Development and Evaluation of Video-Based Educational Materials for Nutritional Management of Cancer in Children Among Healthcare Professionals and Caregivers

Abstract Background A good audio-visual educational material for caregivers on nutrition management of pediatric oncology patients can improve treatment effectiveness, recovery rate, and nutritional status of patients. This study aimed to develop and evaluate a series of video-based educational materials for nutritional management of pediatric oncology patients among healthcare professionals and caregivers.Methods The development of the video series began with subtopic selection and content refinement based on a printed booklet project previously published by the groups of five experts in dietetics and oncology medicine and five caregivers of pediatric cancer patients. 10 healthcare professionals (medical doctors and dietitians with over 5 years of working experience) and 15 caregivers then evaluated the video series for acceptability and relevance using the Malay version of the Patient Education Materials Assessment Tools for Audio-Visual materials (PEMAT-AV). Sets of understandability and actionability statements were given a score of 0 (disagree) or 1 (agree), and the overall percentage was calculated.ResultFour main topics were selected from the booklet and adopted into 5 video series ranging from 3 to 8 minutes in length developed in the Malay language entitled (i) Introduction to Cancer and the Treatment, (ii) The Side Effects of Cancer Treatment and Management (Part 1), (iii) The Side Effects of Cancer Treatment and Management (Part 2), (iv) Nutrition Management in Children with Cancer, and (v) You Ask, We Answer. The average understandability and actionability scores rated by the healthcare professionals were 98.6%% and 98.7%respectively. Whereas the caregivers’ average score for understandability was 99.5% and 99.6% for actionability.ConclusionsThe findings revealed that a high-quality video series was successfully developed and rated as highly understandable and actionable by both healthcare professionals and caregivers. This reflects positive acceptance and relevance of the nutritional management educational videos by both groups who manage and care for pediatric cancer patients. Trial RegistrationCentre for Research and Instrumentation Management, Research Ethics Committee of The National University of Malaysia; Ref. No. UKM/PPI/111/8/JEP-2021-266

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Pediatric Oncology Nurses' Attitudes Related to Discussing Fertility Preservation With Pediatric Cancer Patients and Their Families

Journal of Pediatric Oncology Nursing ◽

10.1177/1043454207303878 ◽

2007 ◽

Vol 24 (5) ◽

pp. 255-263 ◽

Cited By ~ 69

Author(s):

Susan T. Vadaparampil ◽

Heather Clayton ◽

Gwendolyn P. Quinn ◽

Lindsey M. King ◽

Michael Nieder ◽

...

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Pediatric Oncology ◽

Pediatric Cancer ◽

Oncology Nurses ◽

Pediatric Cancer Patients

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Research article: Psychological stress of healthcare professionals caring for pediatric cancer patients during the outbreak of COVID-19

10.22541/au.160492693.34829710/v1 ◽

2020 ◽

Author(s):

Kenichiro Kobayashi ◽

Michiko Inoue ◽

Mariko Shibata ◽

Takayuki Hamabata ◽

Toshiro Maihara ◽

...

Keyword(s):

Cancer Patients ◽

Psychological Stress ◽

Pediatric Cancer ◽

Healthcare Professionals ◽

Research Article ◽

Pediatric Cancer Patients

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Meropenem Use in Pediatric Oncology – Audit on Indication, Appropriateness and Consumption Comparing Patient Derived and Pharmacy Dispensing Data

Klinische Pädiatrie ◽

10.1055/a-1481-8905 ◽

2021 ◽

Author(s):

Svenja Ockfen ◽

Leonie Egle ◽

Katharina Sauter ◽

Manfred Haber ◽

Sören Becker ◽

...

Keyword(s):

Cancer Patients ◽

Pediatric Oncology ◽

Pediatric Cancer ◽

Hospital Pharmacy ◽

Gram Negative ◽

Days Of Therapy ◽

Pediatric Cancer Patients ◽

Third Line ◽

Pharmacy Dispensing Data ◽

Dispensing Data

ABSTRACT Background Meropenem is an important second- or third-line antibiotic in pediatric cancer patients with febrile neutropenia (FN). Concise utilization data of meropenem in this setting is limited. It remains unclear how drug dispensing data from the hospital pharmacy correlate with data derived from patients’ files. Methods Retrospective audit of meropenem-consumption in a University-affiliated pediatric oncology center in days of therapy (DOT)/100 inpatient days. The individual indication for meropenem was critically reviewed. The real consumption (in g/100 inpatient days) was compared with the drug amounts dispensed by the hospital pharmacy (in gram and in defined daily doses (DDD)/100 inpatient days). All patients receiving at least one dose of meropenem from 1st of April 2016 until the 30th of June 2018 were included. Result Of 235 consecutive patients, 45 (19%) received meropenem, comprising 57 FN events. The probability of receiving at least one dose of meropenem was significantly higher in patients with ALL, AML, NHL and certain CNS tumors. Preceding the use of meropenem, only 5% of patients were known to be colonized with multidrug-resistant Gram-negative pathogens. Meropenem was administered as first-line treatment in 26% of all meropenem cycles, in 74% of all FN events with meropenem, Piperacillin-Tazobactam was used for initial treatment. In 5 of 57 FN events (8.8%), initial blood cultures yielded a Gram-negative pathogen. Concerning definite treatment, appropriate alternatives to meropenem with a smaller spectrum of activity would have been available in 4 cases, but a de-escalation was not performed. The median length of therapy in the meropenem group was 6 days, the corresponding median for days of therapy (DOT) was 12 days. This corresponds with combination therapy in 56% of all meropenem treatments, mostly with teicoplanin. On average, drug dispensing data from the hospital pharmacy were 1.53 times higher than real use (relying on patients’ data) without a significant correlation. A higher Case-mix Index positively correlated with meropenem-consumption. Conclusion The use of meropenem should become a target of antibiotic stewardship programs in order to restrict its use to certain indications and preserve its outstanding role as second- or third-line antibiotic in this vulnerable population. Irrespective of the metrics used (g or DDD/100 inpatient days), pharmacy dispensing data do not accurately depict real patient-derived data concerning meropenem use in pediatric cancer patients.

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Mutational Consequences of Chemotherapy in Hematopoietic Stem and Progenitor Cells of Pediatric Cancer Patients

Blood ◽

10.1182/blood-2021-148471 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2154-2154

Author(s):

Eline J.M. Bertrums ◽

Axel Rosendahl-Huber ◽

Jurrian de Kanter ◽

Anais C.N. van Leeuwen ◽

Flavia Peci ◽

...

Keyword(s):

Cancer Treatment ◽

Childhood Cancer ◽

Cancer Patients ◽

Pediatric Cancer ◽

Post Treatment ◽

Chemotherapeutic Drugs ◽

Induced Mutations ◽

Hematopoietic Stem ◽

Pediatric Cancer Patients

Abstract Background Childhood cancer survivors are confronted with a variety of chronic health conditions as a consequence of their life saving therapy. Chemotherapy is the cornerstone of childhood cancer treatment, which consists of combinations of various drugs administered over multiple years. Most chemotherapeutic drugs act by fatally damaging the DNA or blocking the replication thereof. Although high-intensity chemotherapy efficiently eradicates tumor cells, the impact on the genomes of normal, that is noncancerous, cells remains unknown. Mutagenicity of cancer treatment on normal hematopoietic cells may contribute to the development of chronic health conditions later in life, such as therapy-related acute myeloid leukemia (t-AML). Here, we characterized the mutational consequences of chemotherapy in the genomes of hematopoietic stem and progenitor cells (HSPCs) of children treated for cancer. Methods This study was approved by the Biobank and Data Access Committee of the Princess Máxima Center for Pediatric Oncology and all samples were obtained via the in-house biobank. We performed whole-genome sequencing (WGS) on multiple single HSPCs from all patients as well as the t-AML if available. In case of t-AML patients, samples were taken before t-AML treatment. Data on mutation accumulation in HSPCs of healthy individuals from 0-63 years of age was previously acquired. To distinguish the effects of different chemotherapies, we developed an in vitro approach using cord blood HSPCs to experimentally define the mutational consequences of individual chemotherapeutic drugs in primary human cells. Results Our cohort consisted of 22 pediatric cancer patients of which we obtained bone marrow aspirates and/or peripheral blood from timepoints pre- and post-treatment for their first cancer. We included 17 t-AML patients with varying first cancer diagnoses and five acute lymphoblastic leukemia (ALL) patients who did not develop t-AML. Patient characteristics and therapy information is described in Table 1. We compared the mutational burden of pre- and post-treatment HSPCs of the childhood cancer patients to those of healthy treatment-naïve individuals. HSPCs at time of first diagnosis of childhood cancer patients displayed a mutation burden similar to HSPCs of healthy individuals. In contrast, post-treatment HSPCs showed a significantly higher increase in mutation number over time than expected by normal ageing. We used mutational signature analysis to pinpoint the causes of this increased mutation burden in post-treatment HSPCs. Surprisingly, in most of these HSPCs the additive mutational effect could be attributed to clock-like processes, active during normal aging. Only few chemotherapeutic drugs showed direct mutagenic effects, such as platinum drugs and thiopurines. Whereas cisplatin-induced mutations could be observed in all cells exposed to this drug, thiopurine-induced mutations were present in a subset of the exposed HSPCs. These differences in thiopurine-induced mutagenesis across multiple exposed HSPCs could even be observed within individual patients. In one patient, the HSPCs containing the thiopurine-signature shared the oncogenic MLL-rearrangement with the t-AML blasts and had shorter telomeres compared to the HSPCs without this signature. This finding indicates that these cells have undergone more cell divisions, suggesting that thiopurine-induced mutagenesis requires DNA replication. We also identified novel therapy-associated mutational signatures. One of these signatures was observed in multiple patients who received a hematopoietic stem cell transplantation, as part of their cancer treatment, after which they displayed a viral reactivation for which they were treated. By WGS of in vitro exposed cord blood HSPCs, we demonstrated that this signature is caused by the antiviral drug ganciclovir, which is commonly used to treat cytomegalovirus infections. The second signature was present in HSPCs of a patient who received a combination of thiotepa and treosulfan. Conclusions Enhanced mutation accumulation after pediatric cancer treatment is caused by both direct and indirect mechanisms. The variance in mutagenic effects of (chemo)therapies on healthy HSPCs may influence the risk an individual patient has to develop t-AML and could, in future, play a role in t-AML risk assessment of pediatric cancer survivors and the development of new treatment regimens. Figure 1 Figure 1. Disclosures Zwaan: Sanofi: Consultancy.

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Management Experience of Peripherally Inserted Central Catheters in Pediatric Oncology Patients: A 15 Year Population-Based Study from Maritimes, Canada

Blood ◽

10.1182/blood.v126.23.2074.2074 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2074-2074 ◽

Cited By ~ 1

Author(s):

Lisa Borretta ◽

Tamara MacDonald ◽

Victoria E. Price ◽

Conrad Fernandez ◽

Mark Bernstein ◽

...

Keyword(s):

High Risk ◽

Cancer Patients ◽

Pediatric Oncology ◽

Pediatric Cancer ◽

Venous Catheter ◽

Central Venous ◽

Oncology Patients ◽

Pediatric Cancer Patients ◽

Management Experience ◽

Picc Line

Abstract OBJECTIVE: Pediatric oncology patients may require a peripherally inserted central catheter (PICC) for their therapy. Data from adult oncology studies indicate a high risk of complications associated with PICC lines. However, little data exists on the management experience of PICCs in pediatric oncology population. The aim of the present study was to document and analyze the management experience and complications with use of PICC lines in pediatric cancer patients at our center. METHODS: All pediatric cancer patients in the three Maritime Provinces of Nova Scotia, New Brunswick and Prince Edward Island are managed at the IWK health center in Halifax, Nova Scotia in a shared care model with regional hospitals. After ethics approval, all pediatric cancer patients managed at the IWK health center from January 1st 2000 through Dec 31st 2014 who received a PICC line were identified for inclusion in the study. The following databases were used to integrate data on the study patients: (i) pediatric oncology hospital database, (ii) Provincial Cancer in Young People database, (iii) Electronic medical records, (iv) Pharmacy database (v) IWK central line database and (v) Hospital Health records. Patients who received PICC line for an indication not related to their oncologic diagnosis or management were excluded from analysis. SPSS version 22 was used for statistical analysis. RESULTS: A total of 125 PICCs were placed in 102 (11.8%) of the 864 oncology patients. Of these 86 patients received 103 PICCs for oncology related indications. Fifteen (17%) patients required >1 PICC line. For the study cohort, gender ratio was 1:1. The median age at cancer diagnosis was 9.8 years (range: 0-19.3 years). Among the 86 patients who received PICC line, 37% had leukemia, 19% had lymphoma, 13% had brain tumor, 4% had sarcoma, and 28% had other diagnoses. For the first PICC, catheter duration ranged from 0 to 175 days (median 18 days) for a total of 2370 catheter days. The site of insertion was through the antecubital (16%), basilic (31%), brachial (2%), cephalic (41%), jugular (8%), saphenous (2%) veins, and was unknown in 2 patients. In 44% of patients the insertion was through the right side, 56% the left side and was unknown in 2 patients. The indication of the first PICC line included: (i) administration of chemotherapy or bone marrow transplant: 34 (39.5%), (ii) failure of a previous central venous catheter: 15 (17.4%) and (iii) supportive care such as antibiotics, parenteral nutrition or intravenous access: 37 (43.0%). The reasons for removal were as follows: (i) Complications: 24 (28.2%), (ii) elective removal: 55 (64.7%) and (iii) other reasons: 6 (7.1%). Among the 55 PICCs removed electively, 12 (14.0%) were removed at the completion of cancer treatment, 23 (26.7%) at the completion of supportive care, and 20 (23.3%) were replaced with another type of central venous catheter. Among the 24 PICCs removed due to complications, 6 were removed due to infection, 15 due to mechanical complications and 3 due to thrombosis. CONCLUSION: We found that PICC lines are frequently used in pediatric cancer patients for a variety of indications. Seventeen percent of the patients needed >1 PICC line. Further, close to 1/3rd of the patients experienced a complication related to their PICC line. Our experience highlights the need to conduct further studies addressing (i) indications of PICC line insertion in pediatric oncology (ii) determination of causes of PICC line related complications to help guide PICC line indications. Identifying patients at high risk of PICC line related complications will aid judicious choice of PICC line in pediatric cancer patients. Disclosures No relevant conflicts of interest to declare.

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Surveillance of Hospital-Acquired Central Line–Associated Bloodstream Infections in Pediatric Hematology-Oncology Patients Lessons Learned, Challenges Ahead

Infection Control and Hospital Epidemiology ◽

10.1086/669513 ◽

2013 ◽

Vol 34 (3) ◽

pp. 315-320 ◽

Cited By ~ 10

Author(s):

Aditya H. Gaur ◽

David G. Bundy ◽

Cuilan Gao ◽

Eric J. Werner ◽

Amy L. Billett ◽

...

Keyword(s):

Cancer Patients ◽

Pediatric Oncology ◽

Pediatric Cancer ◽

Bloodstream Infections ◽

Central Line ◽

Lessons Learned ◽

Viridans Streptococci ◽

Pediatric Hematology ◽

Pediatric Cancer Patients ◽

Hospital Acquired

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients.

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Adverse Events During Supervised Exercise Interventions in Pediatric Oncology—A Nationwide Survey

Frontiers in Pediatrics ◽

10.3389/fped.2021.682496 ◽

2021 ◽

Vol 9 ◽

Author(s):

Gabriele Gauß ◽

Ronja Beller ◽

Joachim Boos ◽

Julia Däggelmann ◽

Hannah Stalf ◽

...

Keyword(s):

Adverse Events ◽

Cancer Treatment ◽

Cancer Patients ◽

Pediatric Cancer ◽

Exercise Intervention ◽

Exercise Programs ◽

Exercise Interventions ◽

Supervised Exercise ◽

Pediatric Cancer Patients ◽

Safety Procedures

Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors.Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2–5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text.Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2–3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential.Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.

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