Purpose: In this study, we aimed to review the current knowledge about employment outcomes, employment-related factors, and support for childhood, adolescent, and young adult (AYA) cancer survivors. Methods: A literature search was conducted using the MEDLINE, PsycINFO, and CINAHL databases. Results: Thirty-one studies were identified, including 27 quantitative and 4 qualitative studies. The negative employment outcomes observed in the quantitative studies included low rates of employment, no employment experience, more days absent from work, low incomes, limitations in the amount or kind of work, low rates of having a professional occupation, starting their first occupation at an older age, and being unable to work. Factors related to these outcomes included demographics, physical and psychological effects of treatment, specific cancer type and treatment, and social factors. Negative employment outcomes observed in the qualitative studies included difficulty obtaining desired jobs, inability to find jobs with health insurance, difficulty changing jobs or returning to work, deciding whether to continue working, managing potential consequences of disclosure, and limitations in ability to work. Factors related to negative outcomes included not having enough stamina to work, financial and insurance needs, and insufficient support from others. There were no quantitative or qualitative studies evaluating the effectiveness of a work-related support program. Discussion: Childhood and AYA cancer survivors face diverse work-related difficulties. Future investigations should use research methodologies with lower bias. Additionally, future research should address the effectiveness of support programs, assess differences in the needs of survivors according to age at onset, and verify qualitative findings using quantitative methodologies.

After hematopoietic stem cell transplantation, vaccination is recommended to prevent infection, but there have been few reports on factors affecting the effect of live vaccines. In this study, we examined the immunological competence at the time of vaccination after hematopoietic stem cell transplantation and antibody titer after immunization. The seropositivity percentages were 75% for measles, 50% for rubella, 40% for varicella, and 18.2% for mumps. Stimulation index (S.I.) values determined by the phytohemagglutinin (PHA) lymphocyte transformation test were significantly higher in the vaccine-high-efficacy group, which showed antibody positivity for two or more vaccines, than in the low-efficacy group, which showed antibody positivity for one or no vaccine (p=0.028). Functional recovery of lymphocytes, particularly CD4-positive cells, is important for acquiring antibodies after vaccination. It is suggested that the SI value determined by the PHA lymphocyte transformation test could be one of the indicators for judging the time of vaccination.

It is important to grant the wish of families of children with malignancy to have end-of-life at home. Pleuropulmonary blastoma in a 3-year-old boy who had a giant mass in the left thorax at presentation relapsed after surgical therapy and high-dose chemotherapy, resulting in life-threatening respiratory failure. The intrathoracic administration of cisplatin and irinotecan was effective, and the patient achieved second remission. After the second relapse occurred, the patient and his parents desired home-based palliative care. After transitioning to home-based care, the parents were reluctant in continuing the therapy. Therefore, we reconfirmed the close information sharing and clear division of roles and responsibilities between the home and hospital doctors. Eventually, the patient died at home surrounded by his family. To grant the patient’s wish of having end-of-life at home, prompt establishment of a close relationship between family members and the home doctor is imperative.

A 3-year-old boy with B-precursor acute lymphoblastic leukemia developed pulmonary artery thromboembolism (PTE) during the reinduction phase. We had used a peripherally inserted central catheter (PICC) for 6 months since the start of the induction therapy. An increase in D-dimer concentration and thrombotic blockade of the PICC were observed before PTE development. After intravenous administration of unfractionated heparin followed by the removal of the PICC, his clinical symptoms improved in two weeks with warfarin. We reinserted a PICC before the second reinduction phase with warfarin, we continued his subsequent planned chemotherapy without the recurrence of thromboembolism. His clinical course suggests that PTE was caused by PICC-related thrombosis. We should pay careful attention to central venous catheter selection, insertion sites, and long-term management because of the high incidence of thromboembolism associated with PICC use.

Blood transfusion is an important adjuvant therapy in treating high-risk neuroblastoma. Before a child can receive a blood transfusion, informed consent must be obtained from a parental authority. If consent is refused for irrational reasons, a court order for cessation of custody can be requested; however, this action causes communication difficulties with the parental authority. This is clearly an undesirable environment for the treatment of a patient with neuroblastoma. An 18-month-old male with high-risk neuroblastoma was admitted to our hospital. His parents refused a blood transfusion for religious reasons. In cooperation with the Child Consultation Center of our hospital, we obtained temporary trust protection rather than a cessation of custody order. Consent for the transfusion was granted by the head of the Child Consultation Center, and no request was made for cessation of custody, enabling the safe treatment of the neuroblastoma while maintaining a good relationship with the patient’s parents.

Aplastic anemia (AA) can sometimes develop owing to the adverse effects of anti-epileptic drug use. However, the mechanisms remain unclear. We here report a case of very severe AA developed during anti-epileptic drug treatment. A 15-year-old female presented with poor complexion and a peripheral blood examination revealed severe pancytopenia. She had been administered carbamazepine, ethosuximide, sodium valproate and phenobarbital for refractory epilepsy caused by chromosome aberrations until that time. She had no histories of hematological disorders. Unfortunately, she showed no hematological improvement even when the anti-epileptic drug administration was stopped. Eventually, she was diagnosed as having very severe AA on the basis of her clinical course and laboratory findings. A few months later, she finally achieved hematological improvement with bolus methylprednisolone and prednisolone maintenance therapy. We conclude that this combination therapy appears to be effective for AA developing secondary to anti-epileptic drug use.

Hypopyon commonly manifests in infections and autoimmune diseases such as Behcet’s disease, but rarely occurs in patients with acute leukemia. In this case, a 5-year-old girl was diagnosed as having hypopyon by a local physician and referred to our hospital for a definitive diagnosis. She was diagnosed as having B precursor acute lymphoblastic leukemia (ALL), with central nervous system invasion. The patient underwent iridectomy to decrease the intraocular pressure in the left eye, and ALL cells were observed in the iris. Following treatment, she remained in complete remission for 7 years. Hypopyon in patients with acute leukemia is often observed at the time of relapse, but is rarely detected at the initial stage. Regular follow-up for recurrence is necessary owing to the limited transport of anticancer drugs to the eyes.