Objectives: Children with cancer often experience sleep problems, which are associated with many negative physical and psychological health outcomes, as well as with a lower quality of life. Therefore, interventions are strongly required to improve sleep in this population. We evaluated interactive education with respect to sleep hygiene with a social robot at a pediatric oncology outpatient clinic regarding the feasibility, experiences, and preliminary effectiveness. Methods: Researchers approached children (8 to 12 years old) who were receiving anticancer treatment and who were visiting the outpatient clinic with their parents during the two-week study period. The researchers completed observation forms regarding feasibility, and parents completed the Children’s Sleep Hygiene Scale before and two weeks after the educational regimen. The experiences of children and parents were evaluated in semi-structured interviews. We analyzed open answers by labeling each answer with a topic reflecting the content and collapsed these topics into categories. We used descriptive statistics to describe the feasibility and experiences, and a dependent-samples t-test to evaluate the preliminary effectiveness. Results: Twenty-eight families participated (58% response rate) and all interactions with the robot were completed. The children and parents reported that they learned something new (75% and 50%, respectively), that they wanted to learn from the robot more often (83% and 75%, respectively), and that they applied the sleeping tips from the robot afterwards at home (54%). Regarding the preliminary effectiveness, children showed a statistically significant improvement in their sleep hygiene (p = 0.047, d = 0.39). Conclusions: Providing an educational regimen on sleep hygiene in a novel, interactive way by using a social robot at the outpatient clinic seemed feasible, and the children and parents mostly exhibited positive reactions. We found preliminary evidence that the sleep hygiene of children with cancer improved.

Background: Insomnia is common during and after childhood cancer and associated with negative health outcomes and impaired quality of life. Many adolescents and young adults do not receive treatment. Internet‐delivered cognitive behavioral therapy for insomnia (iCBT‐i) can fill this gap. This study assesses the effectiveness of the iCBT‐i intervention “iSleep youth”.Methods: Patients (12–30 years old) with an Insomnia Severity Index ≥8, ≥6 months after treatment, and <10 years after diagnosis were 1:1 randomized to iSleep youth or the wait list‐control group. iSleep youth consists of five online sessions with a coach. Outcomes were sleep efficiency (actigraph‐based), insomnia, fatigue, and health‐related quality of life (HRQOL). Differences over time between iSleep youth and controls, 3 months (T3) and 6 months (T6) from baseline, were assessed with linear mixed models, controlling for age, sex, and time since end of treatment. iSleep youth also had a follow‐up measurement after 12 months (T12).Results: Fifty‐four (response rate, 49%) patients participated: 68.9% females, mean age, 18.5 years (SD = 3.5), and mean time since end of treatment 3.8 years (SD = 2.3). No significant effects between the two groups were found for sleep efficiency. However, iSleep youth had a beneficial effect on insomnia severity at T3 (β = –0.79) and T6 (β = –0.55), on fatigue at T3 (β = –1.08) and T6 (β = –0.52) and on HRQOL at T3 (β = 0.46) and T6 (β = 0.62). The scores did not change from T6 to T12 in iSleep youth.Conclusions: iSleep youth is effective in treating insomnia and concurrent fatigue in adolescents and young adults after childhood cancer and should be implemented.

Pediatric bone sarcoma patients undergo intensive treatment including life-changing local therapy, which results in a high burden of adverse events (AEs) and reduced health-related quality of life (HR-QoL). Given this multidimensional impact, optimal follow-up care requires a multidisciplinary expert team. We setup a multidisciplinary follow-up clinic with carousel consultations-including pediatric oncologists/late effects specialists, orthopedic surgeons, rehabilitation physicians, physical therapists, and psychologists-to screen for local therapy-related issues using standardized measurements. In addition to enhancing care, this clinic enables the study of a nationwide cohort. This cross-sectional study included patients diagnosed with pediatric bone sarcoma from 2003 onwards who completed local therapy and subsequent treatment, and attended the multidisciplinary follow-up clinic between 18 November 2021 and 7 March 2024. Patient satisfaction was assessed using a modified satisfaction questionnaire, and care output was documented based on healthcare professionals' actions following the consultations using a predefined action list. AEs and HR-QoL of the patients seen at the multidisciplinary clinic were evaluated using the Common Terminology Criteria for Adverse Events, Henderson classification, and PedsQL™ Generic Core Scales. Satisfaction with the provided care was reported by 99% (135/136) of patients. Healthcare professionals documented 182 actions, with counseling for identified patient needs being the most frequent. AEs were present in 96% (138/144) of patients, including moderate events in 72% (103/144) and severe events in 41% (59/144). Common AEs included musculoskeletal deformity, muscle weakness, decreased range of motion, gait disturbance, pain, and unequal limb length. HR-QoL scores were lower across all domains compared to the general population, with a high AE burden associated with poorer HR-QoL (B = -8.7, 95% CI -16.8 to -0.7, p = 0.035). The multidisciplinary follow-up care achieved high patient satisfaction and substantial care output, while enabling expert-led, high-quality data collection. The high prevalence of local therapy-related AEs and reduced HR-QoL are important to consider in follow-up and shared decision-making for local therapy in future patients. This multidisciplinary framework is broadly applicable to oncology patients facing treatment-related challenges, with the potential to improve outcomes and advance oncology research and practice. No specific funding was received for this study.

Purpose Fatigue is a common long-term complaint in childhood cancer patients and survivors. Treatment of pediatric bone sarcomas is intensive and can lead to physical, functional and psychosocial challenges; however, little is known about fatigue in this group. This study aimed to gain insight into fatigue and related demographic, medical, psychosocial, and lifestyle factors in pediatric bone sarcoma patients and survivors. Methods Patients treated for pediatric bone sarcoma, ≥ 2 years post-diagnosis and after completion of treatment with no evidence of disease, completed PedsQL™ Multidimensional Fatigue Scale and PROMIS® fatigue measures. Prevalence and mean scores were compared with Dutch normative data using binomial tests, one-sample t-tests, and ANOVA. Linear regression analyses examined associations of fatigue with demographic and medical factors, psychological difficulties (measured with emotion thermometers), pain (measured with a numeric rating scale), and physical activity (using an accelerometer). Results In total, 139 patients participated. In children (N = 44), 51.6% (95% CI 34.0–69.2) reported moderate to severe fatigue, significantly higher than the weighted norm (29.8%), while adults (N = 95) (11.5%, 95% CI 4.4–18.6) did not differ from the weighted norm (12.1%). Children scored worse than the norm on all fatigue measures (Cohen’s d range = 0.58 to 1.10); adults did not significantly differ. Longer time since end of treatment was associated with less cognitive fatigue. More psychological difficulties and pain were associated with more fatigue, while higher levels of physical activity were associated with less fatigue. Conclusion Children after pediatric bone sarcoma experience more fatigue than the norm. More psychological difficulties, more pain, and less physical activity are associated with more fatigue. Medical factors are limited to time since end of treatment, where a longer time is associated with less cognitive fatigue. Implications for Cancer Survivors Screening for fatigue and associated factors during treatment and follow-up may help identify and support patients at risk.

Background: Pediatric bone sarcoma patients and survivors may experience psychosocial challenges related to childhood cancer after their intensive, body‐altering treatment. This cross‐sectional study aimed to evaluate generic and survivor‐specific psychosocial outcomes in a national cohort of pediatric bone sarcoma patients and survivors, and to explore associations between these outcomes. Methods: Patients treated for pediatric bone sarcoma, at least 2 years post‐diagnosis, completed age‐appropriate Pediatric Quality of Life Inventory (PedsQL) and PROMIS measures (generic outcomes). Patients ≥18 years additionally completed the impact of cancer–childhood survivor (IOC‐CS) (survivor‐specific outcomes). Generic psychosocial outcomes of patients were compared with age‐ and sex‐specific Dutch normative data using one‐sample t ‐tests. Linear regression analyses, adjusted for age and sex, examined associations between generic and survivor‐specific outcomes. Results: In total, 139 patients participated (45% female). Mean age was 20.4 years (SD = 5.5) and mean time since end of treatment was 7.0 years (SD = 5.2). Patients scored significantly worse than normative values on cognitive functioning, pain interference, and health‐related quality of life. In other generic domains, such as depressive symptoms or anxiety, patients scored comparably to or better than normative values. Survivor‐specific outcomes were most positive in the socializing domain and most negative in the thinking and memory domain. Approximately 20% reported moderate‐to‐severe negative impact in at least one survivor‐specific domain. Conclusion: Overall, pediatric bone sarcoma patients demonstrated psychosocial outcomes comparable to or more favorable than normative values. However, specific domains showed worse outcomes. In addition, a substantial subgroup experienced moderate‐to‐severe negative impacts of childhood cancer. This highlights the importance of monitoring psychosocial functioning and, where indicated, targeted interventions to address challenges.