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Fitzpatrick S, Jacola LM, Harman JL, Willard VW. Developmental and adaptive functioning of very young children with solid tumors and brain tumors. Pediatr Blood Cancer 2024; 71:e31046. [PMID: 38679847 DOI: 10.1002/pbc.31046] [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: 12/18/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Infancy/toddlerhood is a period of rapid development. All infants/toddlers (0-36 months-of-age) undergoing cancer-directed treatment at one hospital are offered developmental assessments and related services. Yet, literature comparing development of infants/toddlers with brain tumors to those with non-CNS solid tumors is sparse. DESIGN AND METHODS Developmental assessment data were abstracted from electronic health records of infants/toddlers undergoing treatment for a brain tumor (n = 36; mean age = 21.83 ± 9.96 months) or a solid tumor (n = 40; mean age = 17.35 ± 8.50). Z-scores compared obtained data with age expectations. Chi-square analyses assessed whether a greater proportion of participants scored within the clinical range than normative expectations. Multivariate analysis of variance and chi-square analyses compared developmental outcomes between groups. RESULTS Compared with age expectations, the overall group demonstrated significantly less well-developed skills. Infants/toddlers with solid tumors demonstrated clinical deficits at rates higher than expected for most domains; the rate of impairment for the solid tumor group did not differ significantly from that of the brain tumor group across most subtests. CONCLUSIONS Like young patients with brain tumors, the developmental functioning of infants/toddlers with solid tumors should be studied across time to determine the trajectory of functioning for these young patients and to inform future developmental intervention studies. PRACTICE IMPLICATIONS Infants/toddlers with a malignant solid tumor may be at increased risk for delayed development. These very young patients would likely benefit from developmental assessment, early intervention services during and after treatment, and ongoing monitoring of development across time.
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Affiliation(s)
- Sequoya Fitzpatrick
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Lisa M Jacola
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer L Harman
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Victoria W Willard
- Department of Psychology and Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Zhou M, Tang J, Fan J, Wen X, Shen J, Jia R, Chai P, Fan X. Recent progress in retinoblastoma: Pathogenesis, presentation, diagnosis and management. Asia Pac J Ophthalmol (Phila) 2024; 13:100058. [PMID: 38615905 DOI: 10.1016/j.apjo.2024.100058] [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: 01/07/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024] Open
Abstract
Retinoblastoma, the primary ocular malignancy in pediatric patients, poses a substantial threat to mortality without prompt and effective management. The prognosis for survival and preservation of visual acuity hinges upon the disease severity at the time of initial diagnosis. Notably, retinoblastoma has played a crucial role in unraveling the genetic foundations of oncogenesis. The process of tumorigenesis commonly begins with the occurrence of biallelic mutation in the RB1 tumor suppressor gene, which is then followed by a cascade of genetic and epigenetic alterations that correspond to the clinical stage and pathological features of the tumor. The RB1 gene, recognized as a tumor suppressor, encodes the retinoblastoma protein, which plays a vital role in governing cellular replication through interactions with E2F transcription factors and chromatin remodeling proteins. The diagnosis and treatment of retinoblastoma necessitate consideration of numerous factors, including disease staging, germline mutation status, family psychosocial factors, and the resources available within the institution. This review has systematically compiled and categorized the latest developments in the diagnosis and treatment of retinoblastoma which enhanced the quality of care for this pediatric malignancy.
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Affiliation(s)
- Min Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Jieling Tang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Jiayan Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Xuyang Wen
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Jianfeng Shen
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China
| | - Peiwei Chai
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China.
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, People's Republic of China.
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Wise J, Hayashi R, Wu T, Malone S, Badawi AA, King A, Gordon M, Kimera L, Lueder G, Reynolds M. Eye-related quality of life and activities of daily living in pediatric retinoblastoma patients: A single-center, non-controlled, cross-sectional analysis. Pediatr Blood Cancer 2023:e30479. [PMID: 37269496 DOI: 10.1002/pbc.30479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Childhood retinoblastoma (RB) survivors are known to experience long-term morbidity; however, eye-related quality of life (QoL), which may significantly impact activities of daily living (ADL), has not been extensively studied in this population. The purpose of this cross-sectional study was to assess QoL and ADL morbidity among school-age RB survivors. METHODS The Pediatric Eye Questionnaire (PedEyeQ) and Roll Evaluation Activities of Life (REAL) were administered to childhood RB survivors between ages 5 and 17 followed at St. Louis Children's Hospital. Visual outcomes and demographic predictors of ADL and QoL were examined. RESULTS Total 23 patients (mean age 9.6 years) consented for participation in this study. All children experienced at least one domain on the PedEyeQ ≤ 80%. Subjects and parents marked functional vision to be the most impacted domain with a median score of 82.5 and 83.4, respectively. Only 10.5% of participants scored above 75% on the ADL percentile rank. On multivariable analysis, decreased visual acuity (VA) was associated with worse "Child Functional" (odds ratio [OR] -59.2, p = .004) and "Parent Worry Function" (OR -66.5, p = .03) metrics. Decreased contrast sensitivity was associated with worse "Parent Impact" (OR 21.0, p = .02) and "Parent Worry Function" (OR 3.70, p = .04) metrics. Longer saccade horizontal latency was associated with a worse "Parent Worry Function" metric (OR 43.0, p = .009). On multivariable analysis, no variable was significantly associated with ADL. CONCLUSION RB survivors have impaired QoL and ADL. Screening for such difficulties should strongly be considered for all RB patients. Additional studies may help predict morbidity based on visual metrics and demographic data.
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Affiliation(s)
- Jacob Wise
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Robert Hayashi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Tiffany Wu
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Sara Malone
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Amer Al Badawi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Allison King
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Mae Gordon
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Lawrencia Kimera
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Gregg Lueder
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Margaret Reynolds
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
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Sparrow J, Dagen H, Harris A, Schwartzberg S, Weathers L, Kibby M, Harman JL, Jacola LM. Occupational Therapy: An Essential Component of Support for Young Children With Cancer. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:211-217. [PMID: 35929023 DOI: 10.1177/15394492221115060] [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: 11/17/2022]
Abstract
We established a multidisciplinary early childhood clinic to support infants and toddlers receiving cancer treatment. The access to occupational therapy (OT) in this population is unknown. To describe the access to OT for infants and toddlers with cancer. We retrospectively reviewed medical records to determine the frequency and characteristics of children with cancer who were referred to OT. Demographic data, medical information, and frequency of referrals were extracted from September 2015 to September 2018. Of the 134 patients, 112 (83.6%) received an OT evaluation: 88.4% were referred for hospital-based OT services; 42.0% were recommended for services upon returning home. Between-group comparisons revealed significant differences in referrals for home- or community-based OT services based on age and disease. OT is crucial to treatment plans that address the developmental needs of young pediatric oncology patients during hospitalization and thereafter. Recommendations for monitoring this vulnerable population are provided.
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Affiliation(s)
| | - Hannah Dagen
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | - Lucy Weathers
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Megan Kibby
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Lisa M Jacola
- St. Jude Children's Research Hospital, Memphis, TN, USA
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Chahin S, Morse M, Qaddoumi I, Phipps S, Crabtree VM, Brennan RC, Wilson MW, Rodriguez-Galindo C, Russell KM, Parris K, Goode K, Willard VW. An exploratory study of sleep habits in school-aged survivors of retinoblastoma. Sleep Med 2023; 103:123-130. [PMID: 36780752 PMCID: PMC10006349 DOI: 10.1016/j.sleep.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE/BACKGROUND Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits. PATIENTS/METHODS Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data. RESULTS Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent. CONCLUSIONS Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.
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Affiliation(s)
- Summer Chahin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melanie Morse
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Rachel C Brennan
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Ophthalmology, University of Tennessee, Memphis, TN, USA
| | | | - Kathryn M Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kendra Parris
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Goode
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Thompson S, Ritz B, Cockburn M, Heck JE. Prenatal ambient pesticide exposure and childhood retinoblastoma. Int J Hyg Environ Health 2022; 245:114025. [PMID: 36037576 PMCID: PMC9901366 DOI: 10.1016/j.ijheh.2022.114025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Retinoblastoma is a rare tumor of the retina, most commonly found in young children. Due to the rarity of this childhood cancer, few studies have been able to examine prenatal pesticide exposure as a risk factor. OBJECTIVE To examine the relationship between childhood retinoblastoma and prenatal exposure to pesticides through residential proximity to agricultural pesticide applications. METHODS We conducted a population-based case-control study using cases aged 5 and younger identified from the California Cancer Registry, and controls randomly selected from California birth certificates. Frequency matching cases to controls by age resulted in 221 cases of unilateral retinoblastoma and 114 cases of bilateral retinoblastoma, totaling 335 cases and 123,166 controls. Based on addresses from birth certificates we employed Pesticide Use Reports and land use information within a geographic information system approach to individually assess exposures to specific pesticides within 4000 m of the residence reported on birth certificates. The associations between retinoblastoma (all types combined and stratified by laterality) and individual pesticides were expressed as odds ratios estimates obtained from unconditional logistic regression models including a single pesticide, and from a hierarchical logistic regression model including all pesticides. RESULTS We found that exposures to acephate (OR: 1.70, 95% CI: 1.20, 2.41) and bromacil (OR: 1.87, 95% CI: 1.07, 3.26) were associated with increased risk for unilateral retinoblastoma. In addition to acephate, we found that pymetrozine (OR: 1.45, 95% CI: 1.00, 2.08) and kresoxim-methyl (OR: 1.60, 95% CI: 1.00, 2.56) were associated with retinoblastoma (all types combined). CONCLUSION Our findings suggest that certain types of prenatal ambient pesticide exposure from residing near agricultural fields may play a role in the development of childhood retinoblastoma.
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Affiliation(s)
- Shiraya Thompson
- Department of Epidemiology, Fielding School of Public Health, University of California, 650 Charles E. Young Dr. S, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, 650 Charles E. Young Dr. S, Box 951772, Los Angeles, CA, 90095-1772, USA
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001, N. Soto Street, Suite 318-A, Los Angeles, CA, USA
| | - Julia E. Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, 650 Charles E. Young Dr. S, Box 951772, Los Angeles, CA, 90095-1772, USA,Jonsson Comprehensive Cancer Center, University of California, Box 951781, Los Angeles, CA, 90095-1781, USA,College of Health and Public Service, University of North Texas, 1155 Union Circle #311340, Denton, TX, 76203-5017, USA,Center for Racial and Ethnic Equity in Health and Society (CREEHS), 1155 Union Circle, Denton, TX, 76201, USA,Corresponding author.1155 Union Circle #311340, Denton, TX, 76203-5017, USA. (J.E. Heck)
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Retinoblastoma and vision. Eye (Lond) 2022; 37:797-808. [PMID: 34987197 PMCID: PMC10050411 DOI: 10.1038/s41433-021-01845-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/09/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
The assessment of vision has a growing importance in the management of retinoblastoma in the era of globe-conserving therapy, both prior to and after treatment. As survival rates approach 98-99% and globe salvage rates reach ever-higher levels, it is important to provide families with information regarding the visual outcomes of different treatments. We present an overview of the role of vision in determining the treatment given and the impact of complications of treatment. We also discuss screening and treatment strategies that can be used to maximise vision.
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Foster R, Zheng DJ, Netson-Amore KL, Kadan-Lottick NS. Cognitive Impairment in Survivors of Pediatric Extracranial Solid Tumors and Lymphomas. J Clin Oncol 2021; 39:1727-1740. [PMID: 33886354 DOI: 10.1200/jco.20.02358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rebecca Foster
- St Louis Children's Hospital, St Louis, MO.,Washington University, St Louis, MO
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Cobbs LV, Francis JH, Dunkel IJ, Gobin YP, Brodie SE, Abramson DH. Retinoblastoma management in 13q deletion syndrome patients using super-selective chemotherapies and other cancer-directed interventions. Pediatr Blood Cancer 2021; 68:e28845. [PMID: 33355996 PMCID: PMC9316827 DOI: 10.1002/pbc.28845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to identify best practices for treating 13q deletion syndrome (13q-) patients with retinoblastoma in the era of super-selective ophthalmic artery chemosurgery (OAC) and intravitreal injection therapy (IVIT). METHODS Retrospective study of 21 eyes from 14 patients with retinoblastoma and 13q- who were treated at Memorial Sloan Kettering Cancer Center (MSKCC) between May 2006 and May 2020, with a mean follow up of 3.7 years. Ocular survival, patient survival, and treatment toxicities were assessed. RESULTS Nine of the 12 eyes that underwent OAC/IVIT at MSKCC have been progression free for at least 1 year since their last treatments. Fifteen out of 26 OAC cycles resulted in grade 3-4 hematologic toxicity. There was one death from sepsis in the setting of intravenous chemotherapy (IVC) for metastatic disease that occurred after OAC/IVIT therapy. The 2-year Kaplan-Meier ocular survival estimate for the whole cohort was 75% and for the eyes that received OAC or IVIT at MSKCC 83%. For OAC hematologic toxicities, one platelet transfusion and two filgrastim doses were administered, and one patient was hospitalized for neutropenic fevers. CONCLUSIONS The majority of 13q- eyes treated with OAC/IVIT-based regimens can be cured, and there were no deaths related to complications from OAC or IVIT. 13q- Patients did have increased risk of systemic treatment complications, even from super-selective chemotherapies. Despite these toxicities, only one patient developed febrile neutropenia, one patient required a blood product transfusion, and two patients received filgrastim for both OAC and IVC complications. PRÉCIS: Children with 13q deletion syndrome with retinoblastoma managed with intra-arterial and intravitreal chemotherapy have excellent patient and ocular survival with acceptable toxicity.
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Affiliation(s)
- Lucy V. Cobbs
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasmine H. Francis
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Y Pierre Gobin
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Interventional Neuroradiology, Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Scott E. Brodie
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - David H. Abramson
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York,Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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10
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Willard VW, Qaddoumi I, Pan H, Hsu CW, Brennan RC, Wilson MW, Rodriguez-Galindo C, Goode K, Parris K, Phipps S. Cognitive and Adaptive Functioning in Youth With Retinoblastoma: A Longitudinal Investigation Through 10 Years of Age. J Clin Oncol 2021; 39:2676-2684. [PMID: 33891476 DOI: 10.1200/jco.20.03422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the trajectory of cognitive and adaptive functioning in pediatric patients with retinoblastoma from diagnosis through age 10. This is an extension of a previous report that discussed findings from diagnosis through age 5. PATIENTS AND METHODS Ninety-eight participants with retinoblastoma completed psychological assessments as part of their enrollment on an institutional treatment protocol, with 73 completing an additional assessment at age 10. Trajectories of adaptive and cognitive functioning were determined, with data analyzed by treatment strata, and patients with 13q- analyzed separately. RESULTS Longitudinal trajectories identified a significant change point in trends at age 5, with functioning declining from diagnosis through age 5 and then increasing from age 5 to age 10. This pattern was observed for all strata for adaptive functioning, but only for enucleation-only patients (strata C low) for cognitive functioning. Cognitive trajectories were also influenced by laterality and enucleation status. At age 10, overall functioning was generally within the average range, although estimated intelligence quotient was significantly below the normative mean for enucleation-only (C low) patients. Patients with 13q- demonstrated very low functioning, but few analyses were significant because of small sample size. CONCLUSION The results generally indicate that previously demonstrated declines in functioning from diagnosis through age 5 improve by age 10. However, these early declines, as well as the continuous difficulties observed in patients treated with enucleation only, suggest the need for early intervention services for young patients with retinoblastoma. Continuous monitoring of the psychological functioning of patients with retinoblastoma, increased awareness of risk factors such as unilateral disease, enucleation, race, and surgery-only treatment plans, and referral to Early Intervention for all patients are indicated.
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Affiliation(s)
- Victoria W Willard
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Qaddoumi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Chia-Wei Hsu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Rachel C Brennan
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Matthew W Wilson
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN.,Department of Ophthalmology, University of Tennessee, Memphis, TN
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Kristin Goode
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Kendra Parris
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
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11
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Willard VW, Tillery R, Harman JL, Long A, Phipps S. The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer. J Pediatr Psychol 2021; 46:433-442. [PMID: 33355354 DOI: 10.1093/jpepsy/jsaa120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. METHODS Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). RESULTS Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). CONCLUSIONS Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.
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Affiliation(s)
| | - Rachel Tillery
- Department of Psychology, St. Jude Children's Research Hospital
| | | | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
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12
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Impact of enucleation on adult retinoblastoma survivors' quality of life: A qualitative study of survivors' perspectives. Palliat Support Care 2021; 18:322-331. [PMID: 31699178 DOI: 10.1017/s1478951519000920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Retinoblastoma is the most common primary intraocular tumor of childhood with >95% survival rates in the US. Traditional therapy for retinoblastoma often included enucleation (removal of the eye). While much is known about the visual, physical, and cognitive ramifications of enucleation, data are lacking about survivors' perception of how this treatment impacts overall quality of life. METHODS Qualitative analysis of an open-ended response describing how much the removal of an eye had affected retinoblastoma survivors' lives and in what ways in free text, narrative form. RESULTS Four hundred and four retinoblastoma survivors who had undergone enucleation (bilateral disease = 214; 52% female; mean age = 44, SD = 11) completed the survey. Survivors reported physical problems (n = 205, 50.7%), intrapersonal problems (n = 77, 19.1%), social and relational problems (n = 98, 24.3%), and affective problems (n = 34, 8.4%) at a mean of 42 years after diagnosis. Three key themes emerged from survivors' responses; specifically, they (1) continue to report physical and intrapersonal struggles with appearance and related self-consciousness due to appearance; (2) have multiple social and relational problems, with teasing and bullying being prominent problems; and (3) reported utilization of active coping strategies, including developing more acceptance and learning compensatory skills around activities of daily living. SIGNIFICANCE OF RESULTS This study suggests that adult retinoblastoma survivors treated with enucleation continue to struggle with a unique set of psychosocial problems. Future interventions can be designed to teach survivors more active coping skills (e.g., for appearance-related issues, vision-related issues, and teasing/bullying) to optimize survivors' long-term quality of life.
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Morris JN, Roder D, Turnbull D, Hunkin H. The Impact of Cancer on Early Childhood Development: A Linked Data Study. J Pediatr Psychol 2021; 46:49-58. [PMID: 33011800 DOI: 10.1093/jpepsy/jsaa084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study used retrospective linked population data to investigate the impact of early childhood cancer on developmental outcomes. METHODS Children aged <9 years with a recorded malignant neoplasm were identified in the South Australian Cancer Registry. They were then linked to developmental data recorded in the Australian Early Development Census (AEDC) for the 2009, 2012, and 2015 data collection periods; and assigned five matched controls from the same AEDC year. RESULTS Between 2000 and 2015, 43 children had a malignant cancer diagnosis and also participated in the AEDC. Compared to controls, childhood cancer survivors exhibited greater developmental vulnerability in their physical health and wellbeing. Between survivors and controls, no significant developmental differences were observed in social, emotional, language and cognitive, and communication and general knowledge domains. Rural or remote location had a significant positive effect on developmental outcomes for childhood cancer survivors relative to controls, suggesting this was a protective factor in terms of physical health and wellbeing, social competence, communication, and general knowledge. Among all children, socioeconomic advantage was linked to better developmental outcomes on all domains except physical health and wellbeing. CONCLUSION Following an early cancer diagnosis, children may require targeted care to support their physical health and wellbeing. Geographic variation in developmental outcomes indicates remoteness was a protective factor and requires further investigation. This study highlights the feasibility of using administrative whole-population data to investigate cancer outcomes.
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Affiliation(s)
- Julia N Morris
- Behavioural Research and Evaluation Unit, Cancer Council South Australia
| | - David Roder
- UniSA Allied Health & Human Performance, University of South Australia
| | | | - Hugh Hunkin
- Behavioural Research and Evaluation Unit, Cancer Council South Australia
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Willard VW, Berlin KS, Conklin HM, Merchant TE. Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy. Neuro Oncol 2020; 21:678-685. [PMID: 30624746 DOI: 10.1093/neuonc/noz010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric patients with brain tumors who are treated with radiation therapy (RT) are at risk for neurocognitive and psychosocial late effects. Research to date has primarily examined these outcomes at a group level and in isolation. Advanced statistical techniques allow for person-centered analyses, as well as examination of relationships between domain-specific trajectories. METHODS Patients with brain tumors (craniopharyngioma, ependymoma, low-grade astrocytoma, high-grade astrocytoma) were enrolled on a phase II clinical trial of RT. Three hundred and fifty patients completed serial neurocognitive assessments as part of their treatment monitoring, including pre-RT baseline, 6 months post-RT, and then yearly for 5 years. This secondary analysis focused on outcomes of cognition (estimated IQ, parent-reported attention problems) and psychosocial effects (parent-reported socialization and social problems) post-RT. RESULTS Latent growth curve modeling indicated that estimated IQ and socialization were best served by quadratic models, while attention and social problems were best served by linear models. Growth mixture modeling indicated 3-class models were the best fit for IQ and socialization, and 2-class models for attention and social problems. Baseline IQ and socialization scores were associated, but there was no association over time. Young age at diagnosis and pre-RT treatments (surgery, chemotherapy) were associated with class membership. CONCLUSIONS Person-centered statistical analyses provide rich information regarding the variability in neurocognitive and psychosocial functioning following RT for pediatric brain tumor. While many patients do well over time, a subset are exhibiting significant cognitive and/or psychosocial deficits. Class membership was associated with some medical factors (eg, pre-radiation surgery/chemotherapy, age at diagnosis, shunted hydrocephalus).
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Affiliation(s)
- Victoria W Willard
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Heather M Conklin
- Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
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15
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Weintraub N, Reshef N, Pe'er J, Frenkel S, Rot I, Shoshani N, Weintraub M. The impact of monocular vision on motor function and quality of life in survivors of retinoblastoma. Pediatr Blood Cancer 2019; 66:e27623. [PMID: 30688019 DOI: 10.1002/pbc.27623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/19/2018] [Accepted: 12/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Monocular vision has been found to have a negative effect on children's motion processing and motor functions. Yet, knowledge of motor function of survivors of retinoblastoma (RB) with monocular vision (due to enucleation, for example) is limited. This study examined motor function and its relationship to visual-related and health-related quality of life (HRQOL) in survivors of RB with monocular vision. PROCEDURE Parents of 27 survivors of RB, who underwent an enucleation of one eye resulting in monocular vision, and of 21 typically developing children between the ages of 6 and 12, were administered questionnaires relating to their children's motor function (DCDQ), as well as vision-related function (CVFQ) and HRQOL (PedsQL). RESULTS Of the 27 survivors of RB, 7 (25.6%) were found to have difficulties in motor functions, compared with 1 (4.8%) child in the control group. The difficulties were faced mainly in daily function requiring control during movement, including jumping, running, and ball playing. Additionally, significant correlations were found between motor functions and children's QOL. Finally, survivors of RB with monocular vision were found to have lower QOL, specifically physical- and school-related QOL. CONCLUSION Survivors of RB who have monocular vision have a higher rate of decreased motor function and lower QOL. These results point to a need for ongoing assessment of survivors of RB to allow timely detection of motor deficits and to institute appropriate therapeutic interventions.
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Affiliation(s)
- Naomi Weintraub
- School of Occupational Therapy, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Nurit Reshef
- School of Occupational Therapy, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jacob Pe'er
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shahar Frenkel
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ido Rot
- Department of Social Work, Meuhedet Health Services, Jerusalem, Israel.,Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naomi Shoshani
- Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Weintraub
- Department of Pediatric Hematology-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Alyn Hospital, Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
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Early Cognitive and Adaptive Functioning of Clinically Referred Infants and Toddlers with Cancer. J Clin Psychol Med Settings 2019; 27:41-47. [PMID: 30993575 DOI: 10.1007/s10880-019-09619-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Many children with cancer are diagnosed during infancy and toddlerhood (< 3 years of age), potentially resulting in disrupted and/or missed developmental opportunities. Our objective was to describe the functioning of infants and toddlers with cancer who were clinically referred for evaluation at a hospital-based psychology clinic. Data from 29 very young children with cancer (Mage = 23.62 ± 6.6 months; 55.2% male) who completed clinically referred assessments from 2010 to 2015 were abstracted. Children were 11.3 months post-diagnosis (SD = 7.77, range 1-29 months) with just over half off-therapy at the time of assessment (55.2%). Overall, developmental functioning was significantly below expectations [t(22) = - 8.99, p < .001]. Adaptive functioning [t(25) = - 6.41, p < .001] was also significantly below expectations. Infants and toddlers with cancer appear to be at significant risk for weaknesses in early cognitive and adaptive functioning. The margin of deficits found in this study warrant the need for further investigation and consideration of this young population to ensure optimal functional development.
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Cox LE, Kenney AE, Harman JL, Jurbergs N, Molnar AE, Willard VW. Psychosocial Functioning of Young Children Treated for Cancer: Findings From a Clinical Sample. J Pediatr Oncol Nurs 2018; 36:17-23. [DOI: 10.1177/1043454218813905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Many pediatric cancers are diagnosed in early childhood, a time of significant growth and development that lays the foundations for overall adjustment and functioning. The objective of this article was to characterize the psychosocial functioning of young children with cancer. Method: Data from a sample of young children with cancer ( N = 92) who completed a psychological evaluation that included the Behavior Assessment Scale for Children–second edition (BASC-2) parent report were abstracted from the medical record. Patients were primarily White (70.7%), male (54.3%), and 4.81 ± 0.89 years old at evaluation. Most were treated for brain tumors (64.1%). Results: Overall group means on each of the BASC-2 subscales were within normal limits, though significantly more patients than expected had elevated scores on the Internalizing and Behavioral Symptoms indexes. Patients who were on-treatment had higher mean overall Internalizing Problems scores, as well as greater Anxiety and Somatization scores, than those who were off-treatment (Wilks’s λ = 0.75, p < .001). Patients treated for brain tumors had lower mean Activities of Daily Living scores than those with other diagnoses ( F = 15.81, p < .001). Conclusions: Findings from this clinically referred sample indicate that while most young children with cancer are doing well psychosocially, approximately 20% to 30% demonstrated difficulties in at least one area. Findings support the need for monitoring of young children with cancer as well as appropriate intervention services.
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Affiliation(s)
- Lauren E. Cox
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ansley E. Kenney
- St. Jude Children’s Research Hospital, Memphis, TN, USA
- University of Memphis, Memphis, TN, USA
| | | | - Niki Jurbergs
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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Harman JL, Molnar AE, Cox LE, Jurbergs N, Russell KM, Wise J, Willard VW. Parent-reported executive functioning in young children treated for cancer. Child Neuropsychol 2018; 25:548-560. [DOI: 10.1080/09297049.2018.1503647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jennifer L. Harman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew E. Molnar
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lauren E. Cox
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathryn M. Russell
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jillian Wise
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Victoria W. Willard
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Abstract
Functional abilities are needed for activities of daily living. In general, these skills expand with age. We hypothesised that, in contrast to what is normally expected, children surviving the Fontan may have deterioration of functional abilities, and that peri-Fontan stroke is associated with this deterioration. All children registered in the Western Canadian Complex Pediatric Therapies Follow-up Program who survived a Fontan operation in the period 1999-2016 were eligible for inclusion. At the age of 2 years (pre-Fontan) and 4.5 years (post-Fontan), the Adaptive Behavior Assessment System-II general adaptive composite score was determined (population mean: 100, standard deviation: 15). Deterioration of functional abilities was defined as ⩾1 standard deviation decrease in pre- to post-Fontan scores. Perioperative strokes were identified through chart review. Multivariable logistic regression analysis determined predictors of deterioration of functional abilities. Of 133 children, with a mean age at Fontan of 3.3 years (standard deviation 0.8) and 65% male, the mean (standard deviation) general adaptive composite score was 90.6 (17.5) at 2 years and 88.3 (19.1) at 4.5 years. After Fontan, deterioration of functional abilities occurred in 34 (26%) children, with a mean decline of 21.8 (7.1) points. Evidence of peri-Fontan stroke was found in 10 (29%) children who had deterioration of functional abilities. Peri-Fontan stroke (odds ratio 5.00 (95% CI 1.74, 14.36)) and older age at Fontan (odds ratio 1.67 (95% CI 1.02, 2.73)) predicted functional deterioration. The trajectory of functional abilities should be assessed in this population, as more than 25% experience deterioration. Efforts to prevent peri-Fontan stroke, and to complete the Fontan operation at an earlier age, may lead to reduction of this deterioration.
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Akella SS, Francis JH, Knezevic A, Ostrovnaya I, Gobin YP, Friedman D, Guarini E, Eibeler L, Catalanotti F, Abramson DH. Growth patterns of survivors of retinoblastoma treated with ophthalmic artery chemosurgery. PLoS One 2018; 13:e0197052. [PMID: 29734385 PMCID: PMC5937785 DOI: 10.1371/journal.pone.0197052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
Although studies from pediatric cancers (largely acute lymphoblastic leukemia) have shown that patients undergoing systemic chemotherapy may experience decreased growth velocity during the treatment phase, no such data exist for retinoblastoma patients treated with systemic chemotherapy or ophthalmic artery chemosurgery (OAC). The purpose of this study is to report growth patterns of our retinoblastoma (Rb) population who were treated with OAC in a retrospective, single center (Memorial Sloan Kettering Cancer Center) review of 341 patients treated between 2006 and 2016. Children who only received OAC were classified as naive; those who were treated initially with systemic chemotherapy and subsequently presented to our center for OAC were termed secondary; and a small group of patients who received single-agent systemic chemotherapy prior to OAC were labeled bridge. For all patients, height and weight were recorded at monthly intervals during OAC (short-term) and then annually during a follow-up period (long-term) up to 3 years after treatment. Excluded from this study were children who received external radiation therapy and those with genetic syndromes, which are independently associated with growth derangements. During OAC, there was no significant difference in growth velocity between the naïve and secondary groups. In either group, number of treatments also did not affect growth rate. Three years after the end of OAC, naïve patients were in the 68th percentile by height (95% CI 61.30, 74.63) compared to secondary patients in the 61st percentile (95% CI 51.1, 71.47). Both groups were in the same weight percentiles during the first two years of follow-up but at the three-year follow-up period, naïve patients were in the 63rd percentile (95% CI 57.4, 69.4) and secondary patients were in the 60th percentile (95% CI 50.4, 69.7). OAC for retinoblastoma does not appear to impact short-term growth velocity, weight gain during the treatment period or after three years.
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Affiliation(s)
- Sruti S. Akella
- Transitional Year Intern, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
| | - Jasmine H. Francis
- Department of Surgery, Ophthalmic Oncology Service Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Ophthalmology, Weill-Cornell School of Medicine, New York, New York, United States of America
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Y. Pierre Gobin
- Department of Radiology and Neurosurgery, New York Presbyterian Hospital, New York, New York, United States of America
| | - Danielle Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Edith Guarini
- Department of Surgery, Ophthalmic Oncology Service Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Lindsey Eibeler
- Department of Surgery, Ophthalmic Oncology Service Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Federica Catalanotti
- Department of Surgery, Ophthalmic Oncology Service Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - David H. Abramson
- Department of Surgery, Ophthalmic Oncology Service Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Ophthalmology, Weill-Cornell School of Medicine, New York, New York, United States of America
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Harman JL, Wise J, Willard VW. Early intervention for infants and toddlers: Applications for pediatric oncology. Pediatr Blood Cancer 2018; 65:e26921. [PMID: 29271555 DOI: 10.1002/pbc.26921] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/01/2017] [Accepted: 11/16/2017] [Indexed: 01/23/2023]
Abstract
Young children (<3 years) with cancer are at risk for delays in development due to their disease and its required treatments and restrictions. In the United States, Part C of the Individuals with Disabilities Education Act describes a system of early intervention (EI) services for young children with delays or the potential for delays in development. Children with cancer may be eligible for EI but are rarely referred. Our objectives are to describe the critical impact of early childhood development on long-term outcomes, review current considerations for EI, and advocate for the referral to EI for young children with cancer.
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Affiliation(s)
- Jennifer L Harman
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jillian Wise
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Victoria W Willard
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Abstract
OBJECTIVE Most children with cancer are diagnosed in early childhood, potentially resulting in missed developmental opportunities. The most common diagnoses-brain tumors, leukemia-are also associated with increased risk of neurocognitive deficits. Unfortunately, research regarding the functioning of preschool-aged children with cancer is limited. Our objective is to describe the cognitive and psychosocial functioning of preschool-aged children with cancer who completed a clinical evaluation at a hospital-based psychology clinic. METHODS Assessment data from 98 preschool-aged children with cancer (M = 5.17 years old, SD = 0.54; 54.1% male) who completed clinically referred evaluations from 2011 to 2015 were abstracted. Because of variability in assessment measures used across clinicians, indicators of cognitive, adaptive, preacademic, and emotional/behavioral functioning were collapsed before analyses. RESULTS Children were 2.56 years from diagnosis (SD = 1.46, range 0-5.25 years) and most were off therapy (79.6%). Primary diagnostic categories were represented: brain tumor (68.4%), solid tumor (15.3%), and leukemia (16.3%). Mean IQ scores were significantly below expectations (t[80] = -7.95, p < .001). There were no differences based on diagnostic category, treatment status, or sex. Adaptive functioning (t[73] = -8.42, p < .001) and preacademic skills (t[77] = -6.20, p < .001) were also significantly below expectations. Mean scores on a measure of parent-reported emotional/behavioral functioning were in the average range. CONCLUSION Young children with cancer may be at significant risk of deficits in intellectual, adaptive, and preacademic functioning. Although our sample is biased by those who were referred for clinical evaluations, the severity of deficits highlights the potential vulnerability of young patients, even before most have entered formal school. Interventions-such as hospital-based preschool programs to increase preacademic skills-should be designed that explicitly target preschool-aged children and focus on a wide range of domains.
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Willard VW, Qaddoumi I, Zhang H, Huang L, Russell KM, Brennan R, Wilson MW, Rodriguez-Galindo C, Phipps S. A longitudinal investigation of parenting stress in caregivers of children with retinoblastoma. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26279. [PMID: 27808461 PMCID: PMC5584625 DOI: 10.1002/pbc.26279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retinoblastoma is typically diagnosed in young children and may present unique parenting challenges. Qualitative research suggests that parents experience distress related to the initial diagnosis and treatment that subsequently resolves. The objectives were to systematically assess parenting stress over time in parents of young children with retinoblastoma and to examine associations between parenting stress and child outcomes. PROCEDURES Parents of children with retinoblastoma completed the Parenting Stress Index (PSI) during serial psychological assessments scheduled based on the child's age (6 months to 5 years). Caregivers of 92 patients (85.9% mothers) completed the assessments. Child outcomes included developmental functioning and parent-reported adaptive functioning. RESULTS At baseline and age 5, all subscales on the PSI were within normal limits, and most were significantly below normative means (i.e., demonstrating low levels of stress). All domains remained relatively stable over time. Associations between parenting stress and child outcomes were much stronger at age 5 than at baseline. Child-directed parenting stress was a small but significant contributor to declines in child functioning over time. CONCLUSIONS Parents of children with retinoblastoma report normal levels of parenting stress while their children are young. However, baseline parenting stress appears to contribute to changes in child functioning over time. Future studies should assess illness-related aspects of adjustment to further understand the parenting experience of young children with cancer and/or having a visually impaired child.
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Affiliation(s)
| | | | - Hui Zhang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | - Lu Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital
| | | | - Rachel Brennan
- Department of Oncology, St. Jude Children’s Research Hospital
| | - Matthew W. Wilson
- Department of Surgery, St. Jude Children’s Research Hospital,Department of Ophthalmology, University of Tennessee
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital
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Chinnery H, Thompson SBN, Noroozi S, Dyer B, Rees K. Questionnaire study to gain an insight into the manufacturing and fitting process of artificial eyes in children: an ocularist perspective. Int Ophthalmol 2016; 37:1175-1183. [PMID: 27796730 PMCID: PMC5633635 DOI: 10.1007/s10792-016-0383-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 12/04/2022]
Abstract
Purpose To gain an insight into the manufacturing and fitting of artificial eyes in children and potential improvements to the process. Method An online qualitative survey was distributed to 39 ocularists/prosthetists in Europe and Canada. Participants were recruited through purposive sampling, specifically maximum variation sampling from the researcher’s contacts and an online search. Results The findings highlighted the current impression technique as being the most difficult yet most important part of the current process for both the ocularist and child patient. Negatively affecting obtaining a good impression, the child patients distress can be reduced by their parents by providing encouragement, reassurance, practicing the insertion and removal of the artificial eye and being matter of fact. Whilst improvements to the current process provided mixed views, the incorporation of current technology was perceived as not being able to meet the requirements to produce aesthetically pleasing artificial eyes. Conclusion The current artificial eye process can be seen as an interaction with its success being dependent on the child patient’s acceptance and adjustment which is dependent on the factors associated to the process. Investigation into the needs of the patient and whether technology can improve the process are the next steps in its advancement.
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Affiliation(s)
- Holly Chinnery
- Psychology Research Centre, Faculty of Science & Technology, Bournemouth University, P104, Poole House, Talbot Campus, Fern Barrow, Poole, Dorset, BH12 5BB, UK.
| | - Simon B N Thompson
- Clinical Psychology and Neuropsychology, Psychology Research Centre, Faculty of Science & Technology, Bournemouth University, Poole, UK
| | - Siamak Noroozi
- Design Simulation Research Centre, Faculty of Science and Technology, Department of Design and Engineering, Bournemouth University, Poole, UK
| | - Bryce Dyer
- Research & Professional Practice and Principal Academic, Faculty of Science and Technology, Department of Design and Engineering, Bournemouth University, Poole, UK
| | - Karen Rees
- Public Health/Health Visiting, Faculty of Health and Social Science, Department of Nursing and Clinical Science, Bournemouth University, Poole, UK
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Sparrow J, Brennan R, Mao S, Ness KK, Rodriguez-Galindo C, Wilson M, Qaddoumi I. Participation in an occupational therapy referral program for children with retinoblastoma. J Pediatr Rehabil Med 2016; 9:117-24. [PMID: 27285804 PMCID: PMC4939593 DOI: 10.3233/prm-160372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Because retinoblastoma typically arises at a very young age, children are particularly vulnerable to vision impairment, associated developmental delays, and functional limitations. Limited information is available describing developmental delay and functional limitations in this population, necessitating supportive services including rehabilitation. The aims of this study were to describe the participation of children with newly diagnosed retinoblastoma in an occupational therapy program that identifies children in need of rehabilitation services. We also identify indications for referral to rehabilitation services among children with newly diagnosed retinoblastoma and enumerate the likelihood of these children receiving the recommended services. METHODS Twenty-two children participated in longitudinal occupational therapy assessments during the first year after diagnosis. RESULTS We recommended 1 or more types of rehabilitation services for 16 of 22 (72.7%) participants. Twelve of 16 (75%) received services. CONCLUSIONS The results of this pilot study indicate that implementing a prospective occupational therapy-screening program is feasible and results in identification and initiation of therapy services in some children with retinoblastoma. Developmental screenings and follow-up of children with retinoblastoma is strongly recommended.
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Affiliation(s)
- Jessica Sparrow
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rachel Brennan
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Matthew Wilson
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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Abstract
In recent years, there have been dramatic changes in the management of intraocular retinoblastoma. Intraocular retinoblastoma is a highly curable malignancy and current treatments are aimed to preserve vision while reducing the late effects such as treatment-induced secondary malignancies. The advent of intra-arterial chemotherapy changed the treatment paradigm from systemic treatment with chemotherapy to local treatment, and new questions emerged. While intra-arterial chemotherapy achieved encouraging results, only experience from major referral centers is reported, so its indications, advantages and risks are still to be elucidated. Many factors should be considered when choosing the appropriate conservative therapy. When the disease has extended outside the eye, the chances of cure are significantly lower and treatment should be tailored by the presence of pathology risk factors such as invasion of the choroid, the optic nerve, and the sclera. Adjuvant therapy is decided upon this information. Children with overt extraocular disease are treated with higher dose neoadjuvant therapy followed by delayed enucleation and adjuvant therapy.
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