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      Health support to pediatric cancer survivors and their families during the COVID‐19 pandemic

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          Abstract

          To the Editor: The emerging coronavirus disease 2019 (COVID‐19) pandemic is posing tremendous threats and formidable challenges to the global community. Pediatric cancer survivors are not spared from the pandemic. In addition to dealing with a wide array of sequelae of the cancer and related treatments, which includes fatigue, 1 weakened immune system, 2 a reduced functional capacity, 3 and psychological problems, 4 pediatric cancer survivors who are immunocompromised now face an increased susceptibility to COVID‐19 infection. This results in an immense level of additional pressure in their families during the pandemic. To reduce the risk of their immunocompromised children being exposed to and infected with COVID‐19, parents would prefer that their children remain confined at home and avoid participating in any outdoor activities during the pandemic. The home confinement, combined with the lack of physical education resulting from school closures, has led to a dramatic decline in the physical activity levels of pediatric cancer survivors. Physical inactivity is associated with a wide range of adverse health outcomes. Moreover, staying indoors for long periods of time might have a devastating impact on the psychological well‐being of survivors and might make them more prone to developing psychiatric disorders, such as depression and anxiety. Regular physical activity has been shown to exert protective effects by improving cardiorespiratory fitness, reducing fatigue, promoting psychological well‐being, and most importantly strengthening the immune system. 5 , 6 Given this issue, we have continuously offered health support to pediatric cancer survivors and their families using information communication technologies during the pandemic. Instant messages have been delivered regularly via WhatsApp and WeChat to the parents of pediatric cancer survivors. These messages provide information and guidance regarding the importance of regular physical activity. We have introduced a wide variety of home‐based exercises intended to improve survivors’ overall fitness, including stretching exercises, home‐based circuit training, and exercise games. Other messages have given advice on reducing their child's sedentary behaviors, particularly leisure‐time screen‐based activities (eg, television and video use) and smartphone usage. To ease the additional worries experienced by pediatric cancer survivors and their families during this unprecedented crisis and enhance their coping abilities, helpful tips on how to maintain personal, home, and environmental hygiene have been delivered to them. These messages have continually provided information about general hygiene measures, including proper hand hygiene, proper mask usage, the use of bleach to maintain a hygienic environment at home, the observation of good food hygiene, and the adoption of a healthy lifestyle. Using information communication technologies, such as WhatsApp and WeChat applications, via mobile devices for health promotion is highly recommended for healthcare professionals. Such strategy was found to be flexible, feasible, and easy to implement. Most importantly, it allows healthcare professionals to deliver continuous professional advices and personalized support to people with cancer and their families during the pandemic. The far‐reaching impacts of COVID‐19 pandemic have disrupted lives around the world and have led to intense physical and psychological sufferings. Coordinated efforts are required to promote the physical and psychological well‐being of vulnerable populations, including pediatric cancer survivors and their families, during the pandemic and the enormous uncertainties of the future. CONFLICT OF INTEREST The authors declare that there is no conflict of interest.

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          Infections among long-term survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study

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            Increased prevalence of chronic fatigue among survivors of childhood cancers: a population-based study.

            Fatigue is prevalent in adult cancer survivors but less studied in childhood cancer survivors. Aims were to assess fatigue levels, prevalence of chronic fatigue (CF) and the association of CF with health-related quality of life (HRQoL) in survivors of acute myeloid leukemia (AML), infratentorial astrocytoma (IA), and Wilms tumor (WT) in childhood.
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              The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review

              Background There are numerous published controlled trials assessing the safety and the benefits of physical activity (PA) for child and adult cancer survivors. However, trials exclusively comprised of adolescent cancer survivors aged 13-19 years, who may experience different health and quality of life (QOL) effects as a function of their developmental status, are lacking. Rather, some trials have included both adolescent and child cancer survivors together. Objective The aim of this systematic review was to synthesize the findings from randomized controlled trails (RCTs) and controlled clinical trials (CCTs) investigating the effects of PA on health and QOL outcomes in samples comprised of >50% adolescent cancer survivors to summarize the current state of evidence, identify knowledge gaps, and highlight areas in need of additional research within this population. Methods Using a search strategy developed for this review, 10 electronic databases were searched for RCTs and CCTs that reported on the effects of PA on at least 1 health and/or QOL outcome in samples comprised of >50% adolescent cancer survivors. Results From the 2249 articles identified, 2 CCTs met the predetermined eligibility criteria and were included in this review. Combined, 28 adolescents (of 41 participants) who were receiving active treatment participated in the 2 studies reviewed. A total of 4 health and QOL outcomes (ie, bone mass, fatigue, grip strength, QOL) were assessed pre- and post-PA intervention. Conclusions On the basis of the 2 studies reviewed, PA appears to be safe and feasible. PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue, grip strength, and QOL. High-quality controlled trials with larger samples exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population.
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                Author and article information

                Contributors
                william3@hku.hk
                Journal
                Pediatr Blood Cancer
                Pediatr Blood Cancer
                10.1002/(ISSN)1545-5017
                PBC
                Pediatric Blood & Cancer
                John Wiley and Sons Inc. (Hoboken )
                1545-5009
                1545-5017
                09 August 2020
                : e28441
                Affiliations
                [ 1 ] School of Nursing The University of Hong Kong Pokfulam Hong Kong
                [ 2 ] Department of Adolescent Medicine Queen Mary Hospital Pokfulam Hong Kong
                [ 3 ] School of Nursing The Hong Kong Polytechnic University Kowloon Hong Kong
                Author notes
                [*] [* ] Correspondence

                William Ho Cheung Li, School of Nursing, The University of Hong Kong, 4/F, William M W Mong Block, 21 Sassoon Rd, Pokfulam, Hong Kong.

                Email: william3@ 123456hku.hk

                Author information
                https://orcid.org/0000-0002-2562-769X
                https://orcid.org/0000-0001-6543-7551
                Article
                PBC28441
                10.1002/pbc.28441
                7435503
                32776497
                2aa2293c-2453-4258-87d8-b3d47d14147f
                © 2020 Wiley Periodicals LLC

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 13 May 2020
                : 13 May 2020
                : 13 May 2020
                Page count
                Figures: 0, Tables: 0, Pages: 2, Words: 815
                Categories
                Letter to the Editor
                Letters to the Editor
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.7 mode:remove_FC converted:19.08.2020

                Pediatrics
                Pediatrics

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