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Caton L, Duprez C, Flahault C, Lervat C, Antoine P, Calvez A, Lamore K. A Qualitative Study on the Transition from Pediatric to Adult Care in Oncology: How Health Care Professionals Can Adapt Their Practice? J Adolesc Young Adult Oncol 2024. [PMID: 39193765 DOI: 10.1089/jayao.2024.0071] [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: 08/29/2024] Open
Abstract
Purpose: The main objective of this study was to identify the facilitators of and barriers to the transition from pediatric to adult care for adolescents and young adults (AYAs) with cancer according to physicians and nurses working in oncology. The secondary objectives were (1) to explore the viewpoints of health care professionals (HCPs) on this transition and (2) to discover HCP's needs and the needs they perceive among AYAs and their parents. Methods: Semistructured interviews were conducted with 19 HCPs to discover their experiences with pediatric to adult care transitions. Thematic analysis was then conducted. Results: Participants reported that transitioning is a complex process influenced by numerous barriers and facilitators, which can be classified into four themes: (1) balancing the needs and relationships of the three actors involved in the transition process, (2) factors that enable HCPs to determine the ideal time for transitions, (3) institutional and organizational barriers and facilitators that challenge HCPs, and (4) HCPs' reflections on defining and improving the transition process. Conclusion: Beyond the lack of human and financial resources, which hinders the structuring of transitions, our results suggest the need for a paradigm shift. That is, the position given to AYAs in pediatrics before the transition needs to evolve so that they are gradually positioned at the center of the relationship with HCPs and, therefore, are the focus of care and the transition process. This will enable them to acquire the skills, knowledge, and autonomy needed for a successful transition to adult care.
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Affiliation(s)
- Laura Caton
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Christelle Duprez
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Cécile Flahault
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Boulogne-Billancourt, France
| | - Cyril Lervat
- Unité d'oncologie pédiatrique, d'adolescents et jeunes adultes, Centre Oscar Lambret, Lille, France
| | - Pascal Antoine
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Alice Calvez
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Kristopher Lamore
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences cognitives et Sciences Affectives, Villeneuve d'Ascq, France
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Bashiri FA, Hundallah K, Abukhaled M, Alyahya MM, Al Futaisi A, Alshowaeir D, Al Tawari A, Abdullah S, Maaz AUR, AlShamsi ET, Alshuaibi W, Alotaibi F, Aldhalaan H. Diagnosis and management of neurofibromatosis type 1 in Arabian Gulf Cooperation Council Region: challenges and recommendations. Front Oncol 2024; 14:1323176. [PMID: 39257551 PMCID: PMC11385870 DOI: 10.3389/fonc.2024.1323176] [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: 03/12/2024] [Accepted: 08/05/2024] [Indexed: 09/12/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) is a complex multisystem genetic disorder that requires long-term, age-specific monitoring and multidisciplinary care. NF1 symptom burden can significantly affect the quality of life and impose a substantial economic burden on patients and their families. The approval and widespread availability of mitogen-activated protein kinase (MEK) inhibitors such as selumetinib for NF1-related plexiform neurofibromas have revolutionized the standard of care for patients with NF1, however their effective utilization hinges on early recognition of NF1. We present a consensus manuscript describing the challenges observed in the Arabian Gulf Cooperation Council (GCC) for diagnosing and managing NF1. Experts from the GCC also present recommendations for the early recognition and management of NF1 and its complications. A referral pathway that can play a crucial role in helping primary healthcare providers refer their patients to experts is also proposed. Increasing the availability and accessibility of genetic testing at an affordable cost and optimizing personalized NF1 care are essential for NF1 management. Developing regional guidelines for NF1 management and establishing NF1 centers of excellence may facilitate better care and outcomes for patients with NF1 in the GCC region.
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Affiliation(s)
- Fahad A Bashiri
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | - Musaad Abukhaled
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Mossaed Mohammed Alyahya
- Consultant of Neuro-oncology and Neuromuscular-neurology, Department of Oncology, King Faisal Specialist Hospital and Research Centre, Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Al Faisal University, Riyadh, Saudi Arabia
| | - Amna Al Futaisi
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - Daniah Alshowaeir
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asmaa Al Tawari
- Pediatric Neurology Unit, Pediatric Department, AlSabah Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Shaker Abdullah
- Department of Oncology, King Faisal Specialist Hospital & Research Center - Jeddah (KFSHRC-Jed), Jeddah, Saudi Arabia
| | - Ata Ur Rehman Maaz
- HemOnc Division, Department of Child Health, Sidra Medicine, Doha, Qatar
| | - Eman Taryam AlShamsi
- Pediatric Hematology-Oncology Department, Al Jalila children's specialty Hospital, Dubai, United Arab Emirates
| | - Walaa Alshuaibi
- Division of Medical Genetics, Department of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alotaibi
- Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hesham Aldhalaan
- Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Siegel A, Lockridge R, Struemph KL, Toledo-Tamula MA, Little P, Wolters PL, Dufek A, Tibery C, Baker M, Wideman BC, Martin S. Perceived transition readiness among adolescents and young adults with neurofibromatosis type 1 and plexiform neurofibromas: a cross-sectional descriptive study. J Pediatr Psychol 2024; 49:383-391. [PMID: 38366576 PMCID: PMC11175589 DOI: 10.1093/jpepsy/jsae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is a genetic cancer predisposition syndrome that can impact multiple organ systems and is associated with plexiform neurofibroma tumors, requiring care from birth through adulthood. Adolescents and young adults (AYAs) with NF1 face several barriers to transition from pediatric to adult care. This cross-sectional study aimed to assess transition readiness in this population and to evaluate relationships between specific NF1 symptoms and transition readiness. METHODS AYAs (aged 16-24) enrolled in existing studies related to NF1 were eligible. AYAs and their parents completed measures of transition readiness (Transition Readiness Assessment Questionnaire version 4 [TRAQ-4]), and AYAs also completed a transition readiness interview (UNC TRxANSITION). RESULTS Thirty-eight AYAs (mean age = 19.95 ± 2.68 years) participated in the study. Average TRAQ scores indicated that AYAs were still learning Self-Management skills (M = 3.37, SD = 1.08) and Self-Advocacy skills (M = 3.98, SD = 0.67). Older AYAs had higher TRAQ scores for Self-Management (r = 0.70, p < .001) and Self-Advocacy (r = 0.41, p = .011) than younger AYAs. Parents and AYAs had similar TRAQ scores. About one third of AYAs (37.8%, n = 14) expressed uncertainty about how NF1 might affect them in the future. The remaining AYAs mostly expressed concerns regarding tumor growth, pain, or cancer. CONCLUSIONS In this small study, preliminary findings suggest that AYAs with NF1 express confidence in many areas of transition readiness but continue to require support, particularly with Self-Management skills. Given the gaps in understanding of future health risks, AYAs with NF1 would benefit from early assessment, psychoeducation, and support for transition readiness to adult care.
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Affiliation(s)
- Atara Siegel
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Robin Lockridge
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Kari L Struemph
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Mary Anne Toledo-Tamula
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Paige Little
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Cecilia Tibery
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Melissa Baker
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte C Wideman
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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Sanzone EM, Sanzone K, Tirado Z, Rostain A, Koola M. Pediatric Patient With Neurofibromatosis I Presenting With Perceptual Disturbances and a Suicide Attempt. Cureus 2024; 16:e62237. [PMID: 39006636 PMCID: PMC11243691 DOI: 10.7759/cureus.62237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/16/2024] Open
Abstract
This is a case of a pediatric patient with a history of neurofibromatosis I (NFI) presenting to the emergency department secondary to a suicide attempt via self-strangulation after being verbally and physically bullied at school. Upon hospital admission, the 10-year-old patient was found to have significant auditory and visual perceptual hallucinations in addition to suicidal ideations, for which psychiatry was consulted. The patient underwent magnetic resonance imaging (MRI) of the brain to evaluate for intracranial neurofibromas as a potential etiology of his behavior. There is evidence that the growth of neurofibromas in the brain can be associated with psychosis. His brain MRI was significant for multiple foci of non-enhancing lesions seen in the cerebellum, white matter, supratentorial white matter, and bilateral hippocampi that can be seen in NFI, highlighting a medical etiology for the patient's auditory and visual perceptual disturbances. The objective of this case report is to explore medical causes of psychosis including metabolic disorders, neurodegenerative diseases, metabolic disturbances, parathyroid diseases, genetic disorders (Fragile X, Prader-Willi, etc.), autoimmune disorders, multiple sclerosis, temporal lobe epilepsy, infections, and brain tumors.
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Affiliation(s)
- Erin M Sanzone
- Physical Medical and Rehabilitation, Cooper Medical School at Rowan University, Camden, USA
| | | | - Zoe Tirado
- Psychiatry, Cooper University Hospital, Camden, USA
| | - Anthony Rostain
- Psychiatry and Behavioral Health, Cooper University Hospital, Camden, USA
| | - Maju Koola
- Psychiatry, Cooper University Hospital, Camden, USA
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Kerashvili N, Gutmann DH. The management of neurofibromatosis type 1 (NF1) in children and adolescents. Expert Rev Neurother 2024; 24:409-420. [PMID: 38406862 DOI: 10.1080/14737175.2024.2324117] [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: 01/05/2024] [Accepted: 02/23/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is a rare neurogenetic disorder characterized by multiple organ system involvement and a predisposition to benign and malignant tumor development. With revised NF1 clinical criteria and the availability of germline genetic testing, there is now an opportunity to render an early diagnosis, expedite medical surveillance, and initiate treatment in a prompt and targeted manner. AREAS COVERED The authors review the spectrum of medical problems associated with NF1, focusing specifically on children and young adults. The age-dependent appearance of NF1-associated features is highlighted, and the currently accepted medical treatments are discussed. Additionally, future directions for optimizing the care of this unique population of children are outlined. EXPERT OPINION The appearance of NF1-related medical problems is age dependent, requiring surveillance for those features most likely to occur at any given age during childhood. As such, we advocate a life stage-focused screening approach beginning in infancy and continuing through the transition to adult care. With early detection, it becomes possible to promptly institute therapies and reduce patient morbidity. Importantly, with continued advancement in our understanding of disease pathogenesis, future improvements in the care of children with NF1 might incorporate improved risk assessments and more personalized molecularly targeted treatments.
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Affiliation(s)
- Nino Kerashvili
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Goetsch Weisman A, Weiss McQuaid S, Radtke HB, Stoll J, Brown B, Gomes A. Neurofibromatosis- and schwannomatosis-associated tumors: Approaches to genetic testing and counseling considerations. Am J Med Genet A 2023; 191:2467-2481. [PMID: 37485904 DOI: 10.1002/ajmg.a.63346] [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: 03/25/2023] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
Neurofibromatosis (NF) and schwannomatosis (SWN) are genetic conditions characterized by the risk of developing nervous system tumors. Recently revised diagnostic criteria include the addition of genetic testing to confirm a pathogenic variant, as well as to detect the presence of mosaicism. Therefore, the use and interpretation of both germline and tumor-based testing have increasing importance in the diagnostic approach, treatment decisions, and risk stratification of these conditions. This focused review discusses approaches to genetic testing of NF- and SWN-related tumor types, which are somewhat rare and perhaps lesser known to non-specialized clinicians. These include gastrointestinal stromal tumors, breast cancer, plexiform neurofibromas with or without transformation to malignant peripheral nerve sheath tumors, gliomas, and schwannomas, and emphasizes the need for inclusion of genetic providers in patient care and appropriate pre- and post-test education, genetic counseling, and focused evaluation by a medical geneticist or other healthcare provider familiar with clinical manifestations of these disorders.
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Affiliation(s)
- Allison Goetsch Weisman
- Division of Genetics, Genomics and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shelly Weiss McQuaid
- Division of Genetics, Genomics and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Oncology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Heather B Radtke
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children's Tumor Foundation, New York, New York, USA
| | | | - Bryce Brown
- Medical Genomics Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alicia Gomes
- Medical Genomics Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Telman G, Strauss E, Sosnowska-Sienkiewicz P, Halasz M, Januszkiewicz-Lewandowska D. Simultaneous Occurrence of Multiple Neoplasms in Children with Cancer Predisposition Syndromes: Collaborating with Abnormal Genes. Genes (Basel) 2023; 14:1670. [PMID: 37761810 PMCID: PMC10530991 DOI: 10.3390/genes14091670] [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: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
The identification of cancer predisposition syndromes (CPSs) plays a crucial role in understanding the etiology of pediatric cancers. CPSs are genetic mutations that increase the risk of developing cancer at an earlier age compared to the risk for the general population. This article aims to provide a comprehensive analysis of three unique cases involving pediatric patients with CPS who were diagnosed with multiple simultaneous or metachronous cancers. The first case involves a child with embryonal rhabdomyosarcoma, nephroblastoma, glioma, and subsequent medulloblastoma. Genetic analysis identified two pathogenic variants in the BRCA2 gene. The second case involves a child with alveolar rhabdomyosarcoma, juvenile xanthogranuloma, gliomas, and subsequent JMML/MDS/MPS. A pathogenic variant in the NF1 gene was identified. The third case involves a child with pleuropulmonary blastoma and pediatric cystic nephroma/nephroblastoma, in whom a pathogenic variant in the DICER1 gene was identified. Multiple simultaneous and metachronous cancers in pediatric patients with CPSs are a rare but significant phenomenon. Comprehensive analysis and genetic testing play significant roles in understanding the underlying mechanisms and guiding treatment strategies for these unique cases. Early detection and targeted interventions are important for improving outcomes in these individuals.
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Affiliation(s)
- Gabriela Telman
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland; (G.T.)
| | - Ewa Strauss
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland;
| | - Patrycja Sosnowska-Sienkiewicz
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland;
| | - Magdalena Halasz
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland; (G.T.)
| | - Danuta Januszkiewicz-Lewandowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572 Poznan, Poland; (G.T.)
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