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Media narratives can shape public opinion and action, influencing people's perceptions and action regarding uptake of paediatric COVID-19 vaccines. COVID-19 has occurred at a time where 'infodemics', 'misinformation', and 'disinformation' are present, and as a result the COVID-19 response has suffered.To investigate how narratives about paediatric COVID-19 vaccines have unfolded in the media of four English-speaking countries; USA, Australia, Canada and the UK.The Narrative Policy Framework (NPF) was used to guide the comparative analyses of the major print and online news agencies' media regarding COVID-19 vaccines for the 5 to 11 year old age group. Data were sought using systematic searching on Factiva of four key phases of the paediatric vaccine approval and roll-out.400 articles (287 for USA, 40 for Australia, 60 for Canada, and 13 for the United Kingdom) fit the search criteria and were included. Using the NPF, the following were identified in each of the articles: hero, villain, victim, plot. The USA was the earliest to vaccinate children, and other countries' media often lauded the USA for this. Australian and Canadian media narratives about 5-11 year old vaccines were commonly about protecting vulnerable people in society, whereas the USA and the UK narratives focused more on the vaccine helping children get back to school. All four countries focused on the 5-11 year old vaccine as being key to 'ending' the pandemic. Australian and Canadian narratives frequently compared vaccine roll-outs across states/provinces, and bemoaned local progress in vaccine delivery in comparison to other countries globally. Canadian and USA narratives highlighted the 'infodemic' about COVID-19 and disinformation regarding child vaccines as impeding uptake. All four of USA, Australia, UK, and Canada used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by COVID-19 and the media reporting increasingly blamed those who were not vaccinated. The UK media narrative was unique in that it frequently described vaccinating children as a distraction from adult COVID-19 vaccination efforts. The USA and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners (GPs) were enveloped in the language of heroism. And lastly, the Canadian narrative was unique in expressing the desire to forgo adult COVID-19 vaccine 'boosters', as well as paediatric COVID-19 vaccines in order to ensure other adults globally could receive their initial vaccines.Public health emergencies require clear, compelling and above all, accurate communication. The stories told in this pandemic are compelling because they contain the classic elements of a narrative, however they can be reductive and inaccurate.

BACKGROUND Media narratives can shape public opinion and action. Media can influence perceptions, and action regarding COVID-19 vaccines. COVID-19 has occurred at a time where ‘infodemics’ are present, and the COVID-19 response has suffered from this infodemic. OBJECTIVE To investigate how paediatric COVID-19 vaccine narratives have unfolded in the media of four countries USA, Australia, Canada and the UK. METHODS The Narrative Policy Framework (NPF) was used to guide the analyses of the major print and online news agencies’ media regarding COVID-19 vaccines for the 5 to 11 year old age group, in four English speaking countries. Data were sought using systematic searching on Factiva of four key phases of the paediatric vaccine approval and roll-out. RESULTS 400 articles (287 for USA, 40 for Australia, 60 for Canada, and 13 for the United Kingdom) fit our search criteria and were included. Using the NPF, the following were identified in articles: hero, villain, victim, plot. The USA was the earliest to vaccinate children, and other countries’ media often lauded the USA for this. All four of USA, Australia, UK, and Canada used war imagery in reporting COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by COVID-19 and the media reporting increasingly blamed those who were not vaccinated. CONCLUSIONS Analysis of the hero, villain, victim, and plot of 400 media articles about COVID-19 vaccination in children shows that the media coverage of this pandemic relies on interpersonal narrative stories. Public health emergencies require clear, compelling and above all, accurate communication. The stories told in this pandemic are compelling because they contain the classic elements of a narrative, however they can be reductive and inaccurate.

Background: Pregnant or breastfeeding women are routinely excluded from clinical trials due to fear of teratogenicity and toxicity of therapeutic agents, despite a paucity of evidence to support this practice. In response to the diethylstilbesterol (DES) and thalidomide-induced embryopathy in the mid-20 th century, the US Food and Drug Administration (FDA) released new regulations excluding Women of Child-Bearing Potential (WoCBP) from phase I and II trial participation, followed by an introduction of a new pregnancy category labelling system in 1979. The legacy of these measures is a reliance on accidental exposure pregnancy data rather than rigorous clinical trial efficacy and safety data for medication use in pregnancy and lactation. WoCBP when enrolled in clinical trials are often subjected to prescriptive contraceptive requirements to mitigate the risk of accidental pregnancy, without informed consent for the contraceptive side effects. These barriers to trial participation for WoCBP, particularly in the setting of life-threatening haematological diseases, prevent timely access to therapies only accessible via clinical trial participation. Lymphoma and leukaemia in pregnancy occur with an approximate incidence of 1 in 6000 and 1 in 75,000-100,000 pregnancies respectively. We examined the rates and rationale for exclusion of these patients from clinical trials, as well as contraceptive requirements for WoCBP. Methods: We conducted a cross-sectional observational study of clinical trial protocols recruiting patients with potentially life-threatening haematological malignancies. We searched the clinicaltrials.gov clinical trials database for trial protocols enrolling acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL), Hodgkin lymphoma (HL) and/or Diffuse Large B Cell lymphoma (DLBCL) between January 2016 and January 2021. Studies were included if they included WoCBP (15-55 years of age). Studies without complete electronic protocol access were excluded. The following data was collected: target disease, study phase, study location, age of patients, whether pregnant or lactating women were excluded (rationale if provided including evidence of teratogenicity), type of contraception and duration mandated and presence or absence of informed consent for contraception. Results: We identified 68 trials for AML, ALL, DLBCL and HL (40%, 26%, 21% and 13% respectively) (Table 1). Most were phase I-II studies (91%) of novel agents (90%) and of note, the majority were of non-chemotherapy agents (83%). The majority (97%) excluded pregnant women and (69%) without providing rationale. Only 2% cited evidence for embryopathy in either human or animal studies. Most studies (84%) explicitly excluded lactating women, of which 85% did not provide justification. Contraception was mandatory in 90% of the protocols, with 47% of these requiring at least two different forms of contraception for the entire study period. These included hormone-based contraception, barrier methods and abstinence. None of the protocols provided informed consent for the potential side effects of the mandated contraceptive methods in the context of the study. Conclusion: The theoretical harm from anti-cancer therapy to the foetus is typically given greater moral precedence than is a pregnant woman's autonomy. Pregnant and lactating women were almost universally excluded from the trials in this study with limited rationale provided. Study protocols frequently mandated contraception without informed consent of its associated risks in the context of the study. This perpetuates the lack of efficacy and safety data in this patient population, and drives a cycle of systematic exclusion, data shortage, and inequity. Pregnant and lactating women with life threatening haematological malignancies with no alternative treatment options should be eligible for clinical trials where this offers potentially life-saving therapy, with appropriate informed consent around the indefinable and potentially harmful effects on their foetus. We propose obligatory rationale for exclusion of pregnant and breastfeeding women in all clinical trials, using safety data from either human or animal studies and contraception informed consent. Figure 1 Figure 1. Disclosures Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Background: Lymphoma in pregnancy is a rare and challenging diagnosis that complicates approximately 1:6000 pregnancies. Diagnostic delay occurs frequently, as lymphoma-related symptoms may be mistakenly attributed to the pregnancy itself, and diagnostic investigations postponed or omitted. Lymphoma in pregnancy poses a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. This is largely due to a paucity of published management guidelines, with current evidence based on modest case series and expert opinion. In this study we endeavoured to understand women's lived experiences during this challenging time. We performed semi-structured interviews with women previously treated for lymphoma in pregnancy, to identify both gaps in care delivery and valued interventions with the aim of informing future models of care. Methods: We retrospectively identified patients from twelve sites in Australia and New Zealand aged ≥18 years of age diagnosed with Hodgkin (HL) or non-Hodgkin lymphoma (NHL) during pregnancy or within 12 months postpartum, between 1 January 2009 and 31 December 2020. Baseline demographic characteristics, treatment details, and outcomes were collected, and semi-structured interviews were conducted via telephone with those who provided informed consent. Thematic analysis was performed using QSR Int NVivo 12 Pro (March 2020, USA) to quantify salient themes. The initial 5 transcripts were independently coded by two investigators who then reached a consensus on pre-determined codes. These codes were applied to the rest of the transcripts by one coder. The frequency of pre-determined themes was determined via descriptive statistics. Results: A total of 29 women were interviewed. Baseline demographic characteristics are documented in Table 1. The majority were diagnosed during pregnancy (14%, 28% and 17% in the 1 st, 2 nd and 3rd trimesters respectively), while 41% were diagnosed post-partum. HL was the most frequent diagnosis (48%) followed by diffuse large B cell lymphoma and primary mediastinal lymphoma (14% each). More than 90% of women received chemotherapy with 28% receiving combined modality chemoradiotherapy. Sixty-nine percent commenced chemotherapy during pregnancy (17%, 28% and 14% in the 1 st, 2 nd and 3rd trimesters respectively) and 41% commencing postpartum. In the 28% of patients who received radiotherapy, this was administered post-partum. A summary of themes identified and their frequency across the 29 transcripts are shown in Figures 1-3. Diagnostic delay attributed to pregnancy was reported by 41%. 21% of the women reported fatigue, breathlessness, weight change and musculoskeletal pain, which they felt healthcare practitioners found difficult to interpret in the context of pregnancy/postpartum period. Women recalled that their chief concerns at diagnosis were the welfare of their unborn child (41%) and a fear of dying (27%). Over half of the women (55%) reported perceived communication breakdown between health practitioners and patients. They also felt there was a lack of sensitivity in discussions around fertility preservation (45%), teratogenicity of treatment (31%), termination of pregnancy (14%) and cessation of breast-feeding (14%). Valued interventions included financial/logistic assistance from charity organisations (48%), a personal support network (45%), clinical psychology referral (31%) and emergency childcare (10%). Patients also found shared patient experiences (31%) and support groups (17%) beneficial in their treatment journey. Conclusion: To our knowledge this is the first report capturing the lived experiences of survivors of lymphoma during pregnancy. This provides us a unique opportunity to consider our management, psychosocial supports, and delivery of care to meet the needs of these women. Areas for development in future care models include increased patient advocacy, educational materials, economic, psychosocial, and childcare supports. Above all, there is scope for improved, tailored communication between health practitioners and patients, with sensitivity around embryotoxicity, pregnancy termination and adverse outcomes to foster autonomy, build trust and improve maternal wellbeing. Figure 1 Figure 1. Disclosures Greenwood: Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Gangatharan: Astrazeneca: Other: Educational Conference Funding. Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Background: Chemotherapy is potentially harmful to the developing foetus and there is limited data on the foetal impact of immunotherapy except for rituximab. Therefore determining pregnancy status prior to initiation of chemo- and or immuno-therapy (CIT) should be standard of care. Repeat screening or testing during and after chemotherapy should be considered as women often cannot tell that they are pregnant due to overlapping symptoms of pregnancy, malignancy and treatment. This is of particular importance in women who are not on effective forms of contraception for personal choice or clinical reasons. Clinicians cannot presume that a patient's pregnancy status has been checked, or rely on any assumptions of abstinence, contraception or infertility based on secondary amenorrhoea. While CIT teratogenicity should be part of the informed consent discussion and it is recommended that pregnancy screening occur prior to CIT, there are no specific guidelines on this or on testing during CIT. It is our institutional standard to document consent using a standard tick box form to confirm a discussion of common and uncommon side effects of treatment, long term and life threating complications and impacts on fertility. Teratogenicity, pregnancy implications or contraception are not specified. We performed a retrospective review to evaluate the uptake of pregnancy screening prior to and during first-line CIT as well as an audit of documentation of contraception counselling in haematological and solid-organ malignancies at a large Australian tertiary cancer centre. Methods: We searched our electronic outpatient medical record database for Women of Child Bearing Potential (WoCBP) who were diagnosed with a malignancy and received outpatient based CIT between May 1 2015 and June 12 2020. WoCBP was defined as women 18-55 years of age with no record of menopause or definitive infertility. We captured patient demographics, disease details and CIT regimen. We collected result of any serum or urine b-HCG pregnancy tests done within 90 days prior to or during CIT administration and if positive, the pregnancy outcome. We captured any documentation regarding contraception prior to or during treatment. Results: A total of 415 WoCBP with a median age of 42 years (range 19-51) were included. The majority of women (79.3%) were treated for solid organ malignancies compared to haematological malignancies (20.7%) (Table 1). Only 17.1% were screened for pregnancy prior to its initiation. The average time between screening and CIT initiation was 19.5 days (range 0-90 days). Given the broad range of regimens and taking into consideration teratogenicity potential, CIT was categorised as immunotherapy alone (32.5%), chemotherapy containing an alkylating agent (25.8%) or an antimetabolite (3.9%), combination chemoimmunotherapy (15.2%) and other (22.7%). Rates of pregnancy screening within these categories is represented in Figure 1. One patient with early breast cancer had a positive pregnancy test during her 4 th cycle of adjuvant chemotherapy with paclitaxel, in the emergency department for a presentation of nausea, anorexia, abdominal pain and diarrhoea. The outcome in this case was an early spontaneous miscarriage estimated at 3-4 weeks gestation. This is the only patient who had a pregnancy test beyond the first cycle of CIT. Only 14.8% of patients had documentation of past or present contraception methods. None of the patients had documentation regarding counselling on recommended forms of contraception. Conclusion: A minority of WoCBP received a pregnancy test prior to commencing CIT for haematological or solid organ malignancy, and none intentionally received a test prior to subsequent chemotherapy cycles through the oncology/haematology service. Also none of the women had documented counselling on contraception. These results are concerning because missing a positive pregnancy test puts women at risk of foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. Our results are consistent with the 2 other reports on this topic and are likely generalizable to other cancer centres. This highlights the urgent need for guidelines to increase the rate of pregnancy testing in WoCBP receiving CIT and contraception counselling prior to CIT. Figure 1 Figure 1. Disclosures Hamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Previous meta-analyses indicate that computerized cognitive training (CCT) is a safe and efficacious intervention for cognition in older adults. However, efficacy varies across populations and cognitive domains, and little is known about the efficacy of CCT in people with mild cognitive impairment or dementia.The authors searched Medline, Embase, PsychINFO, CINAHL, and CENTRAL through July 1, 2016, for randomized controlled trials of CCT in older adults with mild cognitive impairment or dementia. Overall cognition, individual cognitive domains, psychosocial function, and activities of daily living were pooled separately for mild cognitive impairment and dementia trials.The overall effect on cognition in mild cognitive impairment across 17 trials was moderate (Hedges' g=0.35, 95% CI=0.20-0.51). There was no evidence of publication bias or difference between active- and passive-controlled trials. Small to moderate effects were found for global cognition, attention, working memory, learning, and memory, with the exception of nonverbal memory, and for psychosocial functioning, including depressive symptoms. In dementia, statistically significant effects were found on overall cognition (k=11, g=0.26, 95% CI=0.01-0.52) and visuospatial skills, but these were driven by three trials of virtual reality or Nintendo Wii.CCT is efficacious on global cognition, select cognitive domains, and psychosocial functioning in people with mild cognitive impairment. This intervention therefore warrants longer-term and larger-scale trials to examine effects on conversion to dementia. Conversely, evidence for efficacy in people with dementia is weak and limited to trials of immersive technologies.