{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:22:30Z","timestamp":1792030950002,"version":"4.4.0"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pediatric relapsed or refractory (R\/R) solid tumors carry a dismal prognosis, and postrelapse patient experiences are not well described. We present postrelapse outcomes, including number of R\/R events and subsequent therapy regimens. We analyze whether breaks (&gt;30 days) between events and subsequent therapies affect survival and the associated decision\u2010making rationales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We reviewed data for patients with R\/R extracranial solid tumors treated at Texas Children's Hospital between 2005 and 2023. Descriptive analysis was performed along with univariate chi\u2010square and independent sample\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests. Cox regression analysis was used to evaluate postevent survival (PES).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 466 patients (female: 47%; median age: 8.7 years), most common diagnoses were neuroblastoma (21.5%), rhabdomyosarcoma (19.1%), and osteosarcoma (16.1%). Patients had a median of 3 (interquartile range [IQR]: 1\u20134) R\/R events with a median of 93 (IQR: 52\u2013200) days between events. Of 438 patients who received \u22651 postevent therapy regimen, 116 (26.5%) experienced \u22651 break. Reasons for breaks varied evenly between intentional\/goal\u2010concordant and undesired delays. Median PES for all patients was 12.9 (IQR: 5.8\u201331.4) months. In a multivariable Cox regression model, taking a &gt;30\u2010day break in disease\u2010directed therapy was associated with prolonged PES (hazard ratio 0.58 [95% CI 0.45\u20130.76],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most children with R\/R solid tumors experience multiple events and therapy regimens without a break. Presence of a &gt;30\u2010day break did not negatively affect survival, implying that time between therapy regimens can safely be offered to select patients to promote quality of life and thoughtful decision\u2010making, without compromising survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70199","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T04:36:39Z","timestamp":1773635799000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Course and Impact of Breaks in Therapy for Children With Relapsed\/Refractory Solid Tumors"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-0215","authenticated-orcid":false,"given":"Matthew T.","family":"McEvoy","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology Baylor College of Medicine Texas Children's Hospital  Houston Texas USA"},{"name":"Division of Palliative Care Baylor College of Medicine Texas Children's Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Seashore","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pain, Palliative, and Integrative Medicine and Division of Pediatric Oncology UCSF School of Medicine UCSF Benioff Children's Hospitals  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Susan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Celia Scott Weatherhead School of Public Health and Tropical Medicine Tulane University  New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shondra","family":"Clay","sequence":"additional","affiliation":[{"name":"School of Interdisciplinary Health Professions College of Health and Human Sciences Northern Illinois University  DeKalb Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica A.","family":"Casas","sequence":"additional","affiliation":[{"name":"Division of Palliative Care Baylor College of Medicine Texas Children's Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2126-9768","authenticated-orcid":false,"given":"Jennifer H.","family":"Foster","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Baylor College of Medicine Texas Children's Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1","volume-title":"Pizzo and Poplack's Pediatric Oncology","author":"Scheurer M. 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