Attending Patient Funerals as a Follow-Up Practice of Pediatric Oncologists

2021 ◽  
pp. 105413732110473
Author(s):  
Delaney Schoenbine ◽  
James Gerhart ◽  
Katherine A. McLean ◽  
Joseph deBettencourt ◽  
Farnaz Dadrass ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Family Rituals ◽  
Professional Boundaries ◽  
Risks And Benefits ◽  
Level Of Agreement

This study assessed pediatric oncology professionals’ attitudes and attendance at patient funerals. Many professionals endorsed some level of agreement that funeral attendance respects professional boundaries. Nearly all pediatric oncology professionals (89.2%) reported attending a patient funeral at least once, a rate significantly higher than estimates in other specialties ( p <.001). Attitudes and rates of attendance were slightly higher in older physicians. While periodic funeral attendance may have been somewhat normative in this sample, further reflection and research is needed to ensure the risks and benefits of involvement in funerals and other family rituals and practices are better understood.

High survival rate in advanced-stage B-cell lymphomas and leukemias without CNS involvement with a short intensive polychemotherapy: results from the French Pediatric Oncology Society of a randomized trial of 216 children.

1991 ◽  
Vol 9 (1) ◽  
pp. 123-132 ◽  
Author(s):  
C Patte ◽  
T Philip ◽  
C Rodary ◽  
J M Zucker ◽  
H Behrendt ◽  
...  
Keyword(s):  
Survival Rate ◽  
B Cell ◽  
Pediatric Oncology ◽  
Stage Iv ◽  
High Dose ◽  
High Survival ◽  
Advanced Stage ◽  
High Survival Rate ◽  
Cns Involvement

From April 1984 to December 1987, the French Pediatric Oncology Society (SFOP) organized a randomized trial for advanced-stage B-cell lymphoma without CNS involvement to study the possibility of reducing the length of treatment to 4 months. After receiving the same three intensive six-drug induction courses based on high-dose fractionated cyclophosphamide, high-dose methotrexate (HD MTX), and cytarabine in continuous infusion, patients were evaluated for remission. Those who achieved complete remission (CR) were randomized between a long arm (five additional courses with two additional drugs; 16 weeks of treatment) and a short arm (two additional courses; 5 weeks). For patients in partial remission (PR), intensification of treatment was indicated. Two hundred sixteen patients were registered: 15 stage II nasopharyngeal and extensive facial tumors, 167 stage III, and 34 stage IV, 20 of the latter having more than 25% blast cells in bone marrow. The primary sites of involvement were abdomen in 172, head and neck in 30, thorax in two, and other sites in 12. One hundred sixty-seven patients are alive in first CR with a minimum follow-up of 18 months; four are lost to follow-up. Eight patients died from initial treatment failure, 14 died from toxicity or deaths unrelated to tumor or treatment, and 27 relapsed. The event-free survival (EFS), with a median follow-up of 38 months, is 78% (SE 3) for all the patients, 73% (SE 11) for the stage II patients, 80% (SE 3) for the stage III patients, and 68% (SE 8) for the stage IV and acute lymphoblastic leukemia (ALL) patients. One hundred sixty-six patients were randomized: 82 in the short arm and 84 in the long arm. EFS is, respectively, 89% and 87%. Statistical analysis confirms equivalence of both treatment arms with regard to EFS. Moreover, morbidity was lower in the short arm. This study confirms the high survival rate obtained in the previous LMB 0281 study without radiotherapy or debulking surgery and demonstrates the effectiveness of short treatment.

scholarly journals Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes

2014 ◽  
Vol 14 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Matthew B. Potts ◽  
Sunil A. Sheth ◽  
Jonathan Louie ◽  
Matthew D. Smyth ◽  
Penny K. Sneed ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Target Volume ◽  
Neurological Deficits ◽  
Single Institution ◽  
Risks And Benefits ◽  
Scale Scores ◽  
Time Of Presentation

Object Stereotactic radiosurgery (SRS) is an established treatment modality for brain arteriovenous malformations (AVMs) in children, but the optimal treatment parameters and associated treatment-related complications are not fully understood. The authors present their single-institution experience of using SRS, at a relatively low marginal dose, to treat AVMs in children for nearly 20 years; they report angiographic outcomes, posttreatment hemorrhage rates, adverse treatment-related events, and functional outcomes. Methods The authors conducted a retrospective review of 2 cohorts of children (18 years of age or younger) with AVMs treated from 1991 to 1998 and from 2000 to 2010. Results A total of 80 patients with follow-up data after SRS were identified. Mean age at SRS was 12.7 years, and 56% of patients had hemorrhage at the time of presentation. Median target volume was 3.1 cm3 (range 0.09–62.3 cm3), and median prescription marginal dose used was 17.5 Gy (range 12–20 Gy). Angiograms acquired 3 years after treatment were available for 47% of patients; AVM obliteration was achieved in 52% of patients who received a dose of 18–20 Gy and in 16% who received less than 18 Gy. At 5 years after SRS, the cumulative incidence of hemorrhage was 25% (95% CI 16%–37%). No permanent neurological deficits occurred in patients who did not experience posttreatment hemorrhage. Overall, good functional outcomes (modified Rankin Scale Scores 0–2) were observed for 78% of patients; for 66% of patients, functional status improved or remained the same as before treatment. Conclusions A low marginal dose minimizes SRS-related neurological deficits but leads to low rates of obliteration and high rates of hemorrhage. To maximize AVM obliteration and minimize posttreatment hemorrhage, the authors recommend a prescription marginal dose of 18 Gy or more. In addition, SRS-related symptoms such as headache and seizures should be considered when discussing risks and benefits of SRS for treating AVMs in children.

scholarly journals Prevalence of Human Papillomavirus in Self-Taken Samples from Screening Nonattenders

2017 ◽  
Vol 55 (10) ◽  
pp. 2913-2923 ◽  
Author(s):  
J. U. H. Lam ◽  
M. Rebolj ◽  
D. M. Ejegod ◽  
H. Pedersen ◽  
C. Rygaard ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Reference Population ◽  
Hybrid Capture ◽  
Hpv Prevalence ◽  
Screening Participation ◽  
Hybrid Capture 2 ◽  
Management Of Hpv ◽  
Hpv Assays ◽  
Level Of Agreement

ABSTRACT The Copenhagen Self-Sampling Initiative (CSi) has shown how human papillomavirus (HPV)-based self-sampling can be used to increase screening participation among 23,632 nonattenders in the Capital Region of Denmark. In this study, we describe HPV prevalence and genotype frequency in 4,824 self-samples as determined by three HPV assays (the CLART, Onclarity, and Hybrid Capture 2 [HC2] assays) and compare the results with those for physician-taken follow-up samples. The HPV self-sample findings were also compared to the findings for a reference population of 3,347 routinely screened women from the Horizon study, which had been undertaken in the same screening laboratory. Nonattenders had an HPV prevalence of 11.3% as determined by the CLART assay, which was lower than that for women from the Horizon study (18.5%). One-third of the CSi women who tested HPV positive by self-sampling tested HPV negative on the physician-taken follow-up sample. The CLART and Onclarity assays agreed on 64% (95% confidence interval [CI], 60 to 68%) of the HPV-positive self-taken samples. When the HC2 assay results were added into a three-way comparison, the level of agreement decreased to 27% (95% CI, 24 to 29%). Our findings suggest that further validation of HPV assays on self-taken samples is needed for optimal HPV detection and correct clinical management of HPV-positive women.

Results of a Multicenter Retrospective Study on Pediatric Brain Tumors in Italy

1986 ◽  
Vol 72 (3) ◽  
pp. 285-292
Author(s):  
Enrico Madon ◽  
Luigi Besenzon ◽  
Adalberto Brach del Prever ◽  
Luca Cordero di Montezemolo ◽  
Beniamino Cucchi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pediatric Oncology ◽  
Performance Status ◽  
Pediatric Brain Tumors ◽  
Radical Excision ◽  
Radiotherapy Alone ◽  
Histologic Types ◽  
Lost To Follow Up ◽  
Pediatric Brain

This retrospective study was undertaken to evaluate the clinical characteristics, course and treatment of children (0–14 years of age) diagnosed with a primary CNS tumor during the period 1976–1982 in Italy. Four hundred and sixty-two patients (263 males and 199 females) were followed by 18 various neurosurgical and pediatric oncology centers. The histologic types most frequently reported were: medulloblastoma (23 %), astrocytoma (16 %), ependymoma (11 %) and spongioblastoma (11 %). Of the 388 patients who underwent surgery, radical excision was reported in 42 %, partial excision in 32 %, biopsy only in 6 %, and unqualified surgery in 4 %; 19 % had no surgery. Radiotherapy and chemotherapy combined were administered in 61 % of the 143 patients followed at pediatric oncology centers; 19 % received radiotherapy alone, 3 % chemotherapy alone, and 17 % neither treatment. Forty-six percent of the patients were reported alive, 40 % dead, and 14 % lost to follow-up. Performance status was identified for 62 patients. The investigation revealed marked differences in the therapeutic treatment administered, thus precluding valid data analysis. This emphasizes the need to coordinate efforts among the institutions and the disciplines involved in the treatment of this form of childhood cancer.

Late effects: Ten years long term follow up of pediatric oncology patients - From nihilism to cautious optimism

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 8568-8568
Author(s):  
A. Sachdeva ◽  
S. Sachdeva ◽  
R. Mohan ◽  
P. K. Pruthi ◽  
S. Gupta ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Late Effects ◽  
Oncology Patients ◽  
Long Term Follow Up

Outpatient management of pediatric oncology patients with low-risk fever and neutropenia: Implementation of new clinical practice guideline at Texas Children's Hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 26-26
Author(s):  
Abhishek Amar Bavle ◽  
Amanda Bell Grimes ◽  
Sibo Zhao ◽  
Daniel Joseph Zinn ◽  
Andrea Jackson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Pediatric Oncology ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Outpatient Care ◽  
Blood Cultures ◽  
Low Risk ◽  
Outpatient Management ◽  
Oncology Patients

26 Background: Traditionally, pediatric oncology patients with fever and severe neutropenia (absolute neutrophil count [ANC] <500) are admitted on empiric intravenous (IV) antibiotics pending blood cultures, fever resolution, and a rising ANC. Based on significant evidence that risk-stratification of these patients with fever and neutropenia (FN) and outpatient management of “low-risk” FN (LRFN) patients with oral antibiotics can be safe and effective, we implemented an institutional clinical practice guideline (CPG) to provide outpatient care for children with LRFN. Methods: A validated “Alexander” clinical decision rule was adopted to risk stratify pediatric oncology patients with FN. A new CPG was formulated for the outpatient management of LRFN patients, with either discharge on presentation or at 24-48 hours after admission, with levofloxacin and close follow-up. All stakeholders were educated regarding the new guidelines and process prior to implementation, and the guidelines were approved by the institutional Evidence Based Outcomes Center. Results: In 9 months since guideline implementation, 10/11 (91%) of the eligible patients have been managed outpatient for LRFN (mean ANC 160, range 0 - 480). Seven patients were discharged home from the ER or oncology clinic. Three patients were discharged early at 24 – 48 hours after admission. Outpatient management was safe, and all but one patient had resolution of fever within 48 hours and negative blood cultures. One patient had a positive blood culture with Staphylococcus epidermidis and was admitted for IV antibiotics with no complications. Parents of 9/10 patients responded to surveys. All 9 families found outpatient management to be a good experience, follow-up easy, and reported no adverse effects with levofloxacin. One family preferred inpatient care due to anxiety, while importantly 8/9 (89%) parents said they preferred outpatient care compared to inpatient observation. Conclusions: Pediatric oncology patients with low-risk fever and neutropenia were successfully idenitified and managed in the outpatient setting without adverse events with a high level of parent satisfaction.

Lymphocyte-Predominant Hodgkin’s Lymphoma in Children: Therapeutic Abstention After Initial Lymph Node Resection—A Study of the French Society of Pediatric Oncology

2003 ◽  
Vol 21 (15) ◽  
pp. 2948-2952 ◽  
Author(s):  
B. Pellegrino ◽  
M.J. Terrier-Lacombe ◽  
O. Oberlin ◽  
T. Leblanc ◽  
Y. Perel ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pediatric Oncology ◽  
Hodgkin’S Lymphoma ◽  
Stage I ◽  
Hodgkin's Lymphoma ◽  
French Society ◽  
Complementary Treatment ◽  
Lymph Node Resection ◽  
Initial Surgery

Purpose: To clarify treatment strategy for lymphocyte-predominant Hodgkin’s lymphoma (LPHL), the French Society of Pediatric Oncology initiated a prospective, nonrandomized study in 1988. Patients received either standard treatment for Hodgkin’s lymphoma or were not treated beyond initial adenectomy. Patients and Methods: From 1988 to 1998, 27 patients were available for study. Twenty-four patients were male, and median age was 10 years (range, 4 to 16 years). Twenty-two, two, and three patients had stage I, II, and III disease, respectively. Thirteen patients (stage I, n = 11; stage III, n = 2) received no further treatment after initial surgical adenectomy (SA). Fourteen patients received combined treatment (CT; n = 10), involved-field radiotherapy alone (n = 1), or chemotherapy alone (n = 3). The two groups were comparable for clinical status, treatment, and follow-up. Results: Twenty-three of 27 patients achieved complete remission (CR). With a median follow-up time of 70 months (range, 32 to 214 months), overall survival to date is 100%, and overall event-free survival (EFS) is 69% ± 10% (SA, 42% ± 16%; CT, 90% ± 8.6%; P < .04). If we considered only the patients in CR after initial surgery (n = 12), EFS was no longer significantly different between the two groups. Patients with residual mass after initial surgery (n = 15) had worse EFS if they did not receive complementary treatment (P < .05). Conclusion: Although based on a small number of patients, our study showed that (1) no further therapy is a valid therapeutic approach in LPHL patient in CR after initial lymph node resection, and (2) complementary treatment diminishes relapse frequency but has no impact on survival.

Trigeminal branch stimulation for the treatment of intractable craniofacial pain

2015 ◽  
Vol 123 (1) ◽  
pp. 283-288 ◽  
Author(s):  
Jason A. Ellis ◽  
Juan C. Mejia Munne ◽  
Christopher J. Winfree
Keyword(s):  
Effective Treatment ◽  
Retrospective Review ◽  
Pain Control ◽  
Senior Author ◽  
Electrode Placement ◽  
Risks And Benefits ◽  
Pain Syndromes ◽  
Craniofacial Pain ◽  
Pain Improvement

OBJECT Trigeminal branch stimulation has been used in the treatment of craniofacial pain syndromes. The risks and benefits of such an approach have not been clearly delineated in large studies, however. The authors report their experience in treating craniofacial pain with trigeminal branch stimulation and share the lessons they have learned after 93 consecutive electrode placements. METHODS A retrospective review of all patients who underwent trigeminal branch electrode placement by the senior author (C.J.W.) for the treatment of craniofacial pain was performed. RESULTS Thirty-five patients underwent implantation of a total of 93 trial and permanent electrodes between 2006 and 2013. Fifteen patients who experienced improved pain control after trial stimulation underwent implantation of permanent stimulators and were followed for an average of 15 months. At last follow-up 73% of patients had improvement in pain control, whereas only 27% of patients had no pain improvement. No serious complications were seen during the course of this study. CONCLUSIONS Trigeminal branch stimulation is a safe and effective treatment for a subset of patients with intractable craniofacial pain.

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