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      Psychosocial development in survivors of childhood differentiated thyroid carcinoma: a cross-sectional study

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          Abstract

          Objective

          The impact of childhood differentiated thyroid carcinoma (DTC) on psychosocial development has not yet been studied. The aim of this study was to evaluate the achievement of psychosocial developmental milestones in long-term survivors of childhood DTC.

          Design and methods

          Survivors of childhood DTC diagnosed between 1970 and 2013 were included. Reasons for exclusion were age <18 or >35 years at follow-up, a follow-up period <5 years or diagnosis with DTC as a second malignant neoplasm. Survivors gathered peer controls of similar age and sex ( n = 30). A comparison group non-affected with cancer ( n = 508) and other childhood cancer survivors (CCS) were also used to compare psychosocial development. To assess the achievement of psychosocial milestones (social, autonomy and psychosexual development), the course of life questionnaire (CoLQ) was used.

          Results

          We included 39 survivors of childhood DTC (response rate 83.0%, mean age at diagnosis 15.6 years, and mean age at evaluation 26.1 years). CoLQ scores did not significantly differ between survivors of childhood DTC and the two non-affected groups. CoLQ scores of childhood DTC survivors were compared to scores of other CCS diagnosed at similar ages ( n = 76). DTC survivors scored significantly higher on social development than other CCS, but scores were similar on autonomy and psychosexual developmental scales.

          Conclusions

          Survivors of childhood DTC showed similar development on social, autonomy, and psychosexual domains compared to non-affected individuals. Social development was slightly more favorable in DTC survivors than in other CCS, but was similar on autonomy and psychosexual domains.

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          Most cited references18

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          Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients.

          To examine outcomes and predictors of survival for pediatric patients with thyroid carcinoma. The Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2004 was queried for all patients with thyroid carcinoma less than 20 y of age. A total of 1753 patients with malignant thyroid neoplasms were identified with an age-adjusted annual incidence of 0.54 cases per 100,000 persons. There has been a significant increase in the annual incidence by 1.1% per y. Female patients outnumbered males 4 to 1. Tumors were classified as papillary (n=1044, 60%), follicular variant of papillary (n=389, 23%), follicular (n=165, 10%), and medullary (n=87, 5%). The majority of patients presented with localized and regional disease. Overall mean survival time (MST) was 30.5 y. The MST for females was 40 y, whereas males survived an average of 20.4 y (P=0.0001). Patients with medullary cancer had significantly shorter mean survival than those with papillary cancer (P=0.006). Surgical treatment significantly improved outcome. Multivariate analysis demonstrated that male gender, nonpapillary histology, distant disease, and no surgery were all independent prognostic factors of worse outcome. For patients with medullary thyroid carcinoma, radiation therapy was also identified as an independent predictor of lower survival. The incidence of pediatric thyroid cancer is increasing. Females have a higher incidence than males, but enjoy longer survival. Papillary thyroid cancer has overall excellent survival. Male gender, nonpapillary tumor, distant metastases, and nonsurgical treatment all predict worse outcome.
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            Adolescent psychosocial development: A review of longitudinal models and research.

            This review used 4 types of longitudinal models (descriptive models, prediction models, developmental sequence models and longitudinal mediation models) to identify regular patterns of psychosocial development in adolescence. Eight patterns of adolescent development were observed across countries: (1) adolescent maturation in multiple developmental domains; (2) heterogeneous continuity of personal relationships; (3) good goes together with good, and bad with bad, across time in adolescence; (4) parents transmit values and behaviors to their adolescent children over time; (5) adolescent psychopathology leads to erosion of personal relationships with parents and peers; (6) adolescent psychopathology prevents adolescent independence from parents; (7) parental interference in personal issues of adolescents has counterproductive effects over time; (8) mood variability and (social and personal) uncertainty are mechanisms that maintain psychopathology in adolescence. Principles of life span developmental psychology are used to discuss adolescent maturation, and a developmental contextual perspective is used to discuss links between the various developmental patterns. Strengths and limitations of the various longitudinal models, and links between longitudinal and experimental research are discussed. (PsycINFO Database Record
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              The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy.

              Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.

                Author and article information

                Journal
                Eur J Endocrinol
                Eur. J. Endocrinol
                EJE
                European Journal of Endocrinology
                Bioscientifica Ltd (Bristol )
                0804-4643
                1479-683X
                March 2018
                18 December 2017
                : 178
                : 3
                : 215-223
                Affiliations
                [1 ]Division of Endocrinology Department of Internal Medicine
                [2 ]Department of Wenkebach Institute School of Nursing and Health and Beatrix Children’s Hospital
                [3 ]Department of Pediatric Oncology University of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
                [4 ]Psychosocial Department Academic Medical Center, Amsterdam, the Netherlands
                [5 ]Princess Máxima Center for Pediatric Oncology Utrecht, the Netherlands
                [6 ]Department of Nuclear Medicine and Molecular Imaging
                [7 ]Department of Epidemiology University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
                [8 ]Division of Endocrinology, Department of Internal Medicine VU University Medical Center, Amsterdam, the Netherlands
                [9 ]Division of Endocrinology, Department of Internal Medicine Maastricht University Medical Center, Maastricht, the Netherlands
                [10 ]Department of Pediatric Oncology Rotterdam, the Netherlands
                [11 ]Division of Endocrinology, Department of Internal Medicine Leiden University Medical Center, Leiden, the Netherlands
                [12 ]Department of Pediatric Oncology Academic Medical Center, Amsterdam, the Netherlands
                [13 ]Division of Endocrinology, Department of Internal Medicine Radboud University Medical Center, Nijmegen, the Netherlands
                [14 ]Department of Medical Oncology and Emma Children’s Hospital/Academic Medical Center Amsterdam, the Netherlands
                [15 ]Department of Internal Medicine and Rotterdam Thyroid Center Erasmus Medical Center Rotterdam, the Netherlands
                [16 ]Department of Surgical Oncology University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
                [17 ]Department of Pediatrics University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
                [18 ]Department of Pediatric Endocrinology University of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
                Author notes
                Correspondence should be addressed to T P Links Email: t.p.links@ 123456umcg.nl
                Article
                EJE170741
                10.1530/EJE-17-0741
                5811933
                29254931
                5ea3db9a-c81e-4e89-803f-c0ad98b04ab6
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 07 September 2017
                : 20 November 2017
                : 18 December 2017
                Categories
                Clinical Study

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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