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Sabri S, Mohamed Hussin NA, Chooi WT. Exploration of Hope Among Young Adults with Cancer in Malaysia. J Adolesc Young Adult Oncol 2024; 13:213-223. [PMID: 37389816 DOI: 10.1089/jayao.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Purpose: Hope is vital for cancer patients to cope with their illnesses. It is positively associated with better health outcomes, quality of life, and daily functioning. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. This research aimed to investigate hope among young adults with cancer throughout their cancer experience and the exploration of hope preservation in these individuals. Methods: This qualitative study involved 14 young adults recruited from a closed Facebook group. The median age of the participants was 30.5 years (range 20-39 years), and their median survival year was 3 years (range 1-18 years from the date of diagnosis). Semistructured interviews and a thematic analysis were performed to identify the major themes that emerged from these interviews. Results: The findings identified that young adults expressed hopes for cancer advocacy, good physical and mental health, ease in the afterlife, and uncertain hopes due to thoughts of death. Three areas that influenced their hope are: (1) active hope with cancer peers; (2) cancer prognosis and hope; and (3) hope comes from prayer. Their cultural and religious beliefs influenced the various forms of hope and affected their experiences with cancer. In addition, this study discovered that not all positive communication with their physician resulted in hope. Conclusion: These findings provide important insight to health care professionals (HCPs) by encouraging young adults to discuss hope and improving the existing oncology social work-based intervention. This study suggests that hope is essential for chronic illness patients and should be supported continuously during and after treatments.
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Affiliation(s)
- Sahira Sabri
- School of Social Sciences, Social Work Section, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Weng-Tink Chooi
- School of Social Sciences, Social Work Section, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Liu Q, Ho KY, Lam KKW, Lam W, Ma P, Abu-Odah H, Belay GM, Yuen JWM, Ling DL, Ching SSY, Wong FKY. The associations between spiritual well-being, hope and psychological symptoms in Chinese childhood cancer patients: A path analysis. Psychooncology 2023; 32:1452-1460. [PMID: 37559470 DOI: 10.1002/pon.6198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
AIMS We aimed to test a model in which hope and spiritual well-being acted as protective factors against anxiety and depressive symptoms in childhood cancer patients (CCPs). We hypothesized that hope and spiritual well-being were mutually reinforcing factors that would both reduce anxiety and depressive symptoms. METHODS Using path analysis, the hypothetical model was tested on a cross-sectional sample of 412 Chinese CCPs aged 8-17 years. Self-reported measures were used to obtain data on participants' social and clinical characteristics, spiritual well-being, hope, anxiety and depressive symptoms. RESULTS The hypothetical model was supported. Results suggested that sex, treatment type and diagnosis predicted spiritual well-being; diagnosis and time since diagnosis predicted hope. Spiritual well-being and hope were mutually predictive and mutually reinforcing, and were both negatively associated with anxiety and depressive symptoms. This model predicted 40% of the variance in spiritual well-being, 37% in hope, 39% in depressive symptoms, and 28% in anxiety. CONCLUSION Spiritual well-being and hope were mutually reinforcing and served as protective factors against anxiety and depressive symptoms. These support the value for integrating spiritual and hope elements in developing interventions for CCPs to improve their spiritual and psychological well-being along the disease trajectory.
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Affiliation(s)
- Qi Liu
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Ka-Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | | | - Winsome Lam
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Polly Ma
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Hammoda Abu-Odah
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | | | - John Wai Man Yuen
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Dong-Lan Ling
- Nursing Administration Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Liu Q, Yuen JWM, Ho KY, Lam KKW, Lam W, Cheng H, Yang DL, Ching SSY, Wong FKY. Psychometric evaluation of the Chinese version of the Herth Hope Index (HHI) in Chinese children with cancer. Sci Rep 2023; 13:6805. [PMID: 37100834 PMCID: PMC10133258 DOI: 10.1038/s41598-023-33838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
Hope plays an extremely important role in protecting childhood cancer patients from psychological distress caused by cancer. The availability of a valid and reliable instrument that can accurately assess hope is crucial for the development of interventions to enhance hope among childhood cancer patients. This study aimed to examine the psychometric properties of the Chinese version of the Herth Hope Index (HHI). Chinese childhood cancer patients aged 8-17 years (n = 412) were invited to participate in this cross-sectional study. Participants completed the Chinese translated version of the HHI, the Center for Epidemiology Studies Depression Scale for Children and the Paediatric Quality of Life Inventory 3.0 Cancer Module. Exploratory factor analysis and confirmatory factor analysis were conducted to assess the structural validity of the HHI. Content validity, convergent validity, internal consistency, and test-retest reliability at 2 weeks were also examined. The content validity index for items ranged from 0.8 to 1.0, and that for the scale was 0.9, demonstrating appropriate content validity. There was a positive correlation between HHI and Center for Epidemiology Studies Depression Scale for Children scores and a negative correlation between HHI and Paediatric Quality of Life Inventory 3.0 Cancer Module scores. The results indicated that the Chinese version of the HHI showed reasonable convergent validity and discriminant validity. Exploratory factor analysis yielded a three-factor model, which could explain 82.74% of the total variance. The confirmatory factor analysis results showed that χ2/df was 2.20, comparative fit index was 0.98, goodness of fit index was 0.94, and root-mean-square error of approximation was 0.07. Cronbach's alpha was 0.78, indicating good internal consistency. The findings of the study showed that the Chinese version of the HHI (11-item) is a reliable and valid instrument for assessing hope among Chinese childhood cancer patients. Evidence-based interventions can be provided to enhance hope in this population.
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Affiliation(s)
- Qi Liu
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - John Wai-Man Yuen
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ka-Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
| | - Katherine-Ka-Wai Lam
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Winsome Lam
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Huilin Cheng
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
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Liu Q, Ho KY, Lam KKW, Ho JMC, Lam W, Ma P, Abu-Odah H, Belay GM, Ling DL, Ching SSY, Wong FKY. Effectiveness of spiritual interventions on psychological outcomes and quality of life among paediatric patients with cancer: a study protocol for a systematic review. BMJ Open 2023; 13:e070810. [PMID: 36882254 PMCID: PMC10008432 DOI: 10.1136/bmjopen-2022-070810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Cancer and its treatment affect children's physical, psychological and social well-being throughout the disease trajectory. Spiritual well-being is a fundamental dimension of people's overall health and is considered a source of strength to motivate patients to cope with and adapt to their disease. Appropriate spiritual interventions are important to mitigate the psychological impact of cancer on children, with an ultimate goal of improving their quality of life (QoL) throughout the treatment course. However, the overall effectiveness of spiritual interventions for paediatric patients with cancer remains unclear. This paper describes a protocol to systematically summarise the characteristics of studies related to existing spiritual interventions and synthesise their effectiveness on psychological outcomes and QoL among children with cancer. METHODS AND ANALYSIS Ten databases will be searched to identify appropriate literature: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, LILACS, OpenSIGLE, the Chinese Biomedical Literature Database, the Chinese Medical Current Contents and the Chinese National Knowledge Infrastructure. All randomised controlled trials that meet our inclusion criteria will be included. The primary outcome will be QoL as evaluated by self-reported measures. The secondary outcomes will be self-reported or objectively measured psychological outcomes, including anxiety and depression. Review Manager V.5.3 will be used to synthesise the data, calculate treatment effects, perform any subgroup analyses and assess the risk of bias in included studies. ETHICAL AND DISSEMINATION The results will be presented at international conferences and published in peer-reviewed journals. As no individual data will be involved in this review, ethical approval is not required.
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Affiliation(s)
- Qi Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | | | - Winsome Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Polly Ma
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Dong-Lan Ling
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Scioli A. Emotional and spiritual hope: Back to the future. Curr Opin Psychol 2023; 49:101493. [PMID: 36473376 DOI: 10.1016/j.copsyc.2022.101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
A cognitive approach to hope has dominated psychology for five decades. Representing the farthest reaches of human intentionality, hope, thus rendered, can be viewed as both a product and promoter of the cognitive revolution and larger Western ideals. A different understanding of hope appears in medicine, the arts and humanities, as well as early psychological accounts. In this article, I review evidence for understanding hope as an emotion with extra-rational elements. I focus on recent research but also incorporate classic insights, highlighting grounded studies (e.g., lay beliefs and clinical data) as well as empirical data that distinguishes an emotional and spiritual hope from the cognitive construct. A motivational account of hope is offered, highlighting the needs for attachment, survival, mastery, and spirituality.
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Liu Q, Ho KY, Lam KKW, Lam WYY, Cheng EHL, Ching SSY, Wong FKY. A Descriptive and Phenomenological Exploration of the Spiritual Needs of Chinese Children Hospitalized with Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013217. [PMID: 36293795 PMCID: PMC9602965 DOI: 10.3390/ijerph192013217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 05/12/2023]
Abstract
Spiritual well-being is the fourth dimension of health, as equally important as physical, mental, and social well-being. The shadow of death associated with cancer triggers children to explore their personal values, meanings, and life goals throughout the illness trajectory, enabling them to identify their unique spiritual needs. Chinese children are generally non-religious, unlike Western children, which affects their spiritual needs. To address the literature gaps, we applied a qualitative, descriptive, phenomenological approach for exploring the spiritual needs of Chinese children hospitalized with cancer. Purposive sampling was conducted in two public hospitals with special wards for pediatric oncology patients in Hunan Province, China. Consequently, 22 children, hospitalized with cancer, were recruited and individually interviewed using a semi-structured interview format. We conducted a thematic analysis of the interview transcripts. Four important themes were identified: the need for self-exploration, inner needs, need for a connection with others, and need for a connection with gods, supernatural powers, and fictional characters. We found that culture significantly influenced the spiritual needs of Chinese children with cancer. Hope was a key factor motivating the children to continue cancer treatment. To address their unique spiritual needs, culturally specific interventions should be developed and incorporated into their care to enhance their spiritual well-being.
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Affiliation(s)
| | - Ka-Yan Ho
- Correspondence: ; Tel.: +852-27666417
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Hidalgo CMT, de Freitas AJA, de Abreu LS, Santiago HR, Campolina AG. Spiritual needs among hospitalized patients at a public hospital in Brazil: a cross-sectional study. SAO PAULO MED J 2022; 141:125-130. [PMID: 36043678 PMCID: PMC10005469 DOI: 10.1590/1516-3180.2021.0985.r2.19052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.
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Affiliation(s)
- Cassio Murilo Trovo Hidalgo
- MD. Resident, Internal Medicine Department, Hospital do Servidor
Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Ana Julia Aguiar de Freitas
- BSc. Doctoral Student, Molecular Oncology Research Center,
Barretos Cancer Hospital, Teaching and Research Institute, Barretos (SP),
Brazil
| | - Lucas Salviano de Abreu
- MD. Resident, Internal Medicine Department, Hospital do
Servidor Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Hendrio Reginaldo Santiago
- MD. Resident, Internal Medicine Department, Hospital do
Servidor Público Municipal (HSPM), São Paulo (SP), Brazil
| | - Alessandro Gonçalves Campolina
- MD, MSc, PhD. Scientific Researcher, Centro de Investigação
Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo (ICESP),
Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP),
Brasil
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Case H, Benning T, Lovig Z, Girard J, Thorvilson M, Fischer PR, Homme J. Inpatient pediatric chaplain service utilization among children with chronic, non-cancer diseases. J Health Care Chaplain 2021; 28:578-590. [PMID: 34923924 DOI: 10.1080/08854726.2021.2015054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite the broad importance of pediatric spiritual care, most research focuses on oncologic and palliative care contexts. We aim to describe the utilization of pediatric chaplain services by children hospitalized for non-cancer chronic illnesses and to identify factors that predict utilization of chaplain services. Among 629 patients with 915 admissions, we found chaplain services were utilized in 5.0% of admissions. Utilization was similar between religiously affiliated patients (7.5%, 95%CI [5.3-10.6%]) and un-affiliated patients (6.4%, [3.6-11.0%]). Christian patients (7.3% [5.1-10.5%]) demonstrated similar utilization as non-Christian patients (7.0% [4.3-11.2%]). Utilization was significantly higher among patients with LOS >2 days (10.8% [7.9-14.6%]), compared to LOS ≤2 (1.7% [0.9-3.1%]). These results may represent an addressable gap in spiritual care, and they highlight an opportunity for pediatric chaplains to play a larger role in the holistic care of hospitalized children with chronic diseases, regardless of religious affiliation.
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Affiliation(s)
- Hannah Case
- Alix School of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Tyler Benning
- Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachary Lovig
- Department of Spiritual Care, Mayo Clinic, Rochester, MN, USA
| | - Jeramy Girard
- Department of Spiritual Care, Mayo Clinic, Rochester, MN, USA
| | - Megan Thorvilson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Sheikh Shakhbout Medical City and Khalifa University, Abu Dhabi, UAE
| | - Jason Homme
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Rossato L, Ullán AM, Scorsolini-Comin F. Religious and Spiritual Practices Used by Children and Adolescents to Cope with Cancer. JOURNAL OF RELIGION AND HEALTH 2021; 60:4167-4183. [PMID: 33871781 DOI: 10.1007/s10943-021-01256-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
This study consists of an integrative review of the scientific literature that aimed to know the religious and spiritual practices used by children and adolescents to cope with cancer. From searches in the databases/libraries CINAHL, PsycINFO, PubMed, SciELO and Lilacs (2009-2019), the final sample consisted of 20 articles. Prayers were the most widely used practices, followed by sacred books and objects, going to sacred places and the use of music. Improvements in well-being, physical and emotional health have been reported. It is concluded that such practices should be recognized as important resources in coping with cancer illness in this population.
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Affiliation(s)
- Lucas Rossato
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo At Ribeirão Preto College of Nursing, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil.
| | - Ana M Ullán
- Advanced Research Unit in Pediatric Psychology, Department of Social Psychology and Anthropology, University of Salamanca, Salamanca, Spain
| | - Fabio Scorsolini-Comin
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo At Ribeirão Preto College of Nursing, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
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Clerici CA, Pagani Bagliacca E, Veneroni L, Podda M, Silva M, Gasparini P, Luksch R, Terenziani M, Casanova M, Spreafico F, Meazza C, Biassoni V, Schiavello E, Chiaravalli S, Proserpio T, Massimino M, Ferrari A. Adolescents with Terminal Cancer: Making Good Use of Illusions. J Adolesc Young Adult Oncol 2020; 9:683-686. [PMID: 32716666 DOI: 10.1089/jayao.2020.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The terminal stage of disease in teenagers is extremely complex to manage. In this study, we share some stories of terminally ill adolescent patients who made use of illusion as a way to overcome their anguish in their final stages of illness. These experiences show how young patients can cope better with terminal illness by resorting to a nonrational and fictional dimension that can serve them as a psychological compromise, helping them tolerate their real everyday life by suspending their critical senses for a while. Illusions can serve as a resource for young patients and a potentially useful tool for medical professionals.
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Affiliation(s)
- Carlo Alfredo Clerici
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Proserpio
- Pastoral Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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