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Disparities in end-of-life (EOL) care have been documented across cancer populations. For pediatric oncology patients, disparities in intensity of EOL care have been correlated with income, race, and ethnicity. However, less is known about disparities in psychosocial services provided at EOL for children with cancer. Child life specialists (CLS) work with pediatric oncology patients and families at EOL to provide key legacy interventions to offer support and mitigate complex bereavement. Presently, little is known about disparities in provision of these psychosocial services to children with cancer at EOL. In this retrospective decedent cohort study, we aimed to explore differences in receipt of legacy building services for children with cancer, stratified by race, ethnicity, primary language, diagnosis, and location of death. Using a comprehensive standardized tool, we abstracted data from the electronic medical record for 676 pediatric oncology patients who received care at a single academic pediatric cancer center and died between 2015 and 2019. More than half (52.1%) of patients/families received a legacy intervention during the illness course, at end of life, or following death. The most common legacy interventions included provision of a legacy item alongside a bereavement service (29.2%) or provision of a legacy item only (10.8%). Through univariate analysis, no racial disparities in legacy intervention provision were identified. Hispanic/Latino patients were more likely to receive legacy interventions compared to non-Hispanic patients (60.8% vs. 50.4%, p = 0.0474). Families who spoke Spanish were more likely to receive legacy and bereavement studies than those who spoke English or other languages (65.8% vs. 50.6% vs. 44.4%, p = 0.0317). Patients with brain tumors were less likely to receive legacy interventions compared to patients with hematologic malignancies or solid tumors, (32.0% vs. 35.1% vs. 32.9%, p < 0.001). Brain tumor patients were also more likely to die at home compared to patients with hematologic malignancies or solid tumors (52.5% vs. 11.2% vs. 37.6%, p < 0.001), suggesting that location of death may influence access to legacy interventions. These findings will inform the development and testing of targeted strategies to improve access to and provision of legacy interventions for all children with advanced cancer and their families. Citation Format: Sarah Daniels, Erica C. Kaye, Suraj S. Mothi, Libby Gaitskill, Kathryn Cantrell, Nelson D. Franqui-Ríos. Exploring disparities in the provision of child life legacy and bereavement services at SJCRH: Decedent cohort review [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A037.

Relatives of individuals with schizophrenia have a higher risk of developing the illness compared to the general population. Thus, youth at familial high risk (FHR) offer a unique opportunity to identify neuroimaging-based endophenotypes of psychosis. Previous studies have identified lower amygdalo-hippocampal volume in FHR, as well as lower verbal memory and emotion recognition. However, whether these phenotypes increase the risk of transition to psychosis remains unclear. To determine if individuals who develop psychosis have abnormal neurodevelopmental trajectories of the amygdala and hippocampus, we investigated longitudinal changes of these structures in a unique cohort of 82 youth FHR and 56 healthy controls during a 3-year period. Ten individuals from the FHR group converted to psychosis. Longitudinal changes were compared using linear mixed-effects models. Group differences in verbal memory and emotion recognition performance at baseline were also analyzed. Surface-based morphometry measures revealed variation in amygdalar shape (concave shape of the right dorsomedial region) in those who converted to psychosis. Significantly lower emotion recognition performance at baseline was observed in converters. Percent trial-to-trial transfer on the verbal learning task was also significantly impaired in FHR, independently of the conversion status. Our results identify abnormal shape development trajectories in the dorsomedial amygdala and lower emotion recognition abilities as phenotypes of transition to psychosis. Our findings illustrate potential markers for early identification of psychosis, aiding prevention efforts in youth at risk of schizophrenia.

BackgroundImmune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer.MethodsWe collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI.ResultsICPi-AKI occurred at a median of 16 weeks (IQR 8–32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3–10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI.ConclusionsPatients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery.