Background:A brain tumor can lead to functional impairment, which is particularly concerning for adolescents and young adults (AYA). Patient-reported outcomes (PROs) have typically been examined as isolated domains, rather than as covarying symptoms. This study modeled PRO networks, symptom clustering, and topology among AYA oncology survivors. Methods:Patient-reported outcome networks from 4005 survivors were compared in topology between survivors of primary CNS tumors (n = 164) and non-CNS tumors (n = 3841). Survivors were diagnosed between 1999 and 2015 at ages 18 to 39 years, who completed the EORTC QLQ-SURV100 (Mdn follow-up = 12.31 years). Group-specific networks were estimated based on 33 health-related quality of life (HRQoL) scale scores using graphical LASSO. Wilcoxon rank-sum tests and the Network Comparison Test assessed group differences in the original PRO scales and their network centrality, respectively. Within the CNS subgroup (n = 164), associations with tumor-related and treatment-related characteristics were explored. Results:Survivors of central nervous system (CNS) tumors reported higher symptom burden on most PRO scales, along with a more diffuse network showing weaker within-domain cohesion (lower nodal strength and expected influence) and limited cross-domain integration (lower bridge strength). A small subset of nodes showed higher bridge expected influence (ie, fatigue, physical functioning, sexual problems when sexually active, work), which may represent key targets for intervention. Across both groups, negative health outlook, health distress, and physical functioning emerged as consistent core targets. Conclusion:Core symptoms may warrant prioritization in clinical follow-up and treatment of cancer survivors. These findings contribute to further development and optimization of tailored neurorehabilitation programs in neuro-oncological care.
Research on the social networks of children with posttraumatic stress disorder (PTSD) remains limited. Although a link between PTSD symptoms and the child's social environment is often assumed, this can be impacted in cases of interpersonal trauma. This is important, because social support can play a beneficial role in recovery after experiencing trauma. However, little is known about how children with interpersonal trauma perceive their social network and the support they gain from this network. This qualitative study used semi-structured interviews to explore these perceptions in greater depth. Ten children who experienced interpersonal trauma between the ages of 8 to 12 were interviewed about their social network. The content of the interviews was analyzed using reflexive thematic analysis. Descriptive statistics showed that children had varied networks with 40% of relationships experienced as ambivalent or negative. In addition, there was a general tendency to not discuss their traumatic experiences. Thematic analysis identified four key themes. First of all, the parent-child relationship was often strained with both parents, but in different ways. Second, there seemed to be a contrast between the positive definition children gave of friendship and the negative experiences they had within their own reported friendships. Third, children were able to identify supportive actions from different individuals in their network, related to the trauma as well as more general support. Finally, children reported various reasons for their general reluctance to discuss their trauma. The findings emphasize a need for help with strengthening the children's social network to improve recovery from trauma.
BackgroundFertility preservation prior to puberty suppression or gender-affirming hormone treatment is recommended for transfeminine adolescents who might desire future genetic parenthood. Spermatogenesis is absent in early puberty, so fertility preservation may require delaying treatment until mid-puberty, a process that can cause distressing secondary sex characteristic development.AimsTo determine the optimal timing for fertility preservation with minimal pubertal changes and to explore the experiences of transfeminine adolescents and their parents undergoing this process.MethodsTwo prospective cohort study were combined: the European Network for the Investigation of Gender Incongruence - adolescents, and the Fertility Preservation Outcomes and Experience cohort in the Netherlands. Between December 2022 and March 2025, 49 transfeminine adolescents were consecutively included. Participants underwent clinical assessments including Tanner stage, testicular volume, hormone levels, acne score, body/facial hair growth, and voice frequency. Fertility preservation options included semen cryopreservation or, when not feasible, testicular sperm extraction (TESE). Adolescents and parents completed follow-up questionnaires regarding experiences and perceived pubertal changes.ResultsOf the 49 adolescents, 76% (n = 37) preferred TESE over semen cryopreservation. Most reported they would not pursue fertility preservation if their voice began to deepen (72%) or body hair increased (55%). During follow-up, semen cryopreservation was successful at an average palpated testicular volume of 12 mL (n = 5), while TESE was feasible from an average ultrasound-measured testicular volume of 7.75 mL (n = 14). Voice frequency post-preservation averaged 184 Hz (range 137-200), within the cisgender female range for all but one. After fertility preservation at the start of puberty suppression 56% adolescents exhibited hair growth. Despite stress associated with delaying puberty suppression, most adolescents and parents reported positive experiences after completion.DiscussionResults highlight the need for individualized, intensive fertility care to minimize physical changes and psychological distress. The observed variability in pubertal development and fertility preservation preferences underscores the importance of tailored counseling and decision-making.
Surgical management remains the cornerstone in the management of gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs), yet surgical indications and procedures are often inconsistent. To inform the development of a research agenda to strengthen the evidence in NETs surgical care, we conducted a scoping review to map the existing literature on surgery for gastro-entero-pancreatic (GEP) NETs. The scoping review was conducted following the expanded framework of Arksey and O’Malley. A literature search was run on MEDLINE, Embase, and Scopus in October 2024 for studies published since 2000 reporting on any surgical intervention, performed under general or loco-regional anesthesia on adults with GEP-NETs at any stage. Among the 10,000 studies screened, 260 were included. Publications included were mostly reviews covering a broad range of topics. Of the 120 original investigations, 96.7
To compare perioperative, oncological, and survival outcomes of total gastrectomy (TG) versus subtotal gastrectomy (SG) in patients with locally advanced distal diffuse gastric adenocarcinoma treated with perioperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy. Diffuse distal gastric cancer is characterized by infiltrative growth patterns and early nodal metastasis. Whilst radical resection remains the cornerstone of curative treatment, the optimal extent of surgery with TG or SG, remains debated. This international multicenter cohort study analyzed data from patients with histologically confirmed diffuse gastric adenocarcinoma, located > 5 cm from the gastroesophageal junction. Endpoints included surgical margin status, nodal yield, perioperative morbidity, recurrence patterns, time-to-recurrence (TTR), and overall survival (OS). Outcomes were compared using multivariate analyses. In total, 188 (39.0
