Nervous System Diseases

All Conditions

Symptoms and General Pathology

Wounds and Injuries

Behaviors and Mental Disorders

Rare Diseases

Cerebral Palsy

Paralysis

Brain Injuries

Brain Damage, Chronic

Brain Diseases

Central Nervous System Diseases

Quality of Life

Chronic Graft Versus Host Disease

The children taking part in the return-to-physical-activity program are referred to the Flavigny-sur-Moselle CMPRE for medical consultation due to a state of deconditioning to physical exertion concomitant with a pathological situation. The pathology most frequently encountered during this stay is cerebral palsy. However, the Flavigny CMPRE is accredited in a number of fields (orthopedics, burns, neurology, oncology), and the pathologies of the children referred to this stay are representative of these. These include children with scoliosis, obesity, Guillain-Barré syndrome, cystic fibrosis, Charcot's disease and cancer.

Jonathan Pierret, PhD

A WHO study in 2020 revealed that 81% of adolescents (aged 11-17) do not respect the recommendation of one hour of moderate physical activity per day. In the context of disability, many factors impose limits on physical activity. While the pathology itself induces limitations and restrictions (prolonged sitting time, assisted movement, etc.), organizational constraints also apply to both children and parents, who have to divide their time between work, school and therapeutic care, which is sometimes numerous and varied over the course of a single week. These limitations generate stress and fatigue, and prolonged sedentary periods lead children with chronic illnesses, rare diseases or disabilities into a process of physical deconditioning. The accumulation of sedentary time is detrimental to cardiovascular and metabolic health.

To combat this deconditioning, the 2008 National Physical Activity and Sport Plan (PNAPS) sets out the main guidelines for treatment and implementation. The plan explains that "for patients with chronic illnesses, rare diseases or disabilities, the aim is to encourage care and guidance towards Adapted Physical Activity (APA). The attending physician will be able to identify local therapeutic education programs, rehabilitation services and "sport-santé" offers, to improve access for these patients to supervised local programs". In addition, the plan suggests "developing APA programs in healthcare establishments to enable people with chronic illnesses, rare diseases or disabilities to access health education incorporating practical sessions".

In line with this plan, an exercise reconditioning program has been set up at our facility. This three-month stay includes children with a variety of pathologies, but with a common feature of physical deconditioning.

Evaluation of the Effect of a Physical Activity Recovery Stay

Evaluation of the Effect of a Physical Activity Recovery Stay on the Physical Condition and Quality of Life of Children in a Situation of Physical Deconditioning

To evaluate the effect of the return to physical activity stay prescribed by the doctors at the Flavigny CMPRE on the physical condition of the children taking part in the stay Score between 0 and 20 for each part of the test, with 20 being the best score (and therefore the best physical condition).

Quality of life scale : a T-score value is calculated. Scores range from 10 to 50, where 10 represents the lowest possible value and thus a very low health-related quality of life and 50 the maximum value, i.e. a very high health-related quality of life.

Recording weight on a balance : Ideally, the patient should have lost weight by the end of the reconditioning stay.

Three-minute warm-up without resistance, then increase in difficulty every minute until you reach 80% of your theoretical maximum heart rate.

Functional walking index calculated during a regular, spontaneous 5-minute walk. This index is equal to the ratio of heart rate averaged over the 5th minute to walking speed.

Physical exercise that helps to strengthen the gluteus muscles (located in the buttocks) and hamstrings. The longer you hold the position, the better is.

Assessment of abdominal endurance: keep your shoulders off the ground while lying on your back with your feet raised. The maximum duration of this test is three minutes. Low performance if time less than 60 seconds, maximum if time greater than 150 seconds.

Assessment of trunk extensor endurance: hold the weight of your trunk in isometric position for as long as possible, with your arms crossed over your chest. The maximum duration of this test is 240 seconds. The longer the position is maintained, the better.

he participant stands 1 foot from the bottom of a 14-step flight of stairs. The participant is instructed to "Quickly, but safely go up the stairs, turn around on the top step (landing) and come all the way down until both feet land on the bottom step (landing." The participants are allowed to choose any method of traversing the stairs. The TUDS score was the time in seconds from the "go" cue until the second foot returned to the bottom landing. Shorter times indicated better functional ability.

Evaluation and exercise element designed to teach the subject to get up from the ground using the righting sequence

Tool used in occupational therapy to identify people's occupational problems

A tool for assessing involvement and motivation levels : 7 questions score between 0 and 10. 0 = no motivation 10 = total motivation

Union de Gestion des Etablissements des Caisses d'Assurance Maladie - Nord Est

Caregiver Burden

Explore Factors related to Truth Telling in Primary Caregivers of Children Newly Diagnosed with Cancer

Chen-Ni Li

SHIANN-TARNG JOU, PhD

The purpose in this study was to investigate the current status, changes, correlation, and predictive factors of the truth telling, hope, care burden, and quality of life during treatment in primary caregivers of newly diagnosed children with cancer.

Background: Over the last 50 years, telling truth in adult with cancer was direct. However, studies of truth telling in newly diagnosed children with cancer were seldom. Explore the factors and experiences related to truth telling in primary caregivers of children newly diagnosis with cancer were seldom too. Therefore, we could not estimate the current status of truth telling in primary caregivers of newly diagnosed children with cancer.

Purpose: The purpose in this study was to investigate the current status, changes, correlation, and predictive factors of the truth telling, hope, care burden, and quality of life during treatment in primary caregivers of newly diagnosed children with cancer.

Method: Purposive sampling structured questionnaire, used longitudinal resistance, repeated measurements, correlational design. SAS 9.3 for Windows was used for data entry and analyze. By using the frequency, percentage, mean, and standard deviation to describe demographic information and current status of truth telling. By using the mean, standard deviation, maximum and minimum to analyze hope, care burden, and quality of life. Demographic information, medical information data, truth telling, Herth Hope Index, caregiver burden scale, and quality of life index were tested by Pearson correlation coefficients; the change and predictors about truth telling, Herth Hope Index, caregiver burden scale, and quality of life index were tested by Generalized estimating equation.

Limitation: Studying in one medical center in Taipei, it could not estimate the country's primary caregivers of newly diagnosed children with cancer in conclusions. Because of the limitation of the manpower, time and case numbers, study tracked only six month, could not be assessed the long-term change of the Herth Hope Index, caregiver burden scale, truth telling and quality of life in primary caregivers of newly diagnosed children with cancer.

Factors Related to Truth Telling in Primary Caregivers

Explore Factors Related to Truth Telling in Primary Caregivers of Children Newly Diagnosed With Cancer

The scores of primary caregivers' Herth Hope Index change from baseline at family meeting at 3 months, and at 6 months.

We use Herth Hope Index(HHI) to evaluate the hope that the primary caregivers' care their child during treatment.

There are twelve questions in the Herth Hope Index. The total score is from 12 to 48. Cronbach's α is .89. Retest is .80. Two weeks retest is .86.

The higher the score is, the greater the hope is.

The scores of primary caregivers' quality of life index change from baseline at family meeting at 3 months, and at 6 months.

We use quality of life index(Q.L.I) to evaluate the quality of life that the primary caregivers' care their child during treatment.

There are 66 questions in the quality of life index. The total score is from 66 to 264. Cronbach's α is .95. Two weeks retest is .87.

The primary caregivers' truth telling change from baseline at family meeting at 3 months, and at 6 months.

Asking the primary caregivers' about that if you tell your child that he/she got the cancer, if you tell your child that he/she the treatment in future, and if you tell your child that he/she the rate of survival.

The scores of primary caregivers' care burden change from baseline at family meeting at 3 months, and at 6 months.

We use Questionnaire of care burden to evaluate the care burde that the primary caregivers' care their child during treatment.

There are 20 questions in the quality of life index. The total score is from 0 to 60. Cronbach's α is .91.

The higher the score is, the heavier the care burden is.

National Taiwan University Hospital

Infections

Respiratory Tract (Lung and Bronchial) Diseases

COVID-19

Communicable Diseases

Disease Attributes

Pneumonia

Pneumonia, Viral

Respiratory Tract Infections

Virus Diseases

Coronavirus Infections

Coronaviridae Infections

Nidovirales Infections

RNA Virus Infections

Lung Diseases

Respiratory Tract Diseases

Pediatric Cancer patients with persistent SARS-CoV-2 infection

Pediatric Cancer patients who tested negative for SARS-CoV-2 within 14 days of diagnosis.

Mohamed Diaaeldin Hashem, MBBCh, MSc

The main goal of this study is to characterize the adaptive immune responses to SARS-CoV-2 infection in a cohort of children with cancer and impaired immune responsiveness and prolonged viral shedding of SARS-CoV-2, and to identify SARS-CoV-2 variants that might arise during poorly controlled virus replication

Although the adaptive immune response plays an important role in improving clinical outcomes of patients infected with SARS2, variability in clinical disease and outcome in patients with SARS2 infection has not been explained by the variation in qualitative and quantitative antiviral immune responses. It has been observed that immunocompromised children shed the virus from the upper respiratory tract for prolonged periods of time, even after the resolution of clinical symptoms. Thus deficits in adaptive immune responses might lead to ineffective control of virus replication and prolonged virus shedding. The proposed studies will define the relationship between adaptive immunity and virus replication/shedding, including the contribution of viral variants that could arise during poorly controlled virus replication in children with ineffective immune responses. The specific aims of the proposed study are: (a) To measure (quantify and qualify) the adaptive immune responses (humoral and cell-mediated immune responses) after infection with SARS-CoV-2 in a cohort of hospitalized children with cancer and impaired immune response. (b) To define the long-term kinetics of the antibody response, cell-mediated immune responses following infection with SARS-CoV-2 in a cohort of hospitalized children with cancer and impaired immune response, and to estimate the duration of protective immunity.(c) to statistically assess whether impaired humoral immunity is associated with prolonged viral replication and shedding (persistence) following infection with SARS-CoV-2 in a cohort of children with cancer and impaired immune response, (d) To genetically trace SARS-CoV-2 mutations, and statistically assess the association between persistent SARS-CoV-2 infection and the frequency of viral mutations and the emergence of viral variants in a cohort of children with cancer and impaired immune response, after their infection with SARS-CoV-2 This will be a prospective, observational cohort study design. The study population will include pediatric and adolescent patients undergoing cancer chemotherapy with a confirmed SARS-CoV-2 infection (PCR Positive). Eligible subjects will be followed prospectively for three months from the time they tested positive for SARS-CoV-2 by PCR. SARS-CoV-2 RNA, antibody, and cell-mediated immune responses will be assessed at specified time points and compared between the children with persistent SARS-CoV-2 infection, and those who cleared SARS-CoV-2 virus. Sequence viral variants in the persistent SARS-COV-2 infected group Assess the association between the emergence of viral variants and mutations and strain virulence and clinical outcome

Persistent SARS-CoV-2 Infection in Children With Cancer and Impaired Immune Responsiveness

National Research Centre, Egypt

Pfizer

Children's Cancer Hospital Egypt 57357

Active Ingredient Mukbang will be allocated to the participants in the experimental group. The videos which presented the food images, eating sound and a relaxing and pleasant atmosphere will be sent in sequence through the short video platforms on the smart phone to the participants in the experimental group.

Common Mukbang on short video platforms will be allocated to the participants in the conditional group. The Mukbang videos which made and uploaded by popular Mukbang makers will be sent in sequence through the short videos platforms on the smart phone to the participants in the experimental group.

General short videos without food cues will be allocated to the participants in the placebo control group. There will be no restrictions on the type of short video platforms and specific video content.

Mukbang videos include the items which can truly improve the appetite of children with cancer, such as food images, eating sound and interactivity.

Active Ingredient Mukbang

Common Mukbang videos made and uploaded by the famous Mukbang makers.

Common Mukbang

Short videos that don't contain any food cues.

General short videos

Wei Xia, PhD

This study aims to use a three arms randomized clinical trial study to evaluate the effectiveness of the effective constituent of Mukbang in helping children with cancer hospitalized for radiotherapy and chemotherapy to improve their appetite, nutritional status and quality of life.

Cancer has a high incidence among children and adolescents worldwide. In October 2020, the World Health Organization (WHO) released an overview of the Global Action on Childhood Cancer which showed that more than 400,000 children under the age of 19 were diagnosed with cancer worldwide every year. With the development and progress of diagnosis and treatment technology, the health outcome of children with cancer has been greatly improved.

However, the side effects and complications associated with cancer and its treatment can seriously affect the appetite and food intake of children with cancer, resulting in malnutrition and a low quality of life. Therefore, it is very important to effectively improve the appetite of children with cancer during treatment.

Clinical methods to improve the appetite of cancer patients mainly include drugs, diet or nutrition intervention, traditional Chinese medicine and acupuncture, but each intervention has its own advantages and disadvantages which makes the clinical application effect difficult to evaluate, in urgent need of more effective solutions to solve this problem.

Mukbang has shown great potential in helping children with cancer to improve their appetite and food consumption, finally promote nutritional health. What's more, the features of Mukbang, such as high-quality and clear pictures, relaxed atmosphere created by the video makers, sounds while eating, and attractive images of food, may promote viewers' appetite and increase their intake imperceptibly. In addition to that, watching Mukbang while eating can also provide a pleasant eating experience for children with cancer, and the interaction with the Mukbang anchor can also alleviate the loneliness of children who live in hospital for such a long time, so as to enhance the children's taste experience, relieve the negative emotions of loneliness and depression.

Research has found that Mukbang can help people with low appetites increase their food intake and the interest in food. Several studies have shown that videos containing food cues can increase viewers' appetite and decrease feelings of satiety to a certain extent. At the same time, Mukbang can also increase viewers' taste experience on the basis of physics and improve children's interest in food. Thus, Mukbang is a useful tool for those who are struggling to increase the amount and variety of acceptable foods and gain weight. It also suggests that clinicians who treat eating disorders should be aware that Mukbang is a potential factor in their illness, and that effective positive use may be helpful for patients with anorexia or restrictive eating.

Given that, Mukbang will be applied to help children with cancer to improve appetite, nutritional status and quality of life. Studies have found that food images, eating sounds and interactivity of Mukbang may play a leading role in improving appetite. Thus, we defined the active ingredients of Mukbang as food images, eating sound and interactivity in this study. Based on that, this study aims to compare the effect of active ingredient Mukbang, ordinary Mukbang and general short videos without food cues on improving appetite in children with cancer, to provide evidence for larger randomized controlled trials (RCTS) and provide a new direction for clinical departments to develop nutritional interventions and management programs for children with cancer.

Using Mukbang to Improve Appetite, Nutritional Status and Quality of Life in Children With Cancer

The Effectiveness of Mukbang in Helping Children With Cancer Hospitalized for Radiotherapy and Chemotherapy to Improve Appetite, Nutritional Status and Quality of Life: A Randomized Control Trial

The non-identified individual participant data will be shared after the outcomes have been published.

A subjective sensation that stimulates the intake of food to provide the energy necessary for the most basic activities of life, which can be measured by the Cancer Appetite and Symptom Questionnaire (CASQ).

Insufficient or excessive nutrient intake, imbalance of essential nutrients or impaired nutrient utilization, mainly manifested by wasting, stunting, underweight and micronutrient deficiency. Malnutrition is measured by the Subjective Global Nutritional Risk Assessment (SGNA).

Body mass index (BMI), a simple method to evaluate the nutritional status and changes of children with cancer, which will be calculated as weight/height\^2. Weight and height will be combined to report BMI in kg/m\^2.

Individuals in different cultures and value systems experience their living conditions in relation to their goals, expectations, standards and concerns, including their physical health, mental state, independence, social relations, personal beliefs and relationships with the surrounding environment. This target is measured by the pediatric quality of life inventory measurement models 3.0 (PedsQLTM-3.0-cancer).

Wei XIA, PhD

Philosophic Doctor

Fatigue

Children and adolescents will receive the study intervention, which includes exercise coaching and prescription, that is be incorporated into the standard care they receive from the nurse practitioners during their outpatient visits.

Physical activity coaching

Casey C Hooke, PhD, APRN

During cancer treatment children are less active than their health peers. This inactivity persists into survivorship and can negatively affect health and quality of life. Physical activity may also improve fatigue, a prevalent and distressing symptom during treatment. Improving health behaviors during treatment can have lifelong benefits for cancer survivors. In this study, the effectiveness of the "Kids are Moving" exercise program will be evaluated. The exercise program will follow program guidelines set up by the American College of Sports Medicine and will be adapted for children with cancer. Children ages 6 to 18 years, who are receiving chemotherapy, and their parents, will be coached on how to increase their physical activity and will receive an exercise prescription. This will occur as part of the standard care they receive from the nurse practitioners during the first six months of their outpatient visits. Investigators want to find out if children in the Kids are Moving program are more active and have less fatigue. Activity will be measured through patient questionnaires about activity and fatigue, and by wearing the FitBit activity tracker and an actigraph. Outcomes will be compared to measurements collected from children who received usual care before the exercise program started.

Physical activity is a vital for improving health and quality of life and for providing energy for engaging in positive life experiences as children move along the developmental continuum to a long and healthy future. Outcomes of the study will provide a foundation for larger multi-site clinical trials.

During cancer treatment children are significantly less active than their healthy peers. This inactivity persists into survivorship, negatively influencing their health and quality of life. Physical activity may also improve fatigue, a near-universal and distressing symptom during treatment. Improving health behaviors during treatment can have lifelong benefit.

The goal of this study is to evaluate the effectiveness of the Kids are Moving exercise program that is delivered by nurse practitioners (NP's) during outpatient care provided to a specific population of children. The study will be conducted at two pediatric cancer treatment sites and will translate the American College of Sports Medicine's program, Exercise is Medicine into practice. In this quasi-experimental design, children will receive the study intervention, which includes exercise coaching and prescription, that is be incorporated into the standard care they receive from the nurse practitioners during their outpatient visits. Outcomes will be compared to historical control measurements of children who received usual care. Study aims are to:

1. To compare measurements of activity levels of children receiving exercise coaching over the first 6 months of cancer treatment as measured by self-report and the FitBit Flex tracker
2. To compare activity levels of children receiving exercise coaching during cancer treatment as measured by self-report and the FitBit Flex tracker, to activity levels of children in the historical control group receiving usual care during cancer treatment.
3. To evaluate the influence of activity levels on fatigue experience by children receiving cancer treatment

Children ages 6 to 18, and their parents, will be invited to participate in study measurements which will be completed at the 2nd, 4th, and 6th months of cancer treatment. Patients will be included if recently diagnosed with cancer (excluding bone tumors and bone metastasis), and ambulatory. Validated self-report instruments will be used to measure activity and fatigue. Additionally, the FitBit Flex tracker, a device that measures steps/day and motion in three dimensions and an actigraph, will be worn by subjects over a 3 day period for each measurement point.

Physical activity is a vital intervention for improving health and quality of life and for providing energy for engaging in positive life experiences that advance children along the developmental continuum to a long and healthy future. Outcomes of the study will provide a foundation for larger multi-site clinical trials.

KAM: Kids Are Moving

KAM: Kids Are Moving; An Exercise Program for Children With Cancer

University of Minnesota

The fMRI scanning will be divided into 3 parts, includes structural image scans, resting state scans, and task state scans. For the task state function image scanning, participants will be asked to watch the specific video program which includes the food images and eating sound of Mukbang and General short videos without food cues.

Healthy kids and children with cancer hospitalized for radiotherapy and chemotherapy will both accept this intervention.

Specific video program + fMRI will be allocated to the participants in this group. The specific video program includes control videos without food information, eating and food images without sound, chewing and swallowing sound without images, and Interactive content in Mukbang. Participants will undergo structural image scans, resting state scans, and task state scans. The task-fMRI will be performed while watching Mukbang to explore the activation of brain functional areas.

fMRI + Mukbang videos

Wei Xia

This study aims to use the intervention study method to extract and verify the effective ingredients in Mukbang that promote appetite and eating in children with tumor during radiotherapy and chemotherapy, and to analyze and explore their potential mechanisms of action based on functional magnetic resonance imaging.

Cancer has a high incidence among children and adolescents worldwide. In October 2020, the World Health Organization (WHO) released an overview of the Global Action on Childhood Cancer which showed that more than 400,000 children under the age of 19 were diagnosed with cancer worldwide every year. With the development and progress of diagnosis and treatment technology, the health outcome of children with cancer has been greatly improved.

However, the side effects and complications associated with cancer and its treatment can seriously affect the appetite and food intake of children with cancer, resulting in malnutrition and a low quality of life. Therefore, it is very important to effectively improve the appetite of children with cancer during treatment.

Clinical methods to improve the appetite of cancer patients mainly include drugs, diet or nutrition intervention, traditional Chinese medicine and acupuncture, but each intervention has its own advantages and disadvantages which makes the clinical application effect difficult to evaluate, in urgent need of more effective solutions to solve this problem.

Mukbang has shown great potential in helping children with cancer to improve their appetite and food consumption, finally promote nutritional health. Mukbang is a method independently chosen by hospitalized cancer children with radiotherapy and chemotherapy to help promote appetite, which has a natural high acceptance. What's more, the features of Mukbang, such as high-quality and clear pictures, relaxed atmosphere created by the video makers, sounds while eating, and attractive images of food, may promote viewers' appetite and increase their intake imperceptibly.

In addition to that, watching Mukbang while eating can also provide a pleasant eating experience for children with cancer, and the interaction with the Mukbang anchor can also alleviate the loneliness of children who live in hospital for such a long time, so as to enhance the children's taste experience, relieve the negative emotions of loneliness and depression and promote their appetite and interest in food under the condition of ensuring a healthy diet.

Research has found that Mukbang can help people with low appetites increase their food intake and provide vicarious satisfaction to those who overeat. Several studies have shown that videos containing food cues can increase viewers' appetite and decrease feelings of satiety to a certain extent. At the same time, Mukbang can also increase viewers' taste experience on the basis of physics and improve children's interest in food.

Therefore, on the basis of existing studies, this study will use functional magnetic resonance imaging and cross-case analysis to extract and verify the effective ingredients in Mukbang that promote appetite and eating in children with tumor during radiotherapy and chemotherapy, and analyze and discuss their potential mechanism of action, aiming to provide a new direction for clinical departments to develop nutritional intervention measures and management programs for children with cancer.

Research on the Influence of Mukbang on Brain Activation in Children With Cancer Based on fMRI

The Exploration of the Effect of Mukbang on Functional Connectivity of Related Brain Regions in Children With Cancer Hospitalized for Radiotherapy and Chemotherapy Based on fMRI

The outcome can be collected using the Siemens 3T Prisma functional Magnetic Resonance Imaging machine with an Inspur data processing system. The pictures reflect the brain functional areas which can be activated by watching Mukbang.

Participants' self-reported appetite, to reflect the participants' own perceived appetite.

In order to further evaluate the relationship between the functional activities of the appetition-related regions of the brain and appetite, the number of salivation and increased perceived appetite will be recorded by pressing the button during the MRI scan.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Evaluation of the Effect of a Physical Activity Recovery Stay	NCT06320496	Children With C... Children With C...		8 Years - 18 Years	Union de Gestion des Etablissements des Caisses d'Assurance Maladie - Nord Est
Factors Related to Truth Telling in Primary Caregivers	NCT02214446	Primary Caregiv...		20 Years -	National Taiwan University Hospital
Evaluation of the Effect of a Physical Activity Recovery Stay	NCT06320496	Children With C... Children With C...		8 Years - 18 Years	Union de Gestion des Etablissements des Caisses d'Assurance Maladie - Nord Est
Factors Related to Truth Telling in Primary Caregivers	NCT02214446	Primary Caregiv...		20 Years -	National Taiwan University Hospital
Factors Related to Truth Telling in Primary Caregivers	NCT02214446	Primary Caregiv...		20 Years -	National Taiwan University Hospital
Persistent SARS-CoV-2 Infection in Children With Cancer and Impaired Immune Responsiveness	NCT05172063	Children With C... SARS-CoV-2 Infe...		1 Year - 18 Years	Children's Cancer Hospital Egypt 57357
Persistent SARS-CoV-2 Infection in Children With Cancer and Impaired Immune Responsiveness	NCT05172063	Children With C... SARS-CoV-2 Infe...		1 Year - 18 Years	Children's Cancer Hospital Egypt 57357
Using Mukbang to Improve Appetite, Nutritional Status and Quality of Life in Children With Cancer	NCT05922553	Children With C...	Active Ingredie... Common Mukbang General short v...	6 Years - 18 Years	Sun Yat-sen University
KAM: Kids Are Moving	NCT02626637	Children With C... Fatigue Physical Activi...	Physical activi...	6 Years - 18 Years	University of Minnesota
Research on the Influence of Mukbang on Brain Activation in Children With Cancer Based on fMRI	NCT05922566	Children With C...	fMRI + Mukbang ...	10 Years - 18 Years	Sun Yat-sen University

Spots Global Cancer Trial Database for children with cancer