scholarly journals SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities

2021 ◽  
Author(s):  
Emily E. Johnston ◽  
Isaac Martinez ◽  
Elizabeth S. Davis ◽  
Caroline Caudill ◽  
Joshua Richman ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Pediatric Oncology ◽  
Antibody Therapy ◽  
Population Level ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Children With Cancer ◽  
Adjusted Risk ◽  
Icu Admission ◽  
Publicly Insured

PURPOSE The Pediatric Oncology COVID-19 Case Report registry supplies pediatric oncologists with data surrounding the clinical course and outcomes in children with cancer and SARS-CoV-2. METHODS This observational study captured clinical and sociodemographic characteristics for children (≤ 21 years) receiving cancer therapy and infected with SARS-CoV-2 from the pandemic onset through February 19, 2021. The demographic and clinical characteristics of the cohort were compared with population-level pediatric oncology data (SEER). Multivariable binomial regression models evaluated patient characteristics associated with hospitalization, intensive care unit (ICU) admission, and changes in cancer therapy. RESULTS Ninety-four institutions contributed details on 917 children with cancer and SARS-CoV-2. Median age at SARS-CoV-2 infection was 11 years (range, 0-21 years). Compared with SEER, there was an over-representation of Hispanics (43.6% v 29.7%, P < .01), publicly insured (59.3% v 33.5%, P < .01), and patients with hematologic malignancies (65.8% v 38.3%, P < .01) in our cohort. The majority (64.1%) were symptomatic; 31.2% were hospitalized, 10.9% required respiratory support, 9.2% were admitted to the ICU, and 1.6% died because of SARS-CoV-2. Cancer therapy was modified in 44.9%. Hispanic ethnicity was associated with changes in cancer-directed therapy (adjusted risk ratio [aRR] = 1.3; 95% CI, 1.1 to 1.6]). Presence of comorbidities was associated with hospitalization (aRR = 1.3; 95% CI, 1.1 to 1.6) and ICU admission (aRR = 2.3; 95% CI, 1.5 to 3.6). Hematologic malignancies were associated with hospitalization (aRR = 1.6; 95% CI, 1.3 to 2.1). CONCLUSION These findings provide critical information for decision making among pediatric oncologists, including inpatient versus outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the SARS-CoV-2 pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.

scholarly journals Patterns of seroconversion for SARS-CoV2-IgG in patients with malignant disease and association with anti-cancer therapy

2020 ◽  
Author(s):  
Astha Thakkar ◽  
Kith Pradhan ◽  
Shawn Jindal ◽  
Zhu Cui ◽  
Bradley Rockwell ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cellular Therapy ◽  
Antibody Therapy ◽  
Hematologic Malignancies ◽  
High Rate ◽  
Cell Transplant ◽  
Specific Patient ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
Patient Groups

Abstract Patients with cancer have been identified in several studies to be at high risk of developing severe COVID-19; however, rates of SARS-CoV-2 IgG seroconversion and its association with cancer types and anti-cancer therapy remain obscure. We conducted a retrospective cohort study in patients with cancer that underwent SARS-CoV-2 IgG testing. Two hundred and sixty-one cancer patients underwent SARS-CoV-2 IgG testing and demonstrated a high rate of seroconversion (92%). However, significantly lower seroconversion was observed in patients with hematologic malignancies (82%), patients that received anti-CD-20 antibody therapy (59%), CAR-T/cellular therapy (33%) and stem cell transplant (60%). Interestingly, all 17 patients that received immunotherapy, including 16 that received anti-PD-1/PD-L1 monoclonal antibodies, developed SARS-Cov-2 IgG antibodies (100% seroconversion). These data show differential rates of seroconversion in specific patient groups and bear importance for clinical monitoring and vaccination strategies that are being developed to mitigate the COVID-19 pandemic

Twice weekly prophylaxis with trimethoprim/sulfamethoxazole for Pneumocystis jirovecii pneumonia in pediatric oncology patients

2020 ◽  
pp. 107815522097904
Author(s):  
Monica Awad ◽  
Caroline M Sierra ◽  
Elhaam Mesghali ◽  
Khaled Bahjri
Keyword(s):  
Pediatric Oncology ◽  
Retrospective Cohort ◽  
Hematologic Malignancies ◽  
Primary Objective ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Weekly Dose ◽  
Single Center ◽  
Oncology Patients ◽  
Prophylaxis Therapy

Current recommendations for prophylaxis of Pneumocystis jirovecii pneumonia in oncology patients include administration of trimethoprim/sulfamethoxazole (TMP/SMX) three times weekly or the same total weekly dose given daily. The primary objective of this study was to evaluate the efficacy of two consecutive days per week of TMP/SMX for prevention of Pneumocystis jirovecii pneumonia (PJP) in pediatric oncology patients. A retrospective cohort, single-center analysis was conducted in oncology patients 21 years and younger who received TMP/SMX for PJP prophylaxis between February 1, 2013 and July 31, 2017. Changes to the prophylaxis regimen were documented and analyzed. A total of 322 patients received TMP/SMX on two consecutive days per week for PJP prevention, of whom four had confirmed PJP (1.3%). Neutropenia was the most common reason for switching to alternative prophylaxis therapy (11.5%). Two consecutive prophylaxis days with TMP/SMX may be insufficient to prevent PJP in children with hematologic malignancies. Neutropenia remains a barrier for TMP/SMX use for PJP prophylaxis. Further studies to compare PJP incidence in children receiving alternative prophylaxis regimens should be considered.

Predictors of and Trends in High-Intensity End-of-Life Care Among Children With Cancer: A Population-Based Study Using Health Services Data

2017 ◽  
Vol 35 (2) ◽  
pp. 236-242 ◽  
Author(s):  
Alisha Kassam ◽  
Rinku Sutradhar ◽  
Kimberley Widger ◽  
Adam Rapoport ◽  
Jason D. Pole ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Health Services ◽  
High Intensity ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Children With Cancer ◽  
Eol Care ◽  
Related Mortality

Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data. Based on previous studies, the primary composite measure of HI-EOL care comprised any of the following: intravenous chemotherapy < 14 days from death; more than one emergency department visit; and more than one hospitalization or intensive care unit admission < 30 days from death. Secondary measures included those same individual measures and measures of the most invasive (MI) EOL care (eg, mechanical ventilation < 14 days from death). We determined predictors of outcomes with appropriate regression models. Sensitivity analysis was restricted to cases of cancer-related mortality, excluding treatment-related mortality (TRM) cases. Results The study included 815 patients; of these, 331 (40.6%) experienced HI-EOL care. Those with hematologic malignancies were at highest risk (odds ratio, 2.5; 95% CI, 1.8 to 3.6; P < .001). Patients with hematologic cancers and those who died after 2004 were more likely to experience the MI-EOL care (eg, intensive care unit, mechanical ventilation, odds ratios from 2.0 to 5.1). Excluding cases of TRM did not substantively change the results. Conclusion Ontario children with cancer continue to experience HI-EOL care. Patients with hematologic malignancies are at highest risk even when excluding TRM. Of concern, rates of the MI-EOL care have increased over time despite increased palliative care access. Linking health services and clinical data allows monitoring of population trends in EOL care and identifies high-risk populations for future interventions.

scholarly journals LIBERTI: A SMART study in plastic surgery

2018 ◽  
Vol 15 (3) ◽  
pp. 286-293
Author(s):  
Jonathan C Hibbard ◽  
Jonathan S Friedstat ◽  
Sonia M Thomas ◽  
Renee E Edkins ◽  
C Scott Hultman ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Precision Medicine ◽  
Laser Treatment ◽  
Population Level ◽  
Patient Characteristics ◽  
Patient Response ◽  
Multiple Assignment ◽  
Laser Treatments ◽  
Treatment Plans ◽  
Treatment Rules

Background/aims: Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. Methods: We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. Results: We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. Conclusion: We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.

scholarly journals Obesity Does Not Increase Mortality after Emergency Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Paula Ferrada ◽  
Rahul J. Anand ◽  
Ajai Malhotra ◽  
Michel Aboutanos
Keyword(s):  
Wound Infection ◽  
Emergency Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Obese Patients ◽  
Exact Test ◽  
Icu Admission ◽  
Nonobese Patients ◽  
The Impact

Objective.The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery.Methods.A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression.Results.341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese,P=0.42). Obese patients had an increased incidence of diabetes, (27% versus 7%,P<0.05), hypertension (52% versus 34%,P<0.05), and sleep apnea (0% versus 5%,P<0.05). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%,P<0.05) and ICU admission (obese 58% versus nonobese 42%,P=0.01) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality.Conclusions.A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure.

scholarly journals The national incidence of PML in Sweden, 1988–2013

Neurology ◽  
2018 ◽  
Vol 90 (6) ◽  
pp. e498-e506 ◽  
Author(s):  
Ellen Iacobaeus ◽  
Sarah Burkill ◽  
Shahram Bahmanyar ◽  
Ramil Hakim ◽  
Camilla Byström ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Antibody Treatment ◽  
Monoclonal Antibody Treatment ◽  
National Patient ◽  
Notable Increase ◽  
High Level ◽  
Underlying Diseases ◽  
Record Review

ObjectiveTo investigate the incidence of progressive multifocal leukoencephalopathy (PML) and patient characteristics in Sweden between 1988 and 2013.MethodsAll PML diagnoses in Sweden between 1988 and 2013 were identified in the National Patient Register. Information to validate the diagnosis and patient characteristics was obtained from medical records.ResultsMedical record review classified 108 out of 250 patients (43%) as definite (n = 84), probable (n = 4), or possible (n = 20) PML according to diagnostic criteria. Accurate diagnoses were more common in records obtained from neurology departments (82% of patients seen in neurology departments) compared with other departments (31%) (p < 0.001). The incidence of PML increased from a largely stable level at 0.026 (95% confidence interval [CI] 0.021–0.031) per 100,000 individuals per year during 1988–2010 to 0.11 (95% CI 083–0.137) during 2011–2013, during which time there was a notable increase (p < 0.001). Hematologic malignancies (n = 34), HIV/AIDS (n = 33), and autoimmune disease (n = 23) were the most common underlying diseases. Treatment with a monoclonal antibody prior to PML diagnosis was identified in 26 patients.ConclusionAn increased incidence of PML in Sweden was observed and coincided with the prior use of monoclonal antibody treatment. The high level of misdiagnosis emphasizes the importance of immediate contact with a neurology center upon suspicion of PML.

Adverse Effects of Cancer Therapy in Children

1985 ◽  
Vol 6 (9) ◽  
pp. 259-268
Author(s):  
Arlynn F. Mulne ◽  
John C. Koepke
Keyword(s):  
Primary Care ◽  
Differential Diagnosis ◽  
Cancer Therapy ◽  
Adverse Effects ◽  
Children With Cancer ◽  
Diagnosis And Management ◽  
Primary Care Pediatrician

There are many opportunities for the primary care pediatrician to participate actively in the care of children with cancer. Adverse effects of therapy must be considered in the differential diagnosis of many problems encountered by these patients, and appropriate management instituted. Adverse effects may appear during therapy or may become apparent only many years later. Referral to a hematologist/oncologist should be considered when help is needed in the diagnosis and management of possible therapy-related problems.

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