognitive difficulties; however, to date, no study has focused exclusively on those diagnosed as an AYA or encompassed the entirety of the AYA age range. Future iv studies are needed because cognitive outcomes of survivors of AYA cancer have been largely neglected.Lastly, a cross-sectional, descriptive comparative study described cognitive and occupational function in survivors of adolescent cancer compared to healthy controls. Survivors of adolescent cancer perceived greater cognitive difficulty than healthy peers, although there were not significant measurable differences in performance on neuropsychological tests. Survivors of adolescent cancer also reported poorer work output than healthy controls.This dissertation contributes to the growing body of literature pertaining to health and well-being of cancer survivors, in particular cognitive and occupational function, and unique considerations needed for those diagnosed with cancer as an AYA.v Study 2. While there is a growing body of literature suggesting that many cancer survivors may experience cognitive decline after cancer diagnosis and treatment, much less is known about the cognitive outcomes of those diagnosed during the AYA timeframe. Therefore, the second study of this dissertation is an integrative review to summarize and appraise the current state of published literature involving cognitive function in those diagnosed during adolescence and young adulthood. While the review is a distinct study within the dissertation project, it provides a critically important ...

A gap still remains in helping CCSs transition from oncology to primary care and this pilot study offered insights into how we might better bridge that gap through the use of telemedicine. Further research is needed to refine the transition process for CCSs, including evaluation and testing models for standard of care.

BackgroundThe 5‐year survival for pediatric acute lymphoblastic leukemia (ALL) is greater than 90%. One late effect of pediatric ALL associated with numerous long‐term difficulties is neurocognitive deficits. The experience at our institution, as well as conversations with oncologists at other institutions, suggests an increase in the use of sedation during lumbar punctures (LPs) for treatment of pediatric ALL. Among the most common Children's Oncology Group (COG) ALL protocols, approximately 30 LPs are performed over 2‐3 years. Studies in animals reveal that sedation drugs may harm the developing brain. Gaps in knowledge exist regarding their use in children, particularly repeated exposures. The purpose of this study is to summarize sedation practices for LPs related to the treatment of ALL at COG institutions.MethodsResponsible Individuals (RIs) of the Cancer Control Committee of COG were invited to complete an internet‐based survey about sedation practices at their institutions.ResultsSurveys were sent to 103 RIs with a 62% response rate (N = 64). A combined 2018 new patients with ALL were seen each year (mean = 31.5, range = 3‐110) at the participating institutions. The majority (96%) of children with ALL received sedation for LPs. While there was considerable variability across institutions in the type of sedation given, the most common was propofol alone (n = 36, 56%).ConclusionsA substantial number of children with ALL receive sedation for LPs; however, there is variation in the medication used. Better understanding of sedation practices in children with ALL may inform future research to investigate which methods are the safest, with an emphasis on long‐term neurocognitive late effects.

Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patientcenteredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.

Background Skull base tumors comprise many common benign brain tumors. Treatment has advanced, allowing many survivors to return to work. However, literature is limited about the neuropsychological status of these patients prior to treatment. Literature pertaining to the relationship between neuropsychological functioning and occupational ability prior to surgical intervention is even more limited. The purpose of this analysis was to evaluate the impact of neuropsychological function on work productivity in persons with skull base tumors prior to resection. Methods Neuropsychological function and work productivity were assessed in adults newly diagnosed with skull base tumors (n = 45) prior to surgical intervention. Univariate analyses identified potential predictors of work limitations; variables with P < .10 were analyzed using multivariate regression analyses controlled for age, sex, tumor type, and education. Results Poorer mental attention and flexibility (MF) and higher depressive symptoms (DS) were significantly associated with poor time management at work (MF: β = −0.59, P = .01; DS: β = 3.42, P < .01; R2 = 0.54). Difficulty meeting physical work demands was significantly associated with poorer visuospatial ability (VA) and higher depressive symptoms (VA: β = −3.30, P = .05; DS: β = 2.29, P < .01; R2 = 0.29). Lower learning and memory scores (LM) and higher depressive symptoms were significantly associated with difficulty meeting mental-interpersonal work demands (LM: β = −3.39, P = .04; DS: β = 3.25, P < .01; R2 = 0.47) and overall health-related loss of work productivity (LM: β = −0.72, P = .05; DS: β = 0.659, P < .001; R2 = 0.43). Conclusion Domains of neuropsychological function that predicted work productivity were identified. Future research should examine neuropsychological function, depressive symptoms, and work productivity across the care trajectory from diagnosis through long-term survivorship.