Multidisciplinary consensus on the criteria for fertility preservation in cancer patients

Infertility is one of the main sequelae of cancer and its treatment in both children and adults of reproductive age. It is, therefore, essential that oncologists and haematologists provide adequate information about the risk of infertility and the possibilities for its preservation before starting treatment. Although many international clinical guidelines address this issue, this document is the first Spanish multidisciplinary guideline in paediatric and adult oncological patients. Experts from the Spanish Society of Medical Oncology, the Spanish Fertility Society, the Spanish Society of Haematology and Haemotherapy, the Spanish Society of Paediatric Haematology and Oncology and the Spanish Society of Radiation Oncology have collaborated to develop a multidisciplinary consensus.

Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments – a cross-sectional study

Background Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing. Methods The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study. Results The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05). Conclusions Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts. Trial registration The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).

Diagnostic Capacity for Invasive Fungal Infections in the Greek Paediatric Haematology-Oncology Units: Report from the Infection Working Group of the Hellenic Society of Paediatric Haematology-Oncology

An audit based on a specific questionnaire was attempted, in order to investigate the mycology laboratory diagnostic capacity for invasive fungal diseases (IFDs) in Greek Paediatric Haematology-Oncology departments/units. The study provided the relevant information for the years 2019 and 2020 and included data from all units, concerning culture-based methods and direct microscopy, phenotypic and molecular identification, sensitivity testing, serology and molecular diagnosis, as well as therapeutic drug monitoring. The target was mostly to reveal the level of laboratory coverage for hospitalised paediatric patients, independently of the possibility of performing the tests in the host hospital, or otherwise to refer the specimens elsewhere. In total, the current study demonstrated that the most important facilities and services regarding the IFD diagnostics for paediatric haematology-oncology patients in Greece are available and relatively easily accessible, with a reasonable turnaround time. Acting as an initial registry for further improvements, the audit can serve as a valuable approach to the actual situation and future perspectives. A national clinical mycology network under the auspices of the relevant scientific societies will probably facilitate collaboration between all the departments (clinical and laboratory) involved in invasive fungal infections and provide an easier approach to any necessary test for any hospitalised patient.

Evaluation of Therapeutic Results of A Series of Moroccan Patients Aged 20 To 60 Years Treated According To The Acute Myeloid Leukaemia 03 Protocol At The Paediatric Haematology Oncology Centre In Casablanca

Acute Myeloblastic Leukaemia (AML) is a malignant haemopathy characterized by infiltration and accumulation in the bone marrow by myeloblastic-type blast cells causing medullary insufficiency. At the global level, the search for improved AML treatment is a long-standing concern.PurposeTo evaluate a new protocol AML MA 2003 its therapeutic results and tolerance in de novo AML patients.MethodsIt was a prospective and descriptive unicentre study carried out from January 2003 to December 2010. It included adults of 20 to 60 years with a diagnosis of de novo AML except a promyelocytic leukemia and without treatment by hydroxyurea.ResultsA total of 962 AMLs were diagnosed, 438 met the inclusion criteria, 48.4% women and 51.6% men with a median age of 39.8 years. 36.1% received hydroxyurea in pre-induction. 96.3% patients were induced, 76 (18%) died. A total of 178 (40.6%) of the 438 evaluable patients reached the maintenance phase. The overall survival of all patients was 32.4% at 5 years. Survival without event was 17.6% for all patients.ConclusionThe results of this single-center study illustrate the difficulty of treating AML patients despite the use of drugs recognised for their effectiveness in appropriate doses.

Multidisciplinary consensus on optimising the detection of NTRK gene alterations in tumours

The recent identification of rearrangements of neurotrophic tyrosine receptor kinase (NTRK) genes and the development of specific fusion protein inhibitors, such as larotrectinib and entrectinib, have revolutionised the diagnostic and clinical management of patients presenting with tumours with these alterations. Tumours that harbour NTRK fusions are found in both adults and children; and they are either rare tumours with common NTRK fusions that may be diagnostic, or more prevalent tumours with rare NTRK fusions. To assess currently available evidence on this matter, three key Spanish medical societies (the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Pathological Anatomy (SEAP), and the Spanish Society of Paediatric Haematology and Oncology (SEHOP) have brought together a group of experts to develop a consensus document that includes guidelines on the diagnostic, clinical, and therapeutic aspects of NTRK-fusion tumours. This document also discusses the challenges related to the routine detection of these genetic alterations in a mostly public Health Care System.

Parental Outlook and Problems Faced during Lockdown in COVID-19 Pandemic: Experience from a Paediatric Haematology-Oncology Unit in a Developing Country-A Questionnaire-Based Survey

Introduction: Corona Virus Disease 2019 (COVID-19) pandemic has resulted in disruption of essential healthcare services. Children with cancer are very vulnerable group and delay in seeking treatment or defaulting scheduled medications adversely affects the outcome. Aim: To obtain insight into barriers and to evaluate concerns, outlook and challenges faced by parents of children suffering with malignancy in accessing the healthcare services during lockdown imposed due to COVID-19 pandemic. Materials and Methods: A questionnaire-based survey was conducted from parents of children newly diagnosed (during lockdown restrictions) with malignancy and previously diagnosed and under treatment at Paediatric Haematology Oncology unit in a Tertiary care centre. The responses were recorded in predesigned proforma during 15 days period after restrictions were relaxed. Results: Fifty-five responses were recorded and analysed. Father was the respondent in most cases. Acute Leukaemia (n=37) and Lymphoma (n=14) patients comprised majority of the patients. Major challenges faced were transportation (98.2%), financial burden (96.4%) and loss of job (65.4%). Fear of contracting COVID-19 infection was a primary barrier in seeking treatment for most respondents. Conclusion: The success and outcome of children with malignancy has been suboptimal in low-income and middle-income countries due to effect of lack of timely access of healthcare services, delayed diagnosis, treatment abandonment, poor compliance and financial constraints. The COVID-19 pandemic and associated setbacks have accentuated these factors and may have long term impact in final outcome for such patients.

LINC-20. INFANT BRAIN TUMOURS IN HONG KONG

OBJECTIVES To review the clinical features, pathology and survivals of infants with brain tumours. METHODS A retrospective review of the clinical findings, pathology, treatment and survival outcome in infants with brain tumours. RESULTS From 1999 to 2018, there were 507 children (&lt;18 years) who were diagnosed to have brain tumours in Hong Kong. The patients were treated in five public hospitals. The clinical data were collected by the Hong Kong Paediatric Haematology and Oncology Study Group, and were cross-checked with the data of the Hong Kong Cancer Registry. In this group of patients, there were 36 infants (birth to 365 days of age) i.e. 7.1% of the whole group. Both benign and malignant brain tumours were included, while non-neoplastic lesions were excluded. On average, there was 1.89 cases per year. The pathology of the tumours were astrocytoma (n= 8), medulloblastoma (n=6), germ cell tumour (n=6), PNET (n=5), ATRT (n=4), choroid plexus tumours (n=3), ependymoma (n=2), craniopharyngioma (n= 1) and ganglioglioma (n= 1). These infants were treated according to their clinical conditions and prognosis, with operation, chemotherapy or both. Radiotherapy was withheld or postponed to older age. Some patients only received palliative care due to the poor neurological status or prognosis. The overall survivals of children younger than 18 years old vs infants were 67.3% (±2.3) vs 50.5%(±9.2) respectively, while the event free survivals were 64.4% (±2.4) and 43.5% (±8.8) at 10-years respectively. CONCLUSION Infants with brain tumours have different pathology and inferior outcome.