Search

Background The impact febrile neutropenia (FN) has on the health-related quality of life (HRQoL) of children with cancer and their families is poorly understood. We sought to characterize the course of child and parent HRQoL during and following FN episodes. Method Data on HRQoL were collected in the multisite Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study. Participants were enrolled between November 2016 to January 2018. The Child Health Utility (CHU9D) was used to assess HRQoL in children (N = 167 FN events) and the Assessment of Quality of Life (AQoL-8D) was used to assess HRQoL parents (N = 218 FN events) at three time points: 0–3 days, 7-days and 30-days following the onset of FN. Group-based trajectory modeling (GBTM) was used to characterize the course of HRQoL. Findings For children, three distinct groups were identified: persistently low HRQoL over the 30-day course of follow-up (chronic: N = 78/167; 47%), increasing HRQoL after the onset of FN to 30 days follow-up (recovering: N = 36/167; 22%), and persistently high HRQoL at all three timepoints (resilient: N = 53/167; 32%). Applying these definitions, parents were classified into two distinct groups: chronic (N = 107/218, 49%) and resilient (N = 111/218, 51%). The child being male, having solid cancer, the presence of financial stress, and relationship difficulties between the parent and child were significant predictors of chronic group membership for both parents and children. Children classified as high-risk FN were significantly more likely to belong to the recovery group. Being female, having blood cancers and the absence of financial or relationship difficulties were predictive of both parents and children being in the resilient group. Interpretation Approximately half the children and parents had chronically low HRQoL scores, which did not improve following resolution of the FN episode. The child's sex, cancer type, and presence of financial and relationship stress were predictive of chronic group membership for both parents and children. These families may benefit from increased financial and psychosocial support during anti-cancer treatment. Funding National Health and Medical Research Council Grant (APP1104527).

This chapter provides a summary of research on the use of callous–unemotional (CU) traits for designating a distinct and important subgroup of youth with serious conduct problems. The chapter starts by tying the construct of CU traits to research on the affective components of psychopathy, research on the normal development of conscience, and past attempts to find meaningful subtypes within children and adolescents with serious conduct problems. We then provide a review of research suggesting that CU traits designate a clinically important subgroup of antisocial youth who show more severe aggression and more severe and stable patterns of conduct problems. We also review research showing distinct genetic, biological, emotional, cognitive, family, and peer correlates to conduct problems in children with elevated CU traits and then provide a theoretical model for how these correlates may help to explain different causal pathways to serious conduct problems in youth with and without elevated CU traits. Finally, we conclude with the implications of this research on CU traits for diagnosis and treatment, focusing specifically on the new specifier the diagnosis of Conduct Disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders called “with Limited Prosocial Emotions” that is defined by the presence of CU traits.