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Vlachioti E, Perdikaris P, Megapanou E, Sava F, Matziou V. Assessment of quality of life in adolescent patients with cancer and adolescent survivors of childhood cancer. J SPEC PEDIATR NURS 2016; 21:178-188. [PMID: 27554139 DOI: 10.1111/jspn.12154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/10/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to assess the quality of life (QoL) of adolescents with cancer and survivors of childhood cancer as well as the effect of various demographic factors upon it. DESIGN AND METHODS The sample of the study included 82 adolescents aged 13-20 years who had been diagnosed with any type of cancer. Twenty-six of them received treatment and 56 survivors of childhood cancer had successfully completed their treatment. Data collection lasted from July 2010 to December 2012 in Children's Hematology-Oncology Unit in Athens. For data collection, Minneapolis-Manchester Quality Questionnaire of Life Instrument was used. The assessment of the QoL of adolescents undergoing treatment was performed with three measurements and that of the survivors with one. RESULTS The QoL of adolescent patients did not significantly change during treatment and they showed a satisfactory QoL. Boys scored higher than girls (z = -1.78, p = .04 in psychological function and t = 2.27, p = .02 in body image) as far as QoL in social relations is concerned (z = -2.79, p = .002 in first measurement and z = -2.31, p = .01 in second measurement). Scores on the scale for the QoL of survivors of childhood cancer who completed treatment was 3.91. Survivors showed a higher QoL than the adolescent patients. CONCLUSIONS This research has shown that the studied population scored a sufficient QoL, especially survivors of childhood cancer ones. Moreover, their QoL seemed to be influenced by the stage of treatment, the type of cancer, sex, age, family support, and their level of education.
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Affiliation(s)
- Efrosini Vlachioti
- Service Nursing Education Department, "Agia Sophia" Children's Hospital, Athens, Greece
| | - Pantelis Perdikaris
- Head Nurse, Pediatric Oncology Department, General Children's Hospital "P & A Kyriakou," Lecturer (407/80), Department of Nursing, University of Peloponnese, Athens, Greece.
| | | | - Floria Sava
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Matziou
- Professor of Paediatric Nursing, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Construct validity and reliability of a real-time multidimensional smartphone app to assess pain in children and adolescents with cancer. Pain 2016; 156:2607-2615. [PMID: 26580680 DOI: 10.1097/j.pain.0000000000000385] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the construct validity (including responsiveness), reliability, and feasibility of the Pain Squad multidimensional smartphone-based pain assessment application (app) in children and adolescents with cancer, using 2 descriptive studies with repeated measures. Participants (8-18 years) undergoing cancer treatment were drawn from 4 pediatric cancer centers. In study 1, 92 participants self-reported their level of pain twice daily for 2 weeks using the Pain Squad app to assess app construct validity and reliability. In study 2, 14 participants recorded their level of pain twice a day for 1 week before and 2 weeks after cancer-related surgery to determine app responsiveness. Participants in both studies completed multiple measures to determine the construct validity and feasibility of the Pain Squad app. Correlations between average weekly pain ratings on the Pain Squad app and recalled least, average, and worst weekly pain were moderate to high (0.43-0.68). Correlations with health-related quality of life and pain coping (measured with PedsQL Inventory 4.0, PedsQL Cancer Module, and Pain Coping Questionnaire) were -0.46 to 0.29. The app showed excellent internal consistency (α = 0.96). Pain ratings changed because of surgery with large effect sizes between baseline and the first week postsurgery (>0.85) and small effect sizes between baseline and the second week postsurgery (0.13-0.32). These findings provide evidence of the construct validity, reliability, and feasibility of the Pain Squad app in children and adolescents with cancer. Use of real-time data capture approaches should be considered in future studies of childhood cancer pain. A video accompanying this abstract is available online as Supplemental Digital Content at http://links.lww.com/PAIN/A169.
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Byer L, Kline C, Mueller S. Clinical trials in pediatric neuro-oncology: what is missing and how we can improve. CNS Oncol 2016; 5:233-9. [PMID: 27616346 DOI: 10.2217/cns-2016-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Brain tumors are the most common solid tumor in childhood, yet outcomes vary dramatically. High-grade gliomas have dismal outcomes with poor survival. By contrast, low-grade gliomas, have high survival rates, but children suffer from morbidity of tumor burden and therapy-associated side effects. In this article, we discuss how current trial designs often miss the opportunity to include end points beyond tumor response and thus fail to offer complete assessments of therapeutic approaches. Quality of life, neurocognitive function and neurofunctional deficits need to be considered when assessing overall success of a therapy. Herein, we identify specific end points that should be included in the interpretation of clinical trial results and accordingly, offer a more comprehensive approach to treatment decision-making.
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Affiliation(s)
- Lennox Byer
- School of Medicine, University of California, San Francisco (UCSF), 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - Cassie Kline
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Sabine Mueller
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA.,Department of Neurology & Neurosurgery San Francisco, University of California, 625 Nelson Rising Lane, 4th Floor, San Francisco, CA 94158, USA
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Chevignard M, Câmara-Costa H, Doz F, Dellatolas G. Core deficits and quality of survival after childhood medulloblastoma: a review. Neurooncol Pract 2016; 4:82-97. [PMID: 31385962 DOI: 10.1093/nop/npw013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Medulloblastoma is the most common malignant central nervous system tumor in children. Treatment most often includes surgical resection, craniospinal irradiation, and adjuvant chemotherapy. Although survival has improved dramatically, the tumor and its treatments have devastating long-term side effects that negatively impact quality of survival (QoS). The objective was to review the literature on QoS following childhood medulloblastoma. Methods This narrative review is based on a Medline database search and examination of the reference lists of papers selected. Results Frequent problems after medulloblastoma treatment include medical complications, such as long-term neurological and sensory (hearing loss) impairments; endocrine deficits, including growth problems; and secondary tumors. Neurocognitive impairment is repeatedly reported, with decreasing cognitive performances over time. Although all cognitive domains may be affected, low processing speed, attention difficulties, and working memory difficulties are described as the core cognitive deficits resulting from both cerebellar damage and the negative effect of radiation on white matter development. Long-term psychosocial limitations include low academic achievement, unemployment, and poor community integration with social isolation. Important negative prognostic factors include young age at diagnosis, conventional craniospinal radiotherapy, presence of postoperative cerebellar mutism, and perioperative complications. The influence of environmental factors, such as family background and interventions, remains understudied. Conclusion Future studies should focus on the respective impact of radiation, cerebellar damage, genomic and molecular subgroup parameters, and environmental factors on cognitive and psychosocial outcomes. Long-term (probably lifelong) follow-up into adulthood is required in order to monitor development and implement timely, suitable, multi-disciplinary rehabilitation interventions and special education or support when necessary.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Hugo Câmara-Costa
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - François Doz
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Georges Dellatolas
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
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Eaton Russell C, Bouffet E, Beaton J, Lollis S. Balancing grief and survival: Experiences of children with brain tumors and their parents. J Psychosoc Oncol 2016; 34:376-99. [DOI: 10.1080/07347332.2016.1212448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vlachioti E, Matziou V, Perdikaris P, Mitsiou M, Stylianou C, Tsoumakas K, Moschovi M. Assessment of quality of life of children and adolescents with cancer during their treatment. Jpn J Clin Oncol 2016; 46:453-461. [PMID: 26889049 DOI: 10.1093/jjco/hyw009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/12/2016] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the quality of life of children and adolescents with any type of cancer in all phases of their treatment. METHODS Fifty-six newly diagnosed patients diagnosed with malignancy and hospitalized in a Pediatric Hematology-Oncology Unit in Athens were included in the study. Minneapolis-Manchester Quality of Life Instrument was used for data collection from July 2010 to December 2012. The assessment of children and adolescents' quality of life who were under treatment was performed in three different stages of treatment. RESULTS The results of the study showed that the quality of life of children and adolescents with cancer did not change notably during their treatment (F = 0.16, P = 0.86 and F = 0.03, P = 0.97). For the first measurement, at the beginning of the therapy, the score on the scale for quality of life for children and adolescents was 3.44 and 3.88, respectively, in the middle of the treatment 3.36 and 3.89, respectively, and 3.43 and 3.89, respectively, when therapy was completed. Children and adolescents diagnosed with hematologic cancer stated higher quality of life scores (z = -1.61, P = 0.05 and t = 2.64, P = 0.007). Moreover, teenage patients (F = 13.22, P = 0.001) and male patients (t = 2.31, P = 0.02 and t = 2.27, P = 0.02) expressed better quality-of-life scores. CONCLUSION According to the results, children and adolescents with any kind of cancer have better quality-of-life scores at the end of their treatment, and when they are supported by their family.
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Affiliation(s)
- Efrosini Vlachioti
- In Service Nursing Education Department, "Agia Sophia" Children's Hospital, Athens
| | - Vasiliki Matziou
- Department of Nursing, National and Kapodistrian University of Athens, Athens
| | | | - Maria Mitsiou
- HR Management Department, Hellenic MoD of Athens, Athens
| | - Christos Stylianou
- Department of Nursing, Technological Educational Institute of Athens, Athens
| | | | - Maria Moschovi
- Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Brand SR, Chordas C, Liptak C, Manley P, Recklitis C. Screening for fatigue in adolescent and young adult pediatric brain tumor survivors: accuracy of a single-item screening measure. Support Care Cancer 2016; 24:3581-7. [DOI: 10.1007/s00520-016-3150-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/07/2016] [Indexed: 01/18/2023]
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Netson KL, Ashford JM, Skinner T, Carty L, Wu S, Merchant TE, Conklin HM. Executive dysfunction is associated with poorer health-related quality of life in pediatric brain tumor survivors. J Neurooncol 2016; 128:313-21. [PMID: 27033060 DOI: 10.1007/s11060-016-2113-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
Abstract
Children with a brain tumor (BT) are at risk for a number of physical and cognitive problems that may lower their health-related quality of life (HRQoL). Executive functioning (EF) and intellectual ability are hypothesized to associate with HRQoL and deficits in these areas may be amenable to interventions. This study aimed to investigate intellectual function, EF, and HRQoL following conformal radiation therapy (CRT) for pediatric BT. Forty-five BT survivors (age 12.68 ± 2.56) treated with CRT participated. Thirty-six siblings of BT patients (age 12.36 ± 2.13) and 33 survivors of non-CNS solid tumors (ST; age 12.18 ± 2.88) were comparison groups. IQ estimate (Wechsler Abbreviated Scale of Intelligence; WASI), EF ratings (Behavior Rating Inventory of Executive Function; BRIEF), and HRQoL ratings (KINDL-R) were obtained. BT survivors reported lower overall HRQoL than ST survivors (p = .012). Parents reported lower overall HRQoL for BT survivors than siblings (p = .014). Parent-report on individual areas of HRQoL was higher than self-report for most subscales. IQ and HRQoL ratings were not related (Parent r = .17, p = .27; Child r = .11, p = .49). EF ratings correlated with Parent (r = -.15 to -.73) but not Child HRQoL ratings. Children with BT experienced poorer HRQoL than controls. Children's HRQoL was consistently rated higher by parent- than self-report across all domains. HRQoL was associated with EF, but not with IQ. These findings identify interventions targeting EF (e.g., cognitive rehabilitation, medication) as a possible avenue for improving HRQoL in childhood BT survivors.
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Affiliation(s)
- Kelli L Netson
- Department of Psychiatry & Behavioral Sciences, KU School of Medicine-Wichita, Wichita, KS, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the literature in the area of social competence in pediatric brain tumor survivors published in the last year. RECENT FINDINGS Research published over the past year examining the social competence of pediatric brain tumor survivors has seen the consistent application of a comprehensive conceptual framework that pertains specifically to children with brain disorders. Subsequent to the application of a comprehensive conceptual framework, more sophisticated research approaches have begun to advance our understanding of deficits among this population. Specifically, operationalization of social competence is evolving. SUMMARY Continued application of a conceptual framework and investigation into the components that comprise the framework will enhance the depth of our understanding of social competence deficits among this population. Research must continue to use innovative approaches to measuring social competence. Considerable gaps still exist with respect to identifying risk and resilience factors for social competence deficits.
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de Ruiter MA, Schouten-van Meeteren AYN, van Vuurden DG, Maurice-Stam H, Gidding C, Beek LR, Granzen B, Oosterlaan J, Grootenhuis MA. Psychosocial profile of pediatric brain tumor survivors with neurocognitive complaints. Qual Life Res 2016; 25:435-446. [PMID: 26289022 PMCID: PMC4722086 DOI: 10.1007/s11136-015-1091-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 10/25/2022]
Abstract
PURPOSE With more children surviving a brain tumor, neurocognitive consequences of the tumor and its treatment become apparent, which could affect psychosocial functioning. The present study therefore aimed to assess psychosocial functioning of pediatric brain tumor survivors (PBTS) in detail. METHODS Psychosocial functioning of PBTS (8-18 years) with parent-reported neurocognitive complaints was compared to normative data on health-related quality of life (HRQOL), self-esteem, psychosocial adjustment, and executive functioning (one-sample t tests) and to a sibling control group on fatigue (independent-samples t test). Self-, parent-, and teacher-report questionnaires were included, where appropriate, providing complementary information. RESULTS Eighty-two PBTS (mean age 13.4 years, SD 3.2, 49 % males) and 43 healthy siblings (mean age 14.3, SD 2.4, 40 % males) were included. As compared to the normative population, PBTS themselves reported decreased physical, psychological, and generic HRQOL (d = 0.39-0.62, p < 0.008). Compared to siblings, increased fatigue-related concentration problems (d = 0.57, p < 0.01) were reported, although self-reported self-esteem and psychosocial adjustment seemed not to be affected. Parents of PBTS reported more psychosocial (d = 0.81, p < 0.000) and executive problems (d = 0.35-0.43, p < 0.016) in their child than parents of children in the normative population. Teachers indicated more psychosocial adjustment problems for female PBTS aged 8-11 years than for the female normative population (d = 0.69, p < 0.025), but they reported no more executive problems. CONCLUSIONS PBTS with parent-reported neurocognitive complaints showed increased psychosocial problems, as reported by PBTS, parents, and teachers. IMPLICATIONS FOR CANCER SURVIVORS Systematic screening of psychosocial functioning is necessary so that tailored support from professionals can be offered to PBTS with neurocognitive complaints.
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Affiliation(s)
- Marieke Anna de Ruiter
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | | | | | - Heleen Maurice-Stam
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
| | - Corrie Gidding
- />Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Rachel Beek
- />Department of Medical Psychology, Wilhelmina Children’s Hospital UMC, Utrecht, The Netherlands
| | - Bernd Granzen
- />Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jaap Oosterlaan
- />Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martha Alexandra Grootenhuis
- />Pediatric Psychosocial Department, Emma Children’s Hospital AMC, Meibergdreef 9, Room A3-241, 1105 AZ Amsterdam, The Netherlands
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Demers C, Gélinas I, Carret AS. Activities of Daily Living in Survivors of Childhood Brain Tumor. Am J Occup Ther 2015; 70:7001220040p1-8. [DOI: 10.5014/ajot.2016.014993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
OBJECTIVE. This cross-sectional, descriptive study evaluated the performance in activities of daily living (ADLs) of youth and young adult survivors of childhood brain tumor (BT) and explored associations with health-related quality of life (HRQoL).
METHOD. Thirty-six participants were examined using the Assessment of Motor and Process Skills to evaluate their quality of ADL task performance and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF–12) to evaluate HRQoL.
RESULTS. Participants had significantly lower performance in ADLs compared with age norms (p < .05), and their functional level was positively associated with the SF–12 Physical (r 2 = .5) and Mental (r 2 = .3) scales.
CONCLUSION. Participants had significant limitations in both motor and process skills, which affected their performance in ADLs. Study results emphasize the importance of long-term follow-up and rehabilitation services aimed at improving the functional level and HRQoL of BT survivors.
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Affiliation(s)
- Catherine Demers
- Catherine Demers, MSc, is Graduate Student, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, and Occupational Therapist, Division of Haematology-Oncology, Sainte-Justine University Hospital Centre, Montreal, Quebec;
| | - Isabelle Gélinas
- Isabelle Gélinas, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, and Researcher, Montreal Center for Interdisciplinary Research in Rehabilitation–Jewish Rehabilitation Hospital Research Site, Laval, Quebec
| | - Anne-Sophie Carret
- Anne-Sophie Carret, MD, is Pediatric Haematologist–Oncologist, Division of Haematology–Oncology, Sainte-Justine University Hospital Centre, Montreal, Quebec
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Jibb L, Nathan P, Stevens B, Seto E, Cafazzo J, Stephens N, Yohannes L, Stinson J. Psychological and Physical Interventions for
the Management of Cancer-Related Pain in Pediatric and Young Adult Patients: An Integrative Review. Oncol Nurs Forum 2015; 42:E339-57. [DOI: 10.1188/15.onf.e339-e357] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pruitt R, DaSilva NS, Cappellano A, Belessiotis C, Diez B, Gardner S, Allen J, Weinblatt M, Gottardo N, Dhall G, Finlay JL. Relapse and outcome patterns of patients with central nervous system mixed malignant germ cell tumors treated without irradiation: Findings from the third international central nervous system (CNS) germ cell tumor (GCT) study. Pediatr Blood Cancer 2015; 62:1920-4. [PMID: 26054044 DOI: 10.1002/pbc.25606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/28/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate patterns of relapse and outcome in patients newly diagnosed with CNS Mixed Malignant GCT (MMGCT) treated initially with chemotherapy alone. METHODS A retrospective chart review was conducted using all 25 patients enrolled on the International CNS GCT Study III, with at least 7 years follow-up for all surviving patients. RESULTS Thirteen patients at diagnosis had CNS MMGCT by pathology and tumor markers (n = 11), or tumor markers alone (n = 2). Twelve received chemotherapy alone, one additionally receiving focal irradiation prior to relapse. Six patients (46%) relapsed (mean of 30.5 months; range 6-59 months), two beyond and four within the primary site alone. Three patients relapsed early (6-23 months from diagnosis), two with alpha-fetoprotein elevations and one without tumor markers assessed; all three expired of progressive disease at 2-10 months following initial relapse. Three patients relapsed late (37-59 months) without AFP elevations, one with pathologically pure germinoma, two with mild beta-human chorionic gonadotropin elevations; these patients survive disease-free at 86+, 94+, and 126+ months following additional treatment. CONCLUSIONS Patients with CNS MMGCT relapsing following chemotherapy alone display two distinct patterns of recurrence and outcome; patients relapsing early possess MMGCT elements and have a dismal prognosis, while patients relapsing late do so with pure germinomatous elements and have an excellent outcome. Current cooperative group studies utilizing more localized fields of irradiation should monitor closely the patterns of relapse and outcome; late recurrences with germinomatous elements might be avoided by initial use of low-dose larger field irradiation in select patients.
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Affiliation(s)
- Rachel Pruitt
- Children's Center for Cancer & Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, New York
| | - Nasjla S DaSilva
- Neuro-oncology Program, GRAACC Institute of Pediatric Oncology, Sao Paolo, Brazil
| | - Andrea Cappellano
- Neuro-oncology Program, GRAACC Institute of Pediatric Oncology, Sao Paolo, Brazil
| | - Clara Belessiotis
- Children's Center for Cancer & Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,North Middlesex University Hospital, London, UK
| | - Blanca Diez
- Neuro-Oncology Program, Fundacion para la Lucha contra Enfermedades Neurologicas de la Infancia, Buenos Aires, Argentina
| | | | - Jeffrey Allen
- New York University Medical Center, New York, New York
| | - Mark Weinblatt
- Pediatric Hematology/Oncology, Winthrop-University Hospital, New York, New York
| | | | - Girish Dhall
- Children's Center for Cancer & Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan L Finlay
- Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio
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Gunn ME, Mört S, Arola M, Taskinen M, Riikonen P, Möttönen M, Lähteenmäki PM. Quality of life and late‐effects among childhood brain tumor survivors: a mixed method analysis. Psychooncology 2015; 25:677-83. [DOI: 10.1002/pon.3995] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 12/15/2022]
Affiliation(s)
| | - Susanna Mört
- Department of PediatricsTurku University Hospital Turku Finland
- Turku University of Applied Sciences Turku Finland
| | - Mikko Arola
- Department of PediatricsTampere University Hospital Tampere Finland
| | - Mervi Taskinen
- Children's HospitalHelsinki University Central Hospital Helsinki Finland
| | - Pekka Riikonen
- Department of PediatricsKuopio University Hospital Kuopio Finland
| | - Merja Möttönen
- Department of PediatricsOulu University Hospital Oulu Finland
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Lucas JT, Ladra MM, MacDonald SM, Busse PM, Friedmann AM, Ebb DH, Marcus KJ, Tarbell NJ, Yock TI. Proton therapy for pediatric and adolescent esthesioneuroblastoma. Pediatr Blood Cancer 2015; 62:1523-8. [PMID: 25820437 PMCID: PMC9124545 DOI: 10.1002/pbc.25494] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (EN) of the paranasal sinus comprises less than 3% of tumors of in pediatric and adolescent patients [1]. The collective adult literature indicates a critical role for radiotherapy in attaining cure [2], yet pediatric outcome data is limited. Radiation in pediatric patients with EN can cause significant morbidity due to the proximity of critical structures. Proton radiotherapy offers a potential dosimetric benefit that may improve long-term survival and toxicity outcomes in the pediatric population [3]. METHODS We retrospectively identified eight patients treated for EN with proton radiotherapy from 2000-2013. Times to event clinical endpoints are summarized using the Kaplan-Meier methods and are from the date of radiotherapy completion. Toxicities are reviewed and graded according to CTCAE v. 4.0. RESULTS Median follow up was 4.6 years for survivors (range 0.8-9.4 years). The 4 year overall survival was 87.5%. Four of eight patients (one elective) had comprehensive neck radiotherapy. No local or regional failures were observed. Two patients failed distantly with diffuse leptomeningeal disease and intraparenchymal brain metastases, at 0.6 and 1.3 months respectively. Four patients developed radiation related late toxicities including endocrine dysfunction, two cases of grade 2 retinopathy and one case of grade 3 optic neuropathy. CONCLUSIONS In a limited cohort, proton radiotherapy appears to provide excellent locoregional disease control even in those patients with locally advanced disease and intracranial extension. Distant failure determined overall survival in our cohort. Toxicities were acceptable given disease location and extent.
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Affiliation(s)
- John T. Lucas
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Paul M. Busse
- Department of Radiation Oncology, Boston, Massachusetts
| | | | - David H. Ebb
- Pediatrics at Massachusetts General Hospital, Boston, Massachusetts
| | - Karen J. Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Torunn I Yock
- Department of Radiation Oncology, Boston, Massachusetts,Corresponding author: Torunn I. Yock, MD MCH, Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Proton Center, Room 110, Boston, MA 02114, PH: 617 726-6876, FAX: 617-724-9532,
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Baron Nelson M, Compton P, Macey PM, Patel SK, Jacob E, O'Neil S, Ogren J, Finlay JL, Harper RM. Diffusion Tensor Imaging and Neurobehavioral Outcome in Children With Brain Tumors Treated With Chemotherapy. J Pediatr Oncol Nurs 2015. [PMID: 26219302 DOI: 10.1177/1043454215590104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Childhood brain tumor survivors (CBTS) often experience treatment-related neurocognitive deficits affecting quality of life (QOL), but systemic chemotherapy contributions to outcomes are unclear. Our objective was to relate brain tissue changes to neurocognitive and QOL effects after systemic myeloablative chemotherapy with autologous hematopoietic progenitor cell rescue in CBTS. PROCEDURE Regional brain volumes and diffusion tensor indices were correlated with neurocognitive, behavioral, and QOL measures, and compared between 8 CBTS (mean age 8.5 years, mean age at diagnosis 32 months), and 9 healthy controls (mean 9.3 years). RESULTS Overall QOL, school, and psychosocial functioning were significantly lower in patients (P < .05). Most patients scored within normative ranges on neurocognitive and behavioral assessment. Elevated mean diffusivity and decreased fractional anisotropy, indicating gray and white matter injury, respectively, appeared in memory and executive functioning areas. Low scores on Inhibition on the Neuropsychological Assessment-II were correlated with elevated mean diffusivity in prefrontal cortex. CONCLUSIONS Brain injury, decreased QOL, and to a lesser extent, executive functioning deficits appear in CBTS treated with myeloablative chemotherapy and autologous hematopoietic progenitor cell rescue. Early cognitive and psychological assessment and intervention are warranted in this population.
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Affiliation(s)
- Mary Baron Nelson
- Children's Hospital Los Angeles, Los Angeles, CA, USA UCLA School of Nursing, Los Angeles, CA, USA
| | - Peggy Compton
- UCLA School of Nursing, Los Angeles, CA, USA Georgetown University, Washington, DC, USA
| | - Paul M Macey
- UCLA School of Nursing, Los Angeles, CA, USA David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - Sharon O'Neil
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Ronald M Harper
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Rieber JG, Kessel KA, Witt O, Behnisch W, Kulozik AE, Debus J, Combs SE. Treatment tolerance of particle therapy in pediatric patients. Acta Oncol 2015; 54:1049-55. [PMID: 25615893 DOI: 10.3109/0284186x.2014.998273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Curative treatment of pediatric cancer not only focuses on long-term survival, but also on reducing treatment-related side effects. Advantages of particle therapy are mainly due to their physical ability of significantly reducing integral dose. METHODS Between January 2009 and December 2012, we treated 83 pediatric patients (aged 21 and younger) at the Heidelberg Ion Therapy Center at University Hospital of Heidelberg (HIT). In total 56 patients (67%) received proton irradiation, while 25 (30%) patients were treated with carbon ions (C12). Two patients received both treatments (3%). Treatment toxicity was analyzed retrospectively and documented according to the CTCAE/RTOG classification. In a second step, treatment toxicity from ion therapy was analyzed in comparison to treatment toxicity during photon irradiation of a comparable historical group of 19 pediatric patients. RESULTS In all patients, particle therapy was tolerated well (median follow-up time 3.7 months), children (20 patients) with at least two follow-up visits showed a median follow-up time of 10.2 months. During the first two months patients mainly suffered from radiogenic skin reaction (63%), mucositis (30%), headache and dizziness (35%) as well as nausea and vomiting (13%). Severe toxicity reaction (grade II-IV) was only seen in patients who had intensive simultaneous chemotherapy or who had undergone several operations in the irradiated area before radiotherapy (18%). Treatment toxicity during ion therapy was comparable to treatment toxicity from photon irradiation of a historical group. CONCLUSIONS In comparison to conventional therapy, patients with particle therapy do not suffer from increased acute treatment-related toxicity during the first months. More experience with particle therapy will be needed during the next years to help to thoroughly evaluate the high potential of ion therapy.
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Affiliation(s)
- Juliane G. Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Kerstin A. Kessel
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Olaf Witt
- CCU Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Behnisch
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas E. Kulozik
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Heidelberg Institute of Radiation Oncology, Germany
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Health-related Quality of Life in Long-term Survivors of Brain Tumors in Childhood and Adolescence: A Serial Study Spanning a Decade. J Pediatr Hematol Oncol 2015; 37:362-7. [PMID: 26018809 DOI: 10.1097/mph.0000000000000365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Survivors of brain tumors in childhood experience adverse sequelae that are greater in prevalence and severity than those encountered by survivors of all other forms of cancer in early life, reflected in a burden of morbidity by instruments measuring health-related quality of life (HRQL). However, there are few studies of the change in HRQL over time in such populations. Patients who were above 5 years of age, at least 2 years from completion of therapy, and able to communicate in English were eligible for study of HRQL by the Health Utilities Index HUI2 and HUI3 at study entry, and again 5 and 10 years later. An initial cohort of 40 patients was reduced to 37 and 25 at the second and third time points, respectively, although only 1 death occurred during the study. HRQL showed a progressive decline over the decade, reaching conventional levels of clinical significance for the sizes of the changes. Median scores for HUI2 were 0.93, 0.90, and 0.88; and for HUI3 were 0.88, 0.85, and 0.77 at baseline, 5, and 10 years, respectively. The serial decline in HRQL demands further examination and an exploration of potential targets for therapeutic intervention.
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Daubenbüchel AMM, Hoffmann A, Gebhardt U, Warmuth-Metz M, Sterkenburg AS, Müller HL. Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke's pouch: impact on long-term prognosis. Eur J Endocrinol 2015; 172:561-9. [PMID: 25650403 DOI: 10.1530/eje-14-1029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pediatric patients with sellar masses such as craniopharyngioma (CP) or cyst of Rathke's pouch (CRP) frequently suffer disease- and treatment-related sequelae. We analyzed the impact and prognostic relevance of initial hydrocephalus (HY) and hypothalamic involvement (HI) on long-term survival and functional capacity (FC) in children with CP or CRP. SUBJECTS AND METHODS Using retrospective analysis of patient records, presence of initial HY or HI was assessed in 177 pediatric patients (163 CP and 14 CRP). Twenty-year overall survival (OS) and progression-free survival (PFS), FC, and BMI were analyzed with regard to initial HY, degree of resection, or HI. RESULTS Of the 177 patients, 105 patients (103/163 CP and 2/14 CRP) presented with initial HY and 96 presented with HI. HY at diagnosis was associated (P=0.000) with papilledema, neurological deficits, and higher BMI at diagnosis and during follow-up. OS, PFS, and FC were not affected by HY at initial diagnosis. HI at diagnosis (96/177) had major negative impact on long-term prognosis. Sellar masses with HI were associated with lower OS (0.84±0.04; P=0.021), lower FC (P=0.003), and higher BMI at diagnosis and last follow-up (P=0.000) when compared with sellar masses without HI (OS: 0.94±0.05). PFS was not affected by HI or degree of resection. CONCLUSIONS Initial HY has no impact on outcome in patients with sellar masses. OS and FC are impaired in survivors presenting with initial HI. PFS is not affected by HY, HI, or degree of resection. Accordingly, gross-total resection is not recommended in sellar masses with initial HI to prevent further hypothalamic damage.
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Affiliation(s)
- A M M Daubenbüchel
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
| | - A Hoffmann
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
| | - U Gebhardt
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
| | - M Warmuth-Metz
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
| | - A S Sterkenburg
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
| | - H L Müller
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Strasse 10, 26133 Oldenburg, GermanyUniversity of GroningenGroningen, The NetherlandsDepartment of NeuroradiologyUniversity Hospital, Würzburg, Germany
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Macartney G, Harrison MB, VanDenKerkhof E, Stacey D, McCarthy P. Quality of life and symptoms in pediatric brain tumor survivors: a systematic review. J Pediatr Oncol Nurs 2015; 31:65-77. [PMID: 24608699 DOI: 10.1177/1043454213520191] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the quality of life of children and youth under the age of 20 who have completed treatment for a pediatric brain tumor. This systematic review was conducted to (a) describe the health-related quality of life (HRQL) outcomes in pediatric brain tumor survivors, (b) identify instruments used to measure HRQL, and (c) determine the relationship between symptoms and HRQL. Using a systematic search and review methodology, databases searched included CINAHL, Medline, Embase, and PsycInfo. No date restrictions were used. Search results elicited 485 articles, of which16 met the inclusion criteria. Compared with their healthy peers, pediatric brain tumor survivors did worse on most measures of physical, psychosocial, social, and cognitive domains of HRQL. Compared with other cancer patients, survivors scored themselves significantly lower on the Pediatric Quality of Life Inventory (PedsQL) social functioning scale, and parents of brain tumor survivors reported lower PedsQL social and total functioning scores for their children. Other variables that were associated with decreased HRQL were degree of hypothalamic tumor involvement, osteopenia, need for special education, older age at diagnosis, greater than 1 year since treatment, and radiation treatment. In these studies, pediatric brain tumor survivors fared worse compared with other cancer survivors or healthy peers on several HRQL domains. Only 3 studies explored the relationship between symptoms, including pain or fatigue, and HRQL in pediatric brain tumor survivors. The relationship between symptoms and HRQL was not well elucidated. More research is needed to explore the multidimensional symptom experience and HRQL outcomes in pediatric brain tumor survivors.
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Affiliation(s)
- Gail Macartney
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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71
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Health-related quality of life in young survivors of childhood cancer. Qual Life Res 2015; 24:2151-61. [DOI: 10.1007/s11136-015-0961-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
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Abdel-Baki MS, Hanzlik E, Kieran MW. Multidisciplinary pediatric brain tumor clinics: the key to successful treatment? CNS Oncol 2015; 4:147-55. [PMID: 25923018 PMCID: PMC6088326 DOI: 10.2217/cns.15.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Tumors of the CNS are the most common solid tumors diagnosed in childhood. As technology and research in cancer care are advancing, more specialties are involved in the diagnosis, treatment and follow-up of children with brain tumors. Multidisciplinary clinics have become the standard of care for cancer care throughout the USA, and specialty clinics focused on particular cancer types are gaining attention in improving the patient outcomes and satisfaction. We will discuss the role of multidisciplinary clinics, in an attempt to create preliminary guidelines on establishing and maintaining a multidisciplinary brain tumor clinic in order to optimize the care of the patients and their families.
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Affiliation(s)
- Mohamed S Abdel-Baki
- Cardinal Glennon Children's Medical Center, St Louis University School of Medicine, 1465 S. Grand Boulevard, St Louis, MO 63104–1095, USA
| | - Emily Hanzlik
- Cardinal Glennon Children's Medical Center, St Louis University School of Medicine, 1465 S. Grand Boulevard, St Louis, MO 63104–1095, USA
| | - Mark W Kieran
- Dana-Farber Cancer Institute & Boston Children's Hospital, Harvard Medical School, 450 Brookline Avenue, Rm D-3154, Boston, MA 02215, USA
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Nwachukwu CR, Youland RS, Chioreso C, Wetjen N, NageswaraRao A, Keating G, Laack NN. Health related quality of life (HRQOL) in long-term survivors of pediatric low grade gliomas (LGGs). J Neurooncol 2014; 121:599-607. [PMID: 25467557 DOI: 10.1007/s11060-014-1673-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/23/2014] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to assess the health-related quality of life (HRQOL) and the impact of treatment on HRQOL in long-term survivors of pediatric low-grade gliomas (LGGs) using an adult instrument. QOL of 121 patients with a diagnosis of LGG from the Mayo Clinic were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30 for cancer in general) and (EORTC QLQ-BN20 specific for brain tumors). Median follow-up was 21.9 years for the participants. Median age at diagnosis was 11.8 years and at assessment was 33 years. Mean (standard deviation) global QOL score for the study was 78 (18) and 76.4 (22.8) in a reference population of healthy adults. Using QLQ-C30, radiation treated patients compared to non-radiation patients reported lower physical functioning (p = 0.002), role functioning (p = 0.004), and more constipation problems (p < 0.001). Patients with tumor recurrence reported lower role functioning (p = 0.016), social functioning (p = 0.040), and more financial problems (p = 0.029) compared to their counterparts. Using QLQ-BN20, patients with deep tumors compared to cortical tumors reported more bladder control problems (p = 0.016). Radiation treated patients also reported more bladder control problems (p < 0.001) compared to their counterparts. In the multivariable analysis, radiation therapy remained an independent predictor of physical and role functioning as well as symptoms related to brain tumors like visual disorders and motor dysfunction. Global QOL of long-term survivors of pediatric LGGs is similar to that of a reference population of healthy adults. The following tumor and treatment related factors were most consistently associated with poorer QOL: CNS tumor location, post-operative radiation, and tumor recurrence. Future studies are necessary to identify strategies to improve QOL in this subgroup of patients.
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Affiliation(s)
- Chika R Nwachukwu
- Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Impact of Late Effects on Health-Related Quality of Life in Survivors of Pediatric Brain Tumors. Cancer Nurs 2014; 37:E1-E14. [DOI: 10.1097/ncc.0000000000000110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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75
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Yock TI, Bhat S, Szymonifka J, Yeap BY, Delahaye J, Donaldson SS, MacDonald SM, Pulsifer MB, Hill KS, DeLaney TF, Ebb D, Huang M, Tarbell NJ, Fisher PG, Kuhlthau KA. Quality of life outcomes in proton and photon treated pediatric brain tumor survivors. Radiother Oncol 2014; 113:89-94. [PMID: 25304720 DOI: 10.1016/j.radonc.2014.08.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/11/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Radiotherapy can impair Health Related Quality of Life (HRQoL) in survivors of childhood brain tumors, but proton radiotherapy (PRT) may mitigate this effect. This study compares HRQoL in PRT and photon (XRT) pediatric brain tumor survivors. METHODS HRQoL data were prospectively collected on PRT-treated patients aged 2-18 treated at Massachusetts General Hospital (MGH). Cross-sectional PedsQL data from XRT treated Lucile Packard Children's Hospital (LPCH) patients provided the comparison data. RESULTS Parent proxy HRQoL scores were reported at 3 years for the PRT cohort (PRT-C) and 2.9 years (median) for the XRT cohort (XRT-C). The total core HRQoL score for the PRT-C, XRT-C, and normative population differed from one another and was 75.9, 65.4 and 80.9 respectively (p=0.002; p=0.024; p<0.001). The PRT-C scored 10.3 and 10.5 points higher than the XRT-C in the physical (PhSD) and psychosocial (PsSD) summary domains of the total core score (TCS, p=0.015; p=0.001). The PRT-C showed no difference in PhSD compared with the normative population, but scored 6.1 points less in the PsSD (p=0.003). Compared to healthy controls, the XRT-C scored lower in all domains (p<0.001). CONCLUSIONS The HRQoL of pediatric brain tumor survivors treated with PRT compare favorably to those treated with XRT and similar to healthy controls in the PhSD.
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Affiliation(s)
- Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Proton Center, Boston, United States.
| | - Sundeep Bhat
- Department of Emergency Medicine, Kaiser Permanente, Santa Clara Medical Center, United States
| | - Jackie Szymonifka
- Biostatistics Unit, Department of Medicine, Massachusetts General Hospital, Boston, United States
| | - Beow Y Yeap
- Biostatistics Unit, Department of Medicine, Massachusetts General Hospital, Boston, United States
| | - Jennifer Delahaye
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, United States
| | - Sarah S Donaldson
- Stanford Cancer Center, Department of Radiation Oncology, United States
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Proton Center, Boston, United States
| | - Margaret B Pulsifer
- Department of Psychiatry, Massachusetts General Hospital, Boston, United States
| | - Kristen S Hill
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, United States
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Proton Center, Boston, United States
| | - David Ebb
- Department of Pediatric Oncology, Massachusetts General Hospital, Proton Center, Boston, United States
| | - Mary Huang
- Department of Pediatric Oncology, Massachusetts General Hospital, Proton Center, Boston, United States
| | - Nancy J Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Proton Center, Boston, United States
| | - Paul Graham Fisher
- Stanford University Medical Center, Department of Neurology, Palo Alto, United States
| | - Karen A Kuhlthau
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Department of Pediatrics, Harvard Medical School, Boston, United States
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Salley CG, Hewitt LL, Patenaude AF, Vasey MW, Yeates KO, Gerhardt CA, Vannatta K. Temperament and social behavior in pediatric brain tumor survivors and comparison peers. J Pediatr Psychol 2014; 40:297-308. [PMID: 25287068 DOI: 10.1093/jpepsy/jsu083] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the role of temperament (i.e., surgency/positive affect, negative affect, and effortful control) in the social behavior of pediatric brain tumor survivors and comparison classmates. METHODS Parent-, peer-, and self-report data were collected for 75 children after treatment for a brain tumor, and 67 comparison classmates. Tests of mediation and moderated mediation were run to examine whether effortful control accounted for group differences in social behavior and whether this indirect effect was moderated by surgency/positive or negative affectivity. RESULTS Peers described survivors as lower in Leadership-popularity and higher in Sensitivity-isolation and victimization than comparison classmates. Parent and self-report of surgency/positive affect revealed survivors were lower on this dimension. Survivors were rated by parents as demonstrating less effortful control. Effortful control did not consistently account for group differences in social behavior. There was limited evidence of moderated mediation. CONCLUSIONS Research on the implications of potential changes in temperament following treatment is warranted.
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Affiliation(s)
- Christina G Salley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Larissa L Hewitt
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Andrea F Patenaude
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Michael W Vasey
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Keith O Yeates
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Cynthia A Gerhardt
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
| | - Kathryn Vannatta
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Department of Psychology, Department of Pediatrics, The Ohio State University, and Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital
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Comparison of Resilience in Adolescent Survivors of Brain Tumors and Healthy Adolescents. Cancer Nurs 2014; 37:373-81. [DOI: 10.1097/ncc.0000000000000094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bull KS, Liossi C, Culliford D, Peacock JL, Kennedy CR. Child-related characteristics predicting subsequent health-related quality of life in 8- to 14-year-old children with and without cerebellar tumors: a prospective longitudinal study. Neurooncol Pract 2014; 1:114-122. [PMID: 26034623 DOI: 10.1093/nop/npu016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We identified child-related determinants of health-related quality of life (HRQoL) in children aged 8-14 years who were treated for 2 common types of pediatric brain tumors. METHODS Questionnaire measures of HRQoL and psychometric assessments were completed by 110 children on 3 occasions over 24 months. Of these 110, 72 were within 3 years of diagnosis of a cerebellar tumor (37 standard-risk medulloblastoma, 35 low-grade cerebellar astrocytoma), and 38 were in a nontumor group. HRQoL, executive function, health status, and behavioral difficulties were also assessed by parents and teachers as appropriate. Regression modeling was used to relate HRQoL z scores to age, sex, socioeconomic status, and 5 domains of functioning: Cognition, Emotion, Social, Motor and Sensory, and Behavior. RESULTS HRQoL z scores were significantly lower after astrocytoma than those in the nontumor group and significantly lower again in the medulloblastoma group, both by self-report and by parent-report. In regression modeling, significant child-related predictors of poorer HRQoL z scores by self-report were poorer cognitive and emotional function (both z scores) and greater age (years) at enrollment (B = 0.038, 0.098, 0.136, respectively). By parent-report, poorer cognitive, emotional and motor or sensory function (z score) were predictive of lower subsequent HRQoL of the child (B = 0.043, 0.112, 0.019, respectively), while age at enrollment was not. CONCLUSIONS Early screening of cognitive and emotional function in this age group, which are potentially amenable to change, could identify those at risk of poor HRQoL and provide a rational basis for interventions to improve HRQoL.
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Affiliation(s)
- Kim S Bull
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Christina Liossi
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - David Culliford
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Janet L Peacock
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
| | - Colin R Kennedy
- Faculty of Medicine , University of Southampton, Southampton General Hospital , Southampton, UK (K.S.B., D.C., C.R.K.); University Hospital Southampton NHS Foundation Trust , Southampton, UK (C.R.K.); School of Psychology, Faculty of Social and Human Sciences , University of Southampton , Southampton, UK (C.L.); Division of Health and Social Care Research , King's College London , London, UK (J.L.P.); NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust , London, UK (J.L.P.)
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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Beek L, Schappin R, Gooskens R, Huisman J, Jongmans M. Surviving a brain tumor in childhood: impact on family functioning in adolescence. Psychooncology 2014; 24:89-94. [DOI: 10.1002/pon.3599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Beek
- Department of Medical Psychology and Social Work; Wilhelmina Children's Hospital, UMC Utrecht; The Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work; Wilhelmina Children's Hospital, UMC Utrecht; The Netherlands
| | - Rob Gooskens
- Department of Neurology; Wilhelmina Children's Hospital, UMC Utrecht; The Netherlands
| | - Jaap Huisman
- Department of Medical Psychology and Social Work; Wilhelmina Children's Hospital, UMC Utrecht; The Netherlands
| | - Marian Jongmans
- Department of Special Education, Faculty of Social and Behavioral Sciences; Utrecht University; The Netherlands
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Pérez-Campdepadrós M, Castellano-Tejedor C, Sábado-Álvarez C, Gros-Subías L, Capdevila L, Blasco-Blasco T. Type of tumour, gender and time since diagnosis affect differently health-related quality of life in adolescent survivors. Eur J Cancer Care (Engl) 2014; 24:635-41. [DOI: 10.1111/ecc.12215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Pérez-Campdepadrós
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - C. Castellano-Tejedor
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
- Departament of Psychiatry; Hospital Universitari Vall d'Hebron-Fundació Institut de Recerca; Barcelona Spain
| | - C. Sábado-Álvarez
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - L. Gros-Subías
- Department of Pediatric Oncology and Hematology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - L. Capdevila
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
| | - T. Blasco-Blasco
- Department of Basic Psychology; Universitat Autònoma de Barcelona; Bellaterra Spain
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82
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Improved health-related quality of life outcomes associated with SHH subgroup medulloblastoma in SIOP-UKCCSG PNET3 trial survivors. Acta Neuropathol 2014; 128:151-3. [PMID: 24879579 DOI: 10.1007/s00401-014-1300-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/06/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
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Gudrunardottir T, Lannering B, Remke M, Taylor MD, Wells EM, Keating RF, Packer RJ. Treatment developments and the unfolding of the quality of life discussion in childhood medulloblastoma: a review. Childs Nerv Syst 2014; 30:979-90. [PMID: 24569911 DOI: 10.1007/s00381-014-2388-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/11/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE To describe how the quality of life (QOL) discussion in childhood medulloblastoma (MB) relates to treatment developments, survival and sequelae from 1920 to 2014. METHODS Articles containing "childhood medulloblastoma" and "quality of life" were identified in PubMed. Those containing phrases pertaining to psychological, emotional, behavioral or social adjustment in the title, abstract or keywords were selected. Inclusion of relevant older publications was assured by cross-checking references. RESULTS 1920-1930s: suction, electro-surgery, kilovolt (KV) irradiation. Survival = months. Focus on operative mortality, symptoms and survival. 1940s: radiotherapy improved. 1950s: chemotherapy and intubation. Survival = years. Opinions oscillated between optimism/awareness of physical sequelae of radiotherapy. 1960s: magnified vision, ventriculo-peritoneal (VP) shunts, megavolt (MV) irradiation. Long-term survival shifted the attention towards neurological problems, disability and carcinogenesis of radiotherapy. 1970s: CT, microscope, bipolar coagulation, shunt filters, neuroanesthesia, chemotherapy trials and staging studies. Operative mortality decreased and many patients (re)entered school; emphasis on neuropsychological sequelae, IQ and academic performance. 1980s: magnetic resonance imaging (MRI), Cavitron ultrasonic aspiration (CUSA), laser surgery, hyper-fractionated radiotherapy (HFRT). Cerebellar mutism, psychological and social issues. 1990s: pediatric neurosurgery, proton beams, stem cell rescue. Reflections on QOL as such. 21st century: molecular genetics. Premature aging, patterns of decline, risk- and resilience factors. DISCUSSION QOL is a critical outcome measure. Focus depends on survival and sequelae, determined after years of follow-up. Detailed measurements are limited by time, money and human resources, and self-reporting questionnaires represent a crude measure limited by subjectivity. Therapeutic improvements raise the question of QOL versus cure. QOL is a potential primary research endpoint; multicenter international studies are needed, as are web-based tools that work across cultures.
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Affiliation(s)
- Thora Gudrunardottir
- Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC, USA,
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84
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Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Stinson JN. A smartphone-based pain management app for adolescents with cancer: establishing system requirements and a pain care algorithm based on literature review, interviews, and consensus. JMIR Res Protoc 2014; 3:e15. [PMID: 24646454 PMCID: PMC3978558 DOI: 10.2196/resprot.3041] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and system design features, which are designed using user-centered methods, are required. OBJECTIVE To develop the decision algorithm and system requirements that will inform the pain management advice provided by a real-time smartphone-based pain management app for adolescents with cancer. METHODS A systematic approach to algorithm development and system design was utilized. Initially, a comprehensive literature review was undertaken to understand the current body of knowledge pertaining to pediatric cancer pain management. A user-centered approach to development was used as the results of the review were disseminated to 15 international experts (clinicians, scientists, and a consumer) in pediatric pain, pediatric oncology and mHealth design, who participated in a 2-day consensus conference. This conference used nominal group technique to develop consensus on important pain inputs, pain management advice, and system design requirements. Using data generated at the conference, a prototype algorithm was developed. Iterative qualitative testing was conducted with adolescents with cancer, as well as pediatric oncology and pain health care providers to vet and refine the developed algorithm and system requirements for the real-time smartphone app. RESULTS The systematic literature review established the current state of research related to nonpharmacological pediatric cancer pain management. The 2-day consensus conference established which clinically important pain inputs by adolescents would require action (pain management advice) from the app, the appropriate advice the app should provide to adolescents in pain, and the functional requirements of the app. These results were used to build a detailed prototype algorithm capable of providing adolescents with pain management support based on their individual pain. Analysis of qualitative interviews with 9 multidisciplinary health care professionals and 10 adolescents resulted in 4 themes that helped to adapt the algorithm and requirements to the needs of adolescents. Specifically, themes were overall endorsement of the system, the need for a clinical expert, the need to individualize the system, and changes to the algorithm to improve potential clinical effectiveness. CONCLUSIONS This study used a phased and user-centered approach to develop a pain management algorithm for adolescents with cancer and the system requirements of an associated app. The smartphone software is currently being created and subsequent work will focus on the usability, feasibility, and effectiveness testing of the app for adolescents with cancer pain.
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85
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Porter KR, Menon U, Vick NA, Villano JL, Berbaum ML, Davis FG. Assessment of clinical and nonclinical characteristics associated with health-related quality of life in patients with high-grade gliomas: a feasibility study. Support Care Cancer 2014; 22:1349-62. [PMID: 24382676 DOI: 10.1007/s00520-013-2093-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 12/05/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Results from several studies suggest that there is value in evaluating the association between nonclinical characteristics of patients and quality of life (QoL), but few studies have focused on brain cancer. The primary goal of this feasibility study was to explore the relationship between clinical factors and nonclinical factors and QoL in brain cancer patients. METHODS Participants in this cross-sectional study were drawn from two hospital sites. Eligible patients were 18-75 years old with a pathologically confirmed diagnosis of a brain cancer histology and stable disease after treatment. Data were obtained from medical chart review and a self-administered survey consisting of main study variables and two QoL standardized measures. Independent sample t test was used to determine differences between patient factors and QoL measures. RESULTS The sample population was comprised of 26 patients with a median age at survey of 57.5 years (range 33-72). Quality of life was adversely associated with younger age, having underage children and living alone. Patients' meaning of QoL differed by gender, however most patients viewed it as affecting multiple aspects of their lives. CONCLUSIONS Nonclinical characteristics were significantly associated with QoL more often than clinical characteristics. Identifying these factors may help improve the quality of care for these patients. This effort demonstrates the relevancy and feasibility of conducting a larger scale study to confirm or refute these findings.
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Affiliation(s)
- Kimberly R Porter
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, 60612, USA,
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86
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Piscione PJ, Bouffet E, Mabbott DJ, Shams I, Kulkarni AV. Physical functioning in pediatric survivors of childhood posterior fossa brain tumors. Neuro Oncol 2013; 16:147-55. [PMID: 24305707 DOI: 10.1093/neuonc/not138] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survival rates for children diagnosed with posterior fossa brain tumors (PFBTs) have improved significantly over the past several decades, and long-term functioning assessments have become priorities. These evaluations have occurred frequently in adults but only rarely in children. This study describes a cross-sectional assessment of physical functioning in pediatric survivors of PFBTs using the Bruininks-Osteretsky Test of Motor Performance, Second Edition (BOT-2). METHODS Primary analyses compared BOT-2 scores to normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively. Primary analyses compared BOT-2 scores with normative data using 1-sample t tests for each gross motor subscale (Bilateral Coordinationcoordination, Balance, Running Speed/Agility, Strength) and motor-area composite (Body Coordination and Strength and Agility). Second, the cohort was stratified by diagnostic or treatment variables. Group differences and groups vs norms were evaluated using independent 2-sample and 1-sample t tests, respectively. RESULTS Mean age of 30 participants was 11.4 years (range, 4.9y-18.2y), and mean time from diagnosis was 6.1 years (range, 1.1y-16.7y). Cerebellar astrocytoma (43.3%) and medulloblastoma (40%) were the most common diagnoses. As a group, significantly decreased functioning, compared with norms, was observed in Balance (P < .001) and Running Speed/Agility (P = .005). Specifically in Balance, 21 (70%) participants performed below or well-below average. Participants with a non-astrocytoma performed significantly lower than norms in all areas, independent of age at diagnosis. Survivors with tumors infiltrating the vermis demonstrated significantly lower Body Coordination than norms (P < .001). CONCLUSIONS Pediatric survivors of PFBTs demonstrated decreased physical functioning, most notably in Balance. These data underscore the need for further research and implementation of physical activity programs aimed specifically at approaches to minimize physical limitations.
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Affiliation(s)
- P Janine Piscione
- Corresponding author: P. Janine Piscione, MSc, BScPT, Department of Rehabilitation, Hospital for Sick Children, 555 University Avenue, S229, Toronto, Ontario, Canada M5G 1X8.
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87
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Social competence in pediatric brain tumor survivors: evaluating the psychometric properties of assessment tools. Support Care Cancer 2013; 22:561-9. [DOI: 10.1007/s00520-013-2035-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
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88
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Vision specific quality of life in children with optic pathway gliomas. J Neurooncol 2013; 116:341-7. [PMID: 24197987 DOI: 10.1007/s11060-013-1300-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Abstract
Children with optic pathway gliomas (OPGs) frequently experience vision loss from their tumors. Most pediatric OPG research has focused on radiographic and visual outcomes, yet the impact of vision loss on quality of life (QOL) in children with OPGs has not been studied. The present study prospectively recruited children ≤ 10 years of age with sporadic or neurofibromatosis type 1 (NF1)-related OPGs. Vision specific QOL was assessed by parent proxy using the Children's Visual Function Questionnaire (CVFQ), and scores were analyzed according to magnitude of visual acuity (VA) loss and presence of visual field (VF) loss. Thirty-six subjects completed the study (53 % female) with median age of 4.6 years. Children with mild, moderate and severe vision loss have lower CVFQ subscale scores, indicating a lower vision specific QOL, compared to those with normal vision. Lower Competence scores were noted in participants with more profound vision loss (p < 0.05), reflecting a decreased ability to complete activities of daily living (e.g., feeding, grooming). Children with two visually impaired eyes were rated as having greater difficulty with social interactions and pleasurable activities (Personality subscale, p = 0.039) compared to those with only one impaired eye. In summary, our findings demonstrate that children with vision loss secondary to their OPG have a decreased vision specific QOL compared to those with normal vision. Measuring vision specific QOL may be considered a meaningful secondary outcome measure for pediatric OPG clinical trials.
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Sleeping Beauty mutagenesis in a mouse medulloblastoma model defines networks that discriminate between human molecular subgroups. Proc Natl Acad Sci U S A 2013; 110:E4325-34. [PMID: 24167280 DOI: 10.1073/pnas.1318639110] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The Sleeping Beauty (SB) transposon mutagenesis screen is a powerful tool to facilitate the discovery of cancer genes that drive tumorigenesis in mouse models. In this study, we sought to identify genes that functionally cooperate with sonic hedgehog signaling to initiate medulloblastoma (MB), a tumor of the cerebellum. By combining SB mutagenesis with Patched1 heterozygous mice (Ptch1(lacZ/+)), we observed an increased frequency of MB and decreased tumor-free survival compared with Ptch1(lacZ/+) controls. From an analysis of 85 tumors, we identified 77 common insertion sites that map to 56 genes potentially driving increased tumorigenesis. The common insertion site genes identified in the mutagenesis screen were mapped to human orthologs, which were used to select probes and corresponding expression data from an independent set of previously described human MB samples, and surprisingly were capable of accurately clustering known molecular subgroups of MB, thereby defining common regulatory networks underlying all forms of MB irrespective of subgroup. We performed a network analysis to discover the likely mechanisms of action of subnetworks and used an in vivo model to confirm a role for a highly ranked candidate gene, Nfia, in promoting MB formation. Our analysis implicates candidate cancer genes in the deregulation of apoptosis and translational elongation, and reveals a strong signature of transcriptional regulation that will have broad impact on expression programs in MB. These networks provide functional insights into the complex biology of human MB and identify potential avenues for intervention common to all clinical subgroups.
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90
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Sato I, Higuchi A, Yanagisawa T, Mukasa A, Ida K, Sawamura Y, Sugiyama K, Saito N, Kumabe T, Terasaki M, Nishikawa R, Ishida Y, Kamibeppu K. Cancer-specific health-related quality of life in children with brain tumors. Qual Life Res 2013; 23:1059-68. [PMID: 24132348 DOI: 10.1007/s11136-013-0555-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE To understand the influence of disease and treatment on the health-related quality of life (HRQOL) of children with brain tumors, compared to the HRQOL of children with other cancers, from the viewpoints of children and parents. METHODS A total of 133 children aged 5-18 years and 165 parents of children aged 2-18 completed questionnaires of the Pediatric Quality of Life Inventory Cancer Module (Pain and Hurt, Nausea, Procedural Anxiety, Treatment Anxiety, Worry, Cognitive Problems, Perceived Physical Appearance, and Communication scales); higher scores indicate a better HRQOL. The Cancer Module scores, weighted by age and treatment status, were compared to those obtained in a previous study of children with other cancers (mostly leukemia). RESULTS The weighted mean scores for Pain and Hurt (effect size d = 0.26) and Nausea (d = 0.23) from child reports and the scores for Nausea (d = 0.28) from parent reports were higher for children with brain tumors than scores for children with other cancers. The scores for Procedural Anxiety (d = -0.22) and Treatment Anxiety (d = -0.32) from parent reports were lower for parents of children with brain tumors than the scores for parents of children with other cancers. The child-reported Pain and Hurt score of the Cancer Module was higher (d = 0.29) and in less agreement (intraclass correlation coefficient = 0.43) with scores from the Brain Tumor Module, indicating that assessments completed with the Cancer Module misesteem pain and hurt problems in children with brain tumors. CONCLUSIONS The profiles of cancer-specific HRQOL in children with brain tumors differ from those of children with other cancers; we therefore suggest that these children receive specific psychological support.
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Affiliation(s)
- Iori Sato
- Department of Family Nursing, Faculty of Medicine, Graduate School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Suneja G, Poorvu PD, Hill-Kayser C, Lustig RA. Acute toxicity of proton beam radiation for pediatric central nervous system malignancies. Pediatr Blood Cancer 2013; 60:1431-6. [PMID: 23610011 DOI: 10.1002/pbc.24554] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/08/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Proton beam therapy (PBT) for pediatric CNS malignancies may reduce late toxicity, but acute toxicity is not well defined. We examined acute toxicity for children with CNS malignancies treated with PBT. PROCEDURE We conducted a retrospective review of 48 children with malignant brain tumors treated with PBT at our facility from 2010 to 2012. For each patient, we recorded age at diagnosis, tumor location, histologic subtype, radiation dose, extent of radiation, and use of concurrent chemotherapy. Acute toxicity scores were recorded per the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 at weekly on treatment visits. Maximum grade of fatigue, headache, insomnia, anorexia, nausea, vomiting, alopecia, and dermatitis over the radiation therapy treatment course were recorded, and rates of acute toxicity were calculated. RESULTS The cohort consisted of 16 glial tumors, 9 medulloblastomas, 6 germinomas, 5 ependymomas, 4 craniopharyngiomas, 3 atypical teratoid rhabdoid tumors, and 5 other CNS tumors. The mean age was 10.8 years, and median dose was 5,400 cGy (RBE). Acute toxicities were generally low-grade and manageable. The most commonly observed acute toxicities were fatigue, alopecia, and dermatitis. The least common were insomnia and vomiting. Higher maximum grades for headache, nausea, and vomiting over the treatment course were associated with infratentorial location, while higher maximum grades for anorexia, nausea, and alopecia were associated with craniospinal radiation. CONCLUSIONS PBT appears to be well tolerated in pediatric patients with CNS malignancies. Acute toxicity can be managed with supportive care.
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Affiliation(s)
- Gita Suneja
- Department of Radiation Oncology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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92
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Adolescents’ Psychosocial Health-Related Quality of Life Within 6 Months After Cancer Treatment Completion. Cancer Nurs 2013; 36:E61-72. [DOI: 10.1097/ncc.0b013e3182902119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
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Greenberg-Kushnir N, Freedman S, Eshel R, Zwerdling N, Elhasid R, Dvir R, Yalon M, Kulkarni AV, Constantini S. Screening tool for late-effect pediatric neuro-oncological clinics: a treatment-oriented questionnaire. Pediatr Blood Cancer 2013; 60:1369-74. [PMID: 23418062 DOI: 10.1002/pbc.24495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 01/10/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Many survivors of pediatric brain tumors (SPBTs) suffer from long-term late effects (LEs). Our aim was to create a practical screening tool for detecting LEs in this population. Such a screening tool will improve our ability to identify those patients who may benefit from treatment in LE clinics while focusing on individual relevant issues. PROCEDURE We developed the Treatment-Oriented Screening Questionnaire (TOSQ); a self-reported, risk-based questionnaire that addresses all LEs SPBTs can potentially suffer. As a basis for the TOSQ design we used the Long-Term Follow-Up Guidelines published by the Children's Oncology Group. Output includes individual recommendations for further treatment. We prospectively assessed whether the TOSQ can accurately detect treatment targets in SPBTs by comparing patient and caregiver questionnaire scores with physician evaluations. Data are presented from 41 SPBTs. RESULTS The TOSQ is a precise screening tool for identifying LEs in SPBTs based on the significant correlation (P < 0.05) that was found between parental scores and physician evaluations. Statistical testing proved that parents are a good source of information about child's health status, and that TOSQ accurately reflects the correlation between patient difficulties and quality of life. CONCLUSIONS The TOSQ is the first described screening tool for identification of LEs designed specifically for SPBTs. It is simple to use and provides a valid, comprehensive and economic assessment followed by targeted treatment plan for each patient. By repeatedly using the TOSQ over the years, we can improve our ability to detect and give focused treatment to those who require assistance.
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Affiliation(s)
- Noa Greenberg-Kushnir
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
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95
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Abstract
OBJECTIVE Health-related quality of life (HRQoL) has become an increasingly important measure of research and treatment outcomes across all medical specialties. However, to date, there has not been an in-depth review of research relevant specifically to HRQoL in the populations of children and adolescents with cancer. In this review, the authors examine the effects of cancer on HRQoL from diagnosis to remission/survivorship and the end of life. DESIGN A literature search was conducted using Medline and PsycINFO for articles published from 2002 to 2011. Studies included patients from diagnosis to remission and also the terminally ill. Twenty-nine studies specifically addressing HRQoL were selected after reaching consensus and study quality check. RESULTS Children who are newly diagnosed with cancer and are undergoing treatment or are terminally ill have impaired HRQoL. Survivors of childhood cancer have high HRQoL (with the exception of those who experienced medical comorbidity or PTSD). The authors found that demographic differences, cancer types, and treatment regimens, all significantly influence the negative impact of cancer on patients' HRQoL. CONCLUSIONS There are specific and identifiable impacts of childhood cancer on patients' HRQoL that are significant and complex across the span of the illness. There is a need for continued research in many areas related to this population, especially related to those with terminal illness in order to improve patient care.
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96
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de Ruiter MA, van Mourik R, Schouten-van Meeteren AYN, Grootenhuis MA, Oosterlaan J. Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta-analysis. Dev Med Child Neurol 2013; 55:408-17. [PMID: 23157447 DOI: 10.1111/dmcn.12020] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM This meta-analysis provides a systematic review of studies into intellectual and attentional functioning of paediatric brain tumour survivors (PBTS) as assessed by two widely used measures: the Wechsler Intelligence Scale for Children (3rd edition; WISC-III) and the Conners' Continuous Performance Test (CPT). METHOD Studies were located that reported on performance of PBTS (age range 6-16y). Meta-analytic effect sizes were calculated for Full-scale IQ, Performance IQ, and Verbal IQ as measured by the WISC-III, and mean hit reaction time, errors of omission, and errors of commission as measured by the CPT. Exploratory analyses investigated the possible impacts of treatment mode, tumour location, age at diagnosis, and time since diagnosis on intelligence. RESULTS Twenty-nine studies were included: 22 reported on the WISC-III in 710 PBTS and seven on CPT results in 372 PBTS. PBTS performed below average (p(s) <0.001) on Full-scale IQ (Cohen's d=-0.79), Performance IQ (d=-0.90), and Verbal IQ (d=-0.54). PBTS committed more errors of omission than the norm (d=0.82, p<0.001); no differences were found for mean hit reaction time and errors of commission. Cranial radiotherapy, chemotherapy, and longer time since diagnosis were associated with lower WISC-III scores (p(s) <0.05). INTERPRETATION PBTS have seriously impaired intellectual functioning and attentiveness. Being treated with cranial radiotherapy and/or chemotherapy as well as longer time since diagnosis leads to worse intellectual functioning.
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Affiliation(s)
- Marieke A de Ruiter
- Pediatric Psychosocial Department, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands.
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97
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Wechsler AM, Sánchez-Iglesias I. Psychological adjustment of children with cancer as compared with healthy children: a meta-analysis. Eur J Cancer Care (Engl) 2012; 22:314-25. [PMID: 23279127 DOI: 10.1111/ecc.12031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 11/28/2022]
Abstract
Childhood cancer is a life-threatening disease and the cause of great stress for children who suffer from its diagnosis and treatment. The aim of this study was to verify, through meta-analytical tools, whether children in active treatment for cancer differ in their psychological adjustment from healthy children. Ten studies fulfilled the inclusion criteria for the meta-analytic approach. A fixed effects model did not yield significant results, suggesting that there is no evidence for a difference in psychological adjustment between ill and healthy children, inasmuch as the former seem to adjust as well as the latter. Some methodological aspects are also considered, including issues related to the definition of psychological adjustment and its operationalisation and to the relative scarcity of published articles in this particular realm. Moreover, suggestions for future studies are discussed.
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Affiliation(s)
- A M Wechsler
- Department of Personality, Evaluation and Psychological Treatment I, University Complutense of Madrid, Madrid, Spain.
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98
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de Ruiter MA, Schouten-Van Meeteren AYN, van Mourik R, Janssen TWP, Greidanus JEM, Oosterlaan J, Grootenhuis MA. Neurofeedback to improve neurocognitive functioning of children treated for a brain tumor: design of a randomized controlled double-blind trial. BMC Cancer 2012; 12:581. [PMID: 23217162 PMCID: PMC3530427 DOI: 10.1186/1471-2407-12-581] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurotoxicity caused by treatment for a brain tumor is a major cause of neurocognitive decline in survivors. Studies have shown that neurofeedback may enhance neurocognitive functioning. This paper describes the protocol of the PRISMA study, a randomized controlled trial to investigate the efficacy of neurofeedback to improve neurocognitive functioning in children treated for a brain tumor. METHODS/DESIGN Efficacy of neurofeedback will be compared to placebo training in a randomized controlled double-blind trial. A total of 70 brain tumor survivors in the age range of 8 to 18 years will be recruited. Inclusion also requires caregiver-reported neurocognitive problems and being off treatment for more than two years. A group of 35 healthy siblings will be included as the control group. On the basis of a qEEG patients will be assigned to one of three treatment protocols. Thereafter patients will be randomized to receive either neurofeedback training (n=35) or placebo training (n=35). Neurocognitive tests, and questionnaires administered to the patient, caregivers, and teacher, will be used to evaluate pre- and post-intervention functioning, as well as at 6-month follow-up. Siblings will be administered the same tests and questionnaires once. DISCUSSION If neurofeedback proves to be effective for pediatric brain tumor survivors, this can be a valuable addition to the scarce interventions available to improve neurocognitive and psychosocial functioning. TRIAL REGISTRATION ClinicalTrials.gov NCT00961922.
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Affiliation(s)
- Marieke A de Ruiter
- Psychosocial Department, Emma Children's Hospital AMC, room A3-241, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
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Zhi F, Wang S, Wang R, Xia X, Yang Y. From small to big: microRNAs as new players in medulloblastomas. Tumour Biol 2012. [DOI: 10.1007/s13277-012-0579-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yock TI, Caruso PA. Risk of second cancers after photon and proton radiotherapy: a review of the data. HEALTH PHYSICS 2012; 103:577-585. [PMID: 23032887 DOI: 10.1097/hp.0b013e3182609ba4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Control rates for pediatric and adult malignancies are now approximately 80 and 60%, respectively, due to dramatic improvements in surgery, chemotherapy, and radiotherapy. However, radiotherapy is responsible for many of the adverse late effects of treatment, which is now well documented in the literature. The most serious and life threatening side effect of radiotherapy that affects both children and adults is radiation-induced second primary cancers.
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Affiliation(s)
- Torunn I Yock
- Massachusetts General Hospital, Department of Radiation Oncology, 100 Blossom Street, COX LL, Boston, MA 02114-2617, USA.
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