Improved survival in low- and middle-income countries is generating a rapidly expanding population of childhood cancer survivors (CCS) who will transition to adult care. In India, the capacity and geographic distribution of long-term survivorship care remain poorly characterized. We synthesized survivorship data from three tertiary pediatric oncology centres in North India. Transition-eligible survivors were those diagnosed before age 18 years, who completed cancer-directed therapy between January 2016 and December 2025 and had attained age >18 years by December 2025. We quantified the transition-eligible cohort, projected the transition burden through 2030, mapped adolescent and young adult (AYA) survivors by geographic distance from their treating centre, and risk-stratified survivors for survivorship care planning as per published diagnosis and exposure based criteria. Among 3,060 survivors, 398 (13.0%) were transition-eligible; 288 (72.4%) were male. Lymphomas (34.1%), solid tumors (29.1%), and acute lymphoblastic leukemia (27.8%) were the predominant diagnoses. The transition-eligible cohort is projected to increase to 1,071 by 2030 (+169.1%). Approximately 58% lived >50 km from their treating centre. Overall, 387 (97.2%) were classified as moderate (44.9%) or high risk (52.3%). Transition processes were absent (56%) or informal (33%); barriers included perceived lack of need (78%), unawareness of late effects (67%) and farther distance from treating centre (56%). This study estimates that the transition-eligible CCS population is projected to nearly triple by 2030 and is predominantly composed of moderate- and high-risk survivors. A risk-stratified, geographically distributed survivorship model incorporating tele-support and shared care closer to home is urgently required.
Adolescent and young adult cancer survivors (AYA-CS) make up a distinct, growing oncology patient population that uniquely contends with the challenge of navigating cancer survivorship alongside the typical developmental tasks of emerging adulthood (EA). Though past research has found high levels of psychological distress, anxiety, and depression in this population, AYA-CS remain understudied. Little is known about their personal strategies for coping with stress and their experiences applying evidence-based coping strategies. To fill this gap, we conducted in-depth qualitative semi-structured interviews with AYA-CS (N = 19), all at least one-year post-treatment, to explore their day-to-day stressors, stress management techniques, and use of mindfulness. Interviews lasted approximately one hour each and were conducted via Zoom videoconferencing. Through thematic analysis, three major themes emerged: The fluid salience of survivorship for identity and experience; Applying self-management and accountability to maintain stress-reducing habits; and Implicit mutual understanding among AYA-CS. These, with their corresponding subthemes, reflect the dynamic and nuanced ways in which participants, as AYA-CS in EA, construct and understand their identities and lives during survivorship. While the role of survivorship in identity and stress varied, all participants relied on family and friends for social support and to remain accountable to their personal coping strategies, most commonly exercise. Many participants had been previously introduced to mindfulness by their treatment teams, though only four continued to independently use it in their own lives. Finally, more than half agreed that meeting other AYA-CS, which was rare for them, could promote an instant bond and connection that would not otherwise be possible with those their age who had no cancer history. These findings may be used to inform future intervention development targeted at the specific needs of AYA-CS, who, in this study, demonstrated interest in connecting with peers to share lived experiences and support one another through the unique combination of survivorship and EA. These findings suggest that future peer-supported interventions should be explored and tested.
Testicular adrenal rest tumours (TARTs) are benign intratesticular lesions occurring in males with classic congenital adrenal hyperplasia (CAH), with a prevalence ranging from 0% to 94% depending on age, disease severity and screening method. Although TARTs are non-malignant, their characteristic location can lead to compression of seminiferous tubules causing infertility. Adolescence represents a critical and particularly vulnerable window for TART development and progression. Besides ACTH chronic stimulation, which remains the main pathogenic driver, several other converging factors can contribute to suboptimal hormonal control and promote adrenal rest cell proliferation during adolescence. The aim of this minireview is to provide a comprehensive and updated overview of TARTs in the adolescent population, focusing on three key areas: prevalence across different CAH aetiologies, risk factors driving development and progression during puberty and emerging therapeutic approaches with potential impact on this complication.
Sarah Combs, Bhavana Huliyar, Isabella Brocato, Samantha Hill, Samuel Master, Linda Fan, Chinwe Efuribe, David Bell, Marni Sommer
Menstrual health is a critical component of overall health. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend routine menstrual health screening and care during pediatric visits, yet this topic remains under-addressed in clinical encounters. The study aimed to explore how a diverse group of pediatric-facing providers engage with menstrual health during the pediatric clinical encounter and to identify existing barriers and facilitators for integrating menstrual health into routine care. This qualitative research study included in-depth interviews (N = 46) with pediatric-facing providers across four geographic regions of the United States. Providers were recruited from a range of states, practice settings, urban, suburban, and rural contexts. The interviews sought to understand engagement with the topic of menstrual health within the pediatric encounter, barriers and facilitators to the conversation, and procedures and content when obtaining the menstrual history. Thematic analysis was used to analyze the interview transcripts. Participants represented 22 states across the four major geographic regions of the United States, with an approximately even distribution across practice types. The sample consisted primarily of Medical Doctors (78%), but also included Doctors of Osteopathy, Nurse Practitioners, and Physician Assistants. Roughly half of participants practiced in urban centers, with the remainder divided between suburban and rural settings. Analysis yielded three central themes: (1) formal training and experiential learning shape provider engagement with menstrual health; (2) structural and relational factors influence the extent to which menstrual health is integrated into clinical encounters; and (3) biological, quality-of-life, and condition-specific menstrual health questions affect clinical care. These findings have important implications for the clinical encounter, including potential policy and practice implications to facilitate increased inclusion of attention to menstrual health in pediatric care. Integrating menstrual health questions that address both biological and quality of life issues into the clinical encounter is vital to addressing patient menstrual health holistically.
