1
|
Wang Y, Rae C, Tsangaris E, Nathan PC, Bouffet E, Dix D, Wong Riff K, Klassen A. Establishing Reliability and Validity of the FACE-Q Craniofacial Module for Pediatric Head and Neck Cancer. J Adolesc Young Adult Oncol 2024; 13:307-315. [PMID: 37852001 DOI: 10.1089/jayao.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Purpose: We aimed to establish content validity and assess the psychometric properties of the FACE-Q Craniofacial Module, a patient-reported outcome measure, for use in pediatric and adolescent patients with head and neck cancer (HNC). Methods: To establish content validity (Part 1), between June 2017 and August 2019, cognitive interviews were conducted with survivors of pediatric HNC (n = 15), and input was obtained from clinical experts (n = 21). To examine item and scale performance (Part 2), Rasch Measurement Theory (RMT) analysis was performed using data from two international studies (n = 121). Results: Part 1: Qualitative data from 15 survivors and input from 21 experts provided evidence to support the use of the FACE-Q Craniofacial Module in pediatric HNC. Part 2: The field-test study sample included 121 survivors of pediatric HNC. RMT analysis provided evidence of reliability and validity for 10 FACE-Q scales. Data for each scale fit the RMT model. Scale reliability was high, with Person Separation Index and Cronbach's alpha values ≥0.82 for 9 scales. Mean scores on the Appearance, Psychological, and Social scales were higher for those who liked aspects of their face more. For participants with (vs. without) a facial difference, mean scores were lower for the Face, Jaws, Psychological, and Social scales. Conclusion: The FACE-Q Craniofacial Module evidenced reliability and validity for HNC survivors aged 8-29 years and can be used in research and clinical care to measure quality of life of pediatric survivors with HNC.
Collapse
Affiliation(s)
- Yi Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Tsangaris
- Patient Reported Outcomes Values and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Dix
- Oncology/Hematology/BMT Program, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Karen Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Evageliou N, Renfro LA, Geller J, Perlman E, Kalapurakal J, Paulino A, Dix D, Eklund MJ, Murphy AJ, Romao RLP, Ehrlich PF, Varela CR, Vallance K, Fernandez Hon CV, Dome JS, Mullen EA. Prognostic impact of lymph node involvement and loss of heterozygosity of 1p or 16q in stage III favorable histology Wilms tumor: A report from Children's Oncology Group Studies AREN03B2 and AREN0532. Cancer 2024; 130:792-802. [PMID: 37902955 PMCID: PMC10993001 DOI: 10.1002/cncr.35084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The prognostic impact of positive lymph nodes (LN+) and/or singular loss of heterozygosity (LOH) of 1p or 16q were assessed in children with stage III favorable histology Wilms tumor (FHWT) enrolled on AREN0532 or AREN03B2 alone. PATIENTS AND METHODS A total of 635 stage III FHWT vincristine/dactinomycin/doxorubicin (DD4A)-treated patients met inclusion criteria. Event-free survival (EFS) and overall survival are reported overall and by LN sampling, LN status, LOH 1p, LOH 16q, and a combination of LN status and singular LOH. Patients with unknown or positive combined LOH of 1p and 16q status and AREN03B2-only patients with unknown outcomes or treatment other than DD4A were excluded. RESULTS EFS did not differ by study, supporting pooling. Lack of LN sampling (hazard ratio [HR], 2.12; p = .0037), LN positivity (HR, 2.78; p = .0002), LOH 1p (HR, 2.18; p = .0067), and LOH 16q (HR, 1.72; p = .042) were associated with worse EFS. Compared with patients with both LN- and LOH-, those with negative nodes but positive LOH 1p or 16q and those with LN+ but LOH- for 1p or 16q had significantly worse EFS (HR, 3.05 and 3.57, respectively). Patients positive for both LN and LOH had the worst EFS (HR, 6.33; overall group factor, p < .0001). CONCLUSION Findings confirm LN+ status as an adverse prognostic factor amplified by presence of singular LOH 1p or 16q, supporting study of intensified therapy for patients with LN+ in combination with singular LOH in a prospective clinical trial.
Collapse
Affiliation(s)
- Nicholas Evageliou
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California and Children’s Oncology Group, Monrovia, CA
| | - James Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, the Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago IL
| | - John Kalapurakal
- Department of Radiation Oncology, Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Arnold Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - David Dix
- Division of Oncology, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Meryle J Eklund
- Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Rodrigo LP Romao
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Peter F Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carly R Varela
- Janssen Research and Development, Spring House, PA. (At the time of this work affiliation was Division of Oncology, Children’s National Hospital, Divisions of Pediatric Hematology and Oncology, Inova Fairfax Hospital and Department of Pediatrics, George Washington University School of Medicine, Falls Church, Virginia.)
| | - Kelly Vallance
- Division of Hematology and Oncology, Cook Children’s Hospital, Fort Worth, TX
| | - Conrad V Fernandez Hon
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children’s National Hospital and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children’s Blood Disorders and Cancer Center, MA, USA
| |
Collapse
|
3
|
Tomlinson D, Dupuis LL, Dix D, Crellin-Parsons N, Cook S, Kulkarni K, Schechter T, Tomlinson GA, Sung L. Validation of co-Symptom Screening in Pediatrics Tool: a novel dyadic approach to symptom screening in pediatric patients receiving cancer treatment. J Natl Cancer Inst 2024; 116:160-166. [PMID: 37672037 DOI: 10.1093/jnci/djad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Co-Symptom Screening in Pediatrics Tool (co-SSPedi) is a dyadic (child-guardian) approach to symptom assessment. Objectives were to evaluate the reliability and validity of co-SSPedi for pediatric patients receiving cancer treatments. METHODS This multicenter study included dyads of patients aged 4-18 years of age with cancer or undergoing hematopoietic cell transplant and their guardians. Two groups were enrolled. The more symptomatic group included those receiving active treatment for cancer or undergoing hematopoietic cell transplant where patients were in hospital or clinic for 4 consecutive days. The less symptomatic group included those receiving maintenance therapy for acute lymphoblastic leukemia or who had completed cancer treatments. At baseline, all dyads completed co-SSPedi, and guardians completed measures of mucositis, nausea, pain, quality of life, and overall symptoms. In the more symptomatic group, dyads completed co-SSPedi and a global symptom change scale on day 4. RESULTS There were 501 dyads included: 301 in the more symptomatic group and 200 in the less symptomatic group. Median time to complete co-SSPedi was less than 3 minutes in both groups. Test-retest reliability intraclass correlation coefficient was 0.85 (95% confidence interval [CI] = 0.77 to 0.90). For internal consistency, total co-SSPedi Cronbach alpha was 0.81 (95% CI = 0.78 to 0.83). For known groups validation, mean difference in total co-SSPedi scores between the more symptomatic and less symptomatic groups was 7.8 (95% CI = 6.7 to 8.8; P < .0001). For convergent validation and responsiveness, all hypothesized relationships were demonstrated. CONCLUSIONS Co-SSPedi is a novel approach to dyadic symptom assessment that is reliable, valid, and responsive in pediatric patients aged 4-18 years.
Collapse
Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Nicole Crellin-Parsons
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Sadie Cook
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Ketan Kulkarni
- Division of Hematology-Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
4
|
John L, Smith H, Ilanchezhian M, Lockridge R, Reilly KM, Raygada M, Dombi E, Sandler A, Thomas BJ, Glod J, Miettinen M, Allen T, Sommer J, Levy J, Lozinsky S, Dix D, Bouffet E, MacDonald S, Mukherjee D, Snyderman CH, Rowan NR, Malyapa R, Park DM, Heery C, Gardner PA, Cote GM, Fuller S, Butman JA, Jackson S, Gulley JL, Widemann BC, Wedekind MF. The NIH pediatric/young adult chordoma clinic and natural history study: Making advances in a very rare tumor. Pediatr Blood Cancer 2023; 70:e30358. [PMID: 37347686 PMCID: PMC10739575 DOI: 10.1002/pbc.30358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Chordomas are rare tumors arising from the skull base and spine, with approximately 20 pediatric chordoma cases in the Unitedn States per year. The natural history and optimal treatment of pediatric chordomas, especially poorly differentiated and dedifferentiated subtypes, is incompletely understood. Herein, we present findings from our first National Cancer Institute (NCI) chordoma clinic and a retrospective analysis of published cases of pediatric poorly differentiated chordomas (PDC) and dedifferentiated chordomas (DC). METHODS Patients less than 40 years old with chordoma were enrolled on the NCI Natural History and Biospecimens Acquisitions Study for Children and Adults with Rare Solid Tumors protocol (NCT03739827). Chordoma experts reviewed patient records, evaluated patients, and provided treatment recommendations. Patient-reported outcomes, biospecimens, and volumetric tumor analyses were collected. A literature review for pediatric PDC and DC was conducted. RESULTS Twelve patients (median age: 14 years) attended the clinic, including four patients with active disease and three patients with PDC responsive to systemic therapy. Consensus treatment, management, and recommendations were provided to patients. Literature review returned 45 pediatric cases of PDC or DC with variable treatments and outcomes. CONCLUSIONS A multidisciplinary expert clinic was feasible and successful in improving understanding of pediatric chordoma. While multimodal approaches have all been employed, treatment for PDC has been inconsistent and a recommended standardized treatment approach has not been defined. Centralized efforts, inclusive of specialized chordoma-focused clinics, natural history studies, and prospective analyses will help in the standardization of care for this challenging disease.
Collapse
Affiliation(s)
- Liny John
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Hannah Smith
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Maran Ilanchezhian
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Robin Lockridge
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Karlyne M Reilly
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Margarita Raygada
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Abby Sandler
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Barbara J Thomas
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Markku Miettinen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Taryn Allen
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | | | - Joan Levy
- Chordoma Foundation, Durham, NC, USA
| | | | - David Dix
- BC Children’s Hospital, Vancouver, Canada
| | | | | | | | | | | | - Robert Malyapa
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Christopher Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Paul A. Gardner
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Sarah Fuller
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John A. Butman
- Radiology and Imaging Sciences, The National Institutes of Health, Bethesda, MD, USA
| | - Sadhana Jackson
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - James L. Gulley
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mary Frances Wedekind
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
5
|
Walz AL, Maschietto M, Crompton B, Evageliou N, Dix D, Tytgat G, Gessler M, Gisselsson D, Daw NC, Wegert J. Tumor biology, biomarkers, and liquid biopsy in pediatric renal tumors. Pediatr Blood Cancer 2023; 70 Suppl 2:e30130. [PMID: 36592003 DOI: 10.1002/pbc.30130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 01/03/2023]
Abstract
The expansion of knowledge regarding driver mutations for Wilms tumor (WT) and malignant rhabdoid tumor of the kidney (MRT) and various translocations for other pediatric renal tumors opens up new possibilities for diagnosis and treatment. In addition, there are growing data surrounding prognostic factors that can be used to stratify WT treatment to improve outcomes. Here, we review the molecular landscape of WT and other pediatric renal tumors as well as WT prognostic factors. We also review incorporation of circulating tumor DNA/liquid biopsies to leverage this molecular landscape, with potential use in the future for distinguishing renal tumors at the time of diagnosis and elucidating intratumor heterogeneity, which is not well evaluated with standard biopsies. Incorporation of liquid biopsies will require longitudinal collection of multiple biospecimens. Further preclinical research, identification and validation of biomarkers, molecular studies, and data sharing among investigators are crucial to inform therapeutic strategies that improve patient outcomes.
Collapse
Affiliation(s)
- Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Campinas, São Paulo, Brazil
| | - Brian Crompton
- Department of Pediatric Oncology, Dana-Farber/Harvard Cancer Center, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nicholas Evageliou
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Dix
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, CS Utrecht, The Netherlands
| | - Manfred Gessler
- Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany.,Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, University of Wuerzburg, Wuerzburg, Germany
| | - David Gisselsson
- Cancer Cell Evolution Unit, Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jenny Wegert
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
6
|
Suresh S, Dix D, Wang L, Blydt-Hansen TD. High urinary CXCL10/Cr with onset of Burkitt lymphoma in a pediatric kidney transplant recipient. Pediatr Transplant 2022; 26:e14354. [PMID: 35869900 DOI: 10.1111/petr.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/08/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urinary CXCL10/Cr is a promising diagnostic tool for early detection of TCMR in pediatric transplant recipients, and most studies focus on its utility in the context of localized allograft inflammation thus far. Other sources of inflammation that may be detected by CXCL10 are less clear. METHODS We present a case review of a patient with BL, who was enrolled in a prospective trial of urinary CXCL10 monitoring. To evaluate the potential confounding, we tested for association of CXCL10/Cr and EBV viral load in a prospective cohort of pediatric transplant recipients with serial testing for urinary CXCL10/Cr. RESULTS This report describes a 15-year-old boy, 3.5 years post-transplant with chronic EBV viremia, stable kidney function and no history of rejection. Urinary CXCL10/Cr level increased acutely to 79.43 ng/mmol, 0.8 months prior to onset of BL, identified by a surge in EBV viral load. In a national cohort of 97 pediatric kidney transplant recipients, there was no association between urinary CXCL10/Cr with EBV viral loads when comparing periods of pre-viremia (5.8 ± 9.2 ng/mmol) to active viremia (4.0 ± 5.3 ng/mmol) and periods of active viremia (7.1 ± 8.9 ng/mmol) to post-viremia (4.4 ± 9.8 ng/mmol). CONCLUSIONS Acute rise in urinary CXCL10/Cr was associated with onset of graft-associated BL. We were not able to confirm a general association of EBV viral load and urinary CXCL10. As non-invasive monitoring is implemented using biomarkers like CXCL10 in the clinic, attention will be needed to identify other uncommon, potential sources of CXCL10 elevation.
Collapse
Affiliation(s)
- Shwetha Suresh
- The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Dix
- Oncology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Li Wang
- Pathology & Laboratory Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Nephrology, BC Children's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Madanat-Harjuoja LM, Renfro LA, Klega K, Tornwall B, Thorner AR, Nag A, Dix D, Dome JS, Diller LR, Fernandez CV, Mullen EA, Crompton BD. Circulating Tumor DNA as a Biomarker in Patients With Stage III and IV Wilms Tumor: Analysis From a Children's Oncology Group Trial, AREN0533. J Clin Oncol 2022; 40:3047-3056. [PMID: 35580298 PMCID: PMC9462535 DOI: 10.1200/jco.22.00098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The utility of circulating tumor DNA (ctDNA) analyses has not been established in the risk stratification of Wilms tumor (WT). We evaluated the detection of ctDNA and selected risk markers in the serum and urine of patients with WT and compared findings with those of matched diagnostic tumor samples. PATIENTS AND METHODS Fifty of 395 children with stage III or IV WT enrolled on Children's Oncology Group trial AREN0533 had banked pretreatment serum, urine, and tumor available. Next-generation sequencing was used to detect ctDNA. Copy-number changes in 1q, 16q, and 1p, and single-nucleotide variants in serum and urine were compared with tumor biopsy data. Event-free survival (EFS) was compared between patients with and without ctDNA detection. RESULTS ctDNA was detected in the serum of 41/50 (82%) and in the urine in 13/50 (26%) patients. Agreement between serum ctDNA detection and tumor sequencing results was as follows: 77% for 1q gain, 88% for 16q deletions, and 70% for 1p deletions, with ĸ-coefficients of 0.56, 0.74, and 0.29, respectively. Sequencing also demonstrated that single-nucleotide variants detected in tumors could be identified in the ctDNA. There was a trend toward worse EFS in patients with ctDNA detected in the serum (4-year EFS 80% v 100%, P = .14). CONCLUSION ctDNA demonstrates promise as an easily accessible prognostic biomarker with potential to detect tumor heterogeneity. The observed trend toward more favorable outcome in patients with undetectable ctDNA requires validation. ctDNA profiling should be further explored as a noninvasive diagnostic and prognostic tool in the risk-adapted treatment of patients with WT.
Collapse
Affiliation(s)
| | | | - Kelly Klega
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Brett Tornwall
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Aaron R. Thorner
- Center for Cancer Genomics, Dana-Farber Cancer Institute, Boston, MA
| | - Anwesha Nag
- Center for Cancer Genomics, Dana-Farber Cancer Institute, Boston, MA
| | - David Dix
- BC Children's Hospital, Vancouver, BC, Canada
| | - Jeffrey S. Dome
- Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lisa R. Diller
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | | | - Brian D. Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
| |
Collapse
|
8
|
Mazzone P, Velculescu V, Dix D, Kotagiri S, Sun L, Allen S, Jakubowski D, Leal A, Scharpf R, Bach P, Maddala T. EP01.01-003 DELFI-L101: Development of a Blood-Based Assay That Evaluates Cell-Free DNA Fragmentation Patterns to Detect Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Williamson LM, Rive CM, Di Francesco D, Titmuss E, Chun HJE, Brown SD, Milne K, Pleasance E, Lee AF, Yip S, Rosenbaum DG, Hasselblatt M, Johann PD, Kool M, Harvey M, Dix D, Renouf DJ, Holt RA, Nelson BH, Hirst M, Jones SJM, Laskin J, Rassekh SR, Deyell RJ, Marra MA. Clinical response to nivolumab in an INI1-deficient pediatric chordoma correlates with immunogenic recognition of brachyury. NPJ Precis Oncol 2021; 5:103. [PMID: 34931022 PMCID: PMC8688516 DOI: 10.1038/s41698-021-00238-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023] Open
Abstract
Poorly differentiated chordoma (PDC) is a recently recognized subtype of chordoma characterized by expression of the embryonic transcription factor, brachyury, and loss of INI1. PDC primarily affects children and is associated with a poor prognosis and limited treatment options. Here we describe the molecular and immune tumour microenvironment profiles of two paediatric PDCs produced using whole-genome, transcriptome and whole-genome bisulfite sequencing (WGBS) and multiplex immunohistochemistry. Our analyses revealed the presence of tumour-associated immune cells, including CD8+ T cells, and expression of the immune checkpoint protein, PD-L1, in both patient samples. Molecular profiling provided the rationale for immune checkpoint inhibitor (ICI) therapy, which resulted in a clinical and radiographic response. A dominant T cell receptor (TCR) clone specific for a brachyury peptide-MHC complex was identified from bulk RNA sequencing, suggesting that targeting of the brachyury tumour antigen by tumour-associated T cells may underlie this clinical response to ICI. Correlative analysis with rhabdoid tumours, another INI1-deficient paediatric malignancy, suggests that a subset of tumours may share common immune phenotypes, indicating the potential for a therapeutically targetable subgroup of challenging paediatric cancers.
Collapse
Affiliation(s)
- Laura M Williamson
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Craig M Rive
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Daniela Di Francesco
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Emma Titmuss
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Hye-Jung E Chun
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Scott D Brown
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Katy Milne
- Deeley Research Centre, BC Cancer, Victoria, BC, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC, Canada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Pascal D Johann
- Hopp Children's Cancer Center (KITZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) Core Center, Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center (KITZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) Core Center, Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Melissa Harvey
- Division of Pediatric Hematology Oncology BMT, University of British Columbia, Vancouver, BC, Canada
| | - David Dix
- Division of Pediatric Hematology Oncology BMT, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Renouf
- Pancreas Centre BC, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Robert A Holt
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Brad H Nelson
- Deeley Research Centre, BC Cancer, Victoria, BC, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC, Canada
| | - Martin Hirst
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Microbiology & Immunology, Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Janessa Laskin
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Shahrad R Rassekh
- Division of Pediatric Hematology Oncology BMT, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology Oncology BMT, University of British Columbia, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre at BC Cancer, Vancouver, BC, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
10
|
Hyslop S, Tomlinson D, Baggott C, Dix D, Gibson P, Johnston DL, Orsey AD, Portwine C, Price V, Vanan M, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L. Feeling scared or worried self-report in children receiving cancer treatments using the Symptom Screening in Pediatrics Tool (SSPedi). Support Care Cancer 2020; 29:3137-3144. [PMID: 33067767 DOI: 10.1007/s00520-020-05818-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The objectives of this study were to describe reports of bother for feeling scared or worried among children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients, and to identify factors associated with it. METHODS We included children receiving cancer treatments who were 8-18 years of age. Three patient types were enrolled: inpatients receiving active cancer treatment, outpatients receiving maintenance acute lymphoblastic leukemia chemotherapy, and outpatients in survivorship. Amount of bother due to feeling scared or worried yesterday or today was self-reported using the Symptom Screening in Pediatrics Tool (SSPedi) on a 0-4 scale. Risk factors were evaluated using logistic regression. RESULTS Among the 502 children included, 225 (45.0%) reported any degree of bother (score ≥ 1) and 29 (5.8%) reported severe bother (score ≥ 3) for feeling scared or worried. In multiple regression evaluating any bother, boys were less likely to be bothered (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.41-0.87) and inpatients receiving active cancer treatment were more likely to be bothered compared to outpatients in survivorship (OR 3.58, 95% CI 2.00-6.52). The only factor associated with being severely bothered by feeling scared or worried was clinic visit or admission due to fever (OR 4.57, 95% CI 1.24-13.60). DISCUSSION We found 45% of children receiving cancer treatments reported being bothered by feeling scared or worried. Girls and inpatients receiving active treatment experienced more bother of any degree, while visiting the hospital due to fever was associated with being severely bothered. Future work should identify interventions to prevent or alleviate this symptom.
Collapse
Affiliation(s)
- Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, 800 Welch Road, Palo Alto, CA, 94304, USA
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Andrea D Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Magimairajan Vanan
- Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, University of Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| |
Collapse
|
11
|
Nicholson MC, Naeije L, Hayden AR, Mattman A, Dix D, Chen LY. Etoposide‐based treatment of adult HLH is associated with high biochemical response but poor survival outcomes. ACTA ACUST UNITED AC 2020; 1:277-280. [PMID: 35847699 PMCID: PMC9175702 DOI: 10.1002/jha2.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022]
Abstract
Etoposide‐based treatment is the standard of care for adult HLH in many centers, yet there remains a paucity of data regarding treatment outcomes. We conducted a retrospective study of 23 adults treated with etoposide‐based therapy compared to 10 pediatric HLH cases at a single center. At diagnosis, the median serum ferritin was 20,071 µg/L and 937 µg/L in adults and children, respectively; median sIL‐2r was 14,524 U/mL and 4,478 U/mL. Biochemical response to treatment was high, with 21/23 adults achieving >75% reduction in serum ferritin, but one year survival was only 7/21 compared to 7/10 in pediatric cases.
Collapse
Affiliation(s)
- Matthew C. Nicholson
- Division of Hematology, Department of MedicineUniversity of British Columbia Vancouver BC Canada
| | - Leonie Naeije
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of PaediatricsUniversity of British Columbia Vancouver BC Canada
| | - Anna R. Hayden
- Division of Hematology, Department of MedicineUniversity of British Columbia Vancouver BC Canada
| | - Andre Mattman
- Department of Pathology and Laboratory MedicineUniversity of British Columbia Vancouver Canada
| | - David Dix
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of PaediatricsUniversity of British Columbia Vancouver BC Canada
| | - Luke Y.C. Chen
- Division of Hematology, Department of MedicineUniversity of British Columbia Vancouver BC Canada
- Centre for Health Education ScholarshipUniversity of British Columbia Vancouver BC Canada
| |
Collapse
|
12
|
Renzi S, Bartram J, Ali S, Portwine C, Mitchell D, Dix D, Lewis V, Price V, Johnston DL, Sung L. Perianal Infections in Children With Acute Myeloid Leukemia: A Report From the Canadian Infection in Acute Myeloid Leukemia Research Group. J Pediatric Infect Dis Soc 2019; 8:354-357. [PMID: 30165563 DOI: 10.1093/jpids/piy081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/05/2018] [Indexed: 11/15/2022]
Abstract
Among 235 children with acute myeloid leukemia, 17 experienced 19 perianal infections. Among 12 episodes with definite abscess, 75% were severely neutropenic. Sixteen diagnostic imaging evaluations were performed; diagnostic yield was similar between computerized tomography of pelvis (5 of 10) and ultrasound (3 of 5). Consistent management approaches to perianal infection should be developed.
Collapse
Affiliation(s)
- Samuele Renzi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Jack Bartram
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Salah Ali
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Carol Portwine
- Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Canada
| | - David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Canada
| | - Victoria Price
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
13
|
Anthony SJ, Robertson T, Selkirk E, Dix D, Klaassen RJ, Sung L, Klassen AF. The social impact of early psychological maturity in adolescents with cancer. Psychooncology 2019; 28:586-592. [PMID: 30646430 DOI: 10.1002/pon.4982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/01/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is a growing need to assess the long-term quality of life (QOL) of pediatric oncology patients since many children now survive their disease. This paper highlights the subjective perspectives of pediatric cancer patients and specifically explores how experiencing cancer at a young age impacts adolescents in the areas of social functioning, peer relationships, and QOL. The findings emerged from a qualitative research study that explored how pediatric oncology patients ascribe meaning to their illness. METHODS Study participants were recruited from four Canadian academic pediatric hospitals. In this study, we used an interpretative description approach. Semistructured interviews were completed, transcribed verbatim, and coded through the method of constant comparison. RESULTS A total of 37 children and adolescents (n = 19 female; 51%) participated. The majority of participants were diagnosed with leukemia (n = 16; 43%) or lymphoma (n = 9; 24%). Sixty-two percent of participants were adolescents between the ages of 13 and 18 years (n = 23). Data illustrated a unique adolescent experience, which has been reported as a subset of the original population. Adolescent participants noted an accelerated experience of maturation, which invited reflections of gratitude as well as feelings of isolation and disconnect from peers. Participants were saddened to have "missed out" on normative parts of childhood. CONCLUSION Findings highlighted experiences of accelerated maturity that prompted adverse social outcomes for adolescent participants, which impacted their QOL. Future research is needed to explore the intersection of accelerated maturity attributed to illness, social functioning, and QOL. Peer support through technology engagement is suggested for this population.
Collapse
Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Taylor Robertson
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Enid Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - David Dix
- Department of Pediatrics Hem/Onc/BMT, BC Children's Hospital, Vancouver, BC, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lillian Sung
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
14
|
Fahy AS, Kong I, Weitzman S, Dix D, Baruchel S, Gerstle JT. A role for surgery in the treatment of relapsed Hodgkin lymphoma. Pediatr Blood Cancer 2019; 66:e27402. [PMID: 30294914 DOI: 10.1002/pbc.27402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/01/2023]
Abstract
Treatment of Hodgkin lymphoma (HL) has advanced over time, rendering a fatal disease now largely curable. Multiagent chemotherapy regimens, hematopoietic stem cell transplantation, and radiotherapy are the mainstays of care. Surgical intervention is rarely indicated other than for biopsy at diagnosis. However, for patients with recurrent relapsed HL isolated to one anatomical location, refractory to all other therapy, there may be a beneficial role for surgical excision. Herein, we report the surgical management of three relapsed patients with stage IVB HL who were refractory to multiple other therapeutic approaches, who all achieved good event-free survival after operative management.
Collapse
Affiliation(s)
- A S Fahy
- Division of General and Thoracic Surgery, Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - I Kong
- Department of Oncology, McMaster University, Alberta, Canada
| | - S Weitzman
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - D Dix
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - S Baruchel
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - J T Gerstle
- Division of General and Thoracic Surgery, Hospital for Sick Children/University of Toronto, Toronto, Canada
| |
Collapse
|
15
|
Truong TH, Pole JD, Barber R, Dix D, Kulkarni KP, Martineau E, Randall A, Stammers D, Strahlendorf C, Strother D, Sung L. Enrollment on clinical trials does not improve survival for children with acute myeloid leukemia: A population‐based study. Cancer 2018; 124:4098-4106. [DOI: 10.1002/cncr.31728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Tony H. Truong
- Departments of Pediatrics and OncologyAlberta Children’s Hospital Calgary Alberta Canadas
| | - Jason D. Pole
- Pediatric Oncology Group of Ontario Toronto Ontario Canada
| | | | - David Dix
- Department of PediatricsBritish Columbia Children's Hospital Vancouver British Columbia Canada
- Department of PediatricsUniversity of British Columbia Vancouver British Columbia Canada
| | - Ketan P. Kulkarni
- Division of Hematology/Oncology, Department of PediatricsIWK Health Center Halifax Nova Scotia Canada
| | - Emilie Martineau
- Department of PediatricsUniversity of Quebec Hospital Center‐Laval University Quebec City Quebec Canada
| | - Alicia Randall
- Division of Hematology/Oncology, Department of PediatricsIWK Health Center Halifax Nova Scotia Canada
| | - David Stammers
- Department of PediatricsRoyal University Hospital Saskatoon Saskatchewan Canada
| | - Caron Strahlendorf
- Department of PediatricsUniversity of British Columbia Vancouver British Columbia Canada
| | - Douglas Strother
- Departments of Pediatrics and OncologyAlberta Children’s Hospital Calgary Alberta Canadas
| | - Lillian Sung
- Division of Hematology/OncologyThe Hospital for Sick Children Toronto Ontario Canada
| |
Collapse
|
16
|
Palmero R, Taus A, Viteri S, Majem M, Carcereny E, Garde-Noguera J, Felip E, Sampayo M, Gomez L, Lopez N, Olsen S, Jackson M, Faull I, Dix D, Karachaliou N, Rosell R. P2.03-02 Cell-Free DNA (cfDNA) Testing in Lung Adenocarcinoma (LUAC) Patients: Spanish Lung Liquid Versus Invasive Biopsy Program (SLLIP). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
17
|
Karachaliou N, Lefterova M, Draper J, Molina MA, Chaib I, Palmero R, Taus A, Viteri S, González Cao M, Majem Tarruella M, Carcereny Costa E, Moran T, Garde Noguera J, Felip Font E, Olsen S, Jackson M, Sampayo M, Faull I, Dix D, Rosell R. Homology-directed repair (HDR)-defective lung adenocarcinomas (LUACs) in circulating tumor DNA (ctDNA). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy304.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Hyslop S, Dupuis LL, Baggott C, Dix D, Gibson P, Kuczynski S, Johnston DL, Orsey A, Portwine C, Price V, Spiegler B, Tomlinson D, Vanan M, Tomlinson GA, Sung L. Validation of the Proxy Version of Symptom Screening in Pediatrics Tool in Children Receiving Cancer Treatments. J Pain Symptom Manage 2018; 56:107-112. [PMID: 29630923 DOI: 10.1016/j.jpainsymman.2018.03.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Primary objectives were to evaluate the interrater reliability and validity of proxy-report Symptom Screening in Pediatrics Tool (SSPedi) in children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients. Secondary objective was to describe the interrater reliability of each SSPedi item. METHODS Respondents were children aged eight to 18 years with cancer or HSCT recipients, and their parents or guardians. We enrolled two pediatric respondent groups. The more symptomatic group was receiving active treatment for cancer, admitted to hospital, and expected to be in a hospital three days later. The less symptomatic group either was in maintenance therapy for acute lymphoblastic leukemia or had completed cancer treatments. Convergent validity was evaluated by comparing proxy-reported mucositis, nausea and vomiting, pain, and total SSPedi scores, with child self-reported validated scales, and we hypothesized fair correlations. Discriminant validity was evaluated by comparing proxy-reported total SSPedi scores between groups. Interrater reliability of each SSPedi item was evaluated. RESULTS Four hundred thirty-nine child and parent or guardian pairs were recruited. Mean difference in proxy-reported SSPedi scores between the more and less symptomatic groups was 8.2, 95% CI 6.6-9.8. All hypothesized relationships among measures were observed. Intraclass correlation coefficients for SSPedi items ranged from 0.34 (problems with thinking) to 0.80 (diarrhea). CONCLUSION Proxy-report SSPedi is reliable and valid in children aged 8 years to 18 years with cancer and HSCT recipients. Future work should support proxy-reported symptom assessment in clinical settings where children are not able to self-report or communicate bothersome symptoms.
Collapse
Affiliation(s)
- Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada; Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, Palo Alto, California, USA
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, Vancouver, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), Toronto, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Andrea Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Magimairajan Vanan
- Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| |
Collapse
|
19
|
Dupuis LL, Johnston DL, Baggott C, Hyslop S, Tomlinson D, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Sung L. Validation of the Symptom Screening in Pediatrics Tool in Children Receiving Cancer Treatments. J Natl Cancer Inst 2018; 110:661-668. [PMID: 29272441 PMCID: PMC6005103 DOI: 10.1093/jnci/djx250] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 01/22/2023] Open
Abstract
Background The objective was to evaluate the reliability and validity of the self-report Symptom Screening in Pediatrics Tool (SSPedi) from the perspective of children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients. Methods In this multicenter study, respondents were children age eight to 18 years who had cancer or had received HSCT, and their parents. Two different child respondent populations were targeted. More symptomatic respondents were receiving active treatment for cancer, admitted to the hospital, and expected to be in the hospital three days later. Less symptomatic respondents were in maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Children completed SSPedi and then responded to validated self-report measures of mucositis, nausea, pain, and global quality of life. Children in the more symptomatic group repeated SSPedi and a global symptom change scale three days later. Parent proxy-report was optional. Reliability was evaluated using intraclass correlations while convergent validity was evaluated using Spearman correlations. Results Of 502 children enrolled, 302 were in the more symptomatic group and 200 were in the less symptomatic group. Intraclass correlation coefficients were 0.88 (95% confidence interval [CI] = 0.82 to 0.92) for test-retest reliability and 0.76 (95% CI = 0.71 to 0.80) for inter-rater reliability. The mean difference in SSPedi scores between more and less symptomatic groups was 7.8 (95% CI = 6.4 to 9.2). SSPedi was responsive to change in global symptoms. All hypothesized relationships among measures were observed. Conclusions SSPedi is a self-report symptom bother tool for children with cancer and HSCT recipients that is reliable, valid, and responsive to change. SSPedi can be used for clinical and research purposes. Future work should focus on integration into care delivery.
Collapse
Affiliation(s)
- L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, Palo Alto, CA
| | - Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Andrea Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, CT
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Magimairajan Vanan
- Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children’s Hospital, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), Toronto, Ontario, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Ronsley R, Rassekh SR, Shen Y, Lee AF, Jantzen C, Halparin J, Albert C, Hawkins DS, Amed S, Rothstein R, Mungall AJ, Dix D, Blair G, Nadel H, Jones SJM, Laskin J, Marra MA, J Deyell R. Application of genomics to identify therapeutic targets in recurrent pediatric papillary thyroid carcinoma. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a002568. [PMID: 29610391 PMCID: PMC5880264 DOI: 10.1101/mcs.a002568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/03/2018] [Indexed: 01/24/2023] Open
Abstract
Children with papillary thyroid carcinoma (PTC) may relapse despite response to radioactive iodine (RAI). Two children with multiply relapsed PTC underwent whole-genome and transcriptome sequencing. A TPM3-NTRK1 fusion was identified in one tumor, with outlier NTRK1 expression compared to the TCGA thyroid cancer compendium and to Illumina BodyMap normal thyroid. This patient demonstrated resolution of multiple pulmonary nodules without toxicity on oral TRK inhibitor therapy. A RET fusion was identified in the second tumor, another potentially actionable finding. Identification of oncogenic drivers in recurrent pediatric PTC may facilitate targeted therapy while avoiding repeated RAI.
Collapse
Affiliation(s)
- Rebecca Ronsley
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - S Rod Rassekh
- BC Children's Hospital Research Institute, Vancouver, British Columbia V5Z 4H4, Canada.,Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Yaoqing Shen
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Colleen Jantzen
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Jessica Halparin
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Catherine Albert
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA
| | - Shazhan Amed
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Ralph Rothstein
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - David Dix
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Geoffrey Blair
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Helen Nadel
- Department of Radiology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Janessa Laskin
- British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Rebecca J Deyell
- BC Children's Hospital Research Institute, Vancouver, British Columbia V5Z 4H4, Canada.,Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| |
Collapse
|
21
|
Johnston DL, Hyslop S, Tomlinson D, Baggott C, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Dupuis LL, Sung L. Describing symptoms using the Symptom Screening in Pediatrics Tool in hospitalized children with cancer and hematopoietic stem cell transplant recipients. Cancer Med 2018; 7:1750-1755. [PMID: 29573197 PMCID: PMC5943541 DOI: 10.1002/cam4.1433] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/05/2018] [Accepted: 02/17/2018] [Indexed: 01/26/2023] Open
Abstract
Objectives were to describe any bothersome symptom and severely bothersome symptoms in inpatient children with cancer and hematopoietic stem cell transplant (HSCT) recipients. We included children 8–18 years of age with cancer or HSCT recipients who were receiving active treatment for cancer, admitted to hospital, and expected to be in hospital 3 days later. We administered the self‐report Symptom Screening in Pediatrics Tool (SSPedi). We described those who identified any degree of symptom bother (at least “a little”) and those who rated the degree of bother as severe (“a lot” or “extremely”). Factors associated with severe symptoms and total SSPedi scores were examined using multiple logistic and linear regression. Among the 302 patients, 298 (98.7%) reported having any bothersome symptom and 181 (59.9%) had at least one severely bothersome symptom. In multiple regression, older children were significantly more likely to have at least one severely bothersome symptom (15–18 and 11–14 years vs. 8–10 years; P = 0.008) and to have higher total SSPedi scores (P = 0.0003). Those with relapsed disease were more likely to have at least one severely bothersome symptom (odds ratio 2.1, 95% confidence interval 1.1–4.3; P = 0.037) and HSCT recipients were more likely to have higher symptom scores (β = 3.48, standard error = 1.6; P = 0.030). Almost all children receiving cancer therapies experience bothersome symptoms and 60% have at least one severely bothersome symptom. Older children experienced more severely bothersome symptoms and higher symptom scores. Future studies should follow children longitudinally to better understand the symptom trajectory and should institute interventions to manage symptoms.
Collapse
Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, 800 Welch Road, MC 5757, Palo Alto, California, 94305
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Andrea Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, Connecticut, 06106
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, British Columbia, V6H 3V4, Canada
| | - Vicky Price
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Magimairajan Vanan
- Departments of Pediatrics & Child Health and Biochemistry & Medical Genetics, Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, University of Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children's Hospital, Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Laura Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
22
|
Renzi S, Ali S, Portwine C, Mitchell D, Dix D, Lewis V, Price V, Science M, Sung L. Adenovirus Infection in Children With Acute Myeloid Leukemia: A Report From the Canadian Infection in Acute Myeloid Leukemia Research Group. Pediatr Infect Dis J 2018; 37:135-137. [PMID: 28806282 DOI: 10.1097/inf.0000000000001723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with acute myeloid leukemia (AML) are at high risk of life-threatening bacterial and fungal infection. However, little is known about the prevalence or severity of adenovirus infection in this population. Objective was to describe the characteristics, treatments and outcomes of adenovirus infection in children with newly diagnosed AML. METHODS We performed a retrospective chart review based upon 2 multicenter cohort studies that focused on identifying risk factors for infection in children with AML. Inclusion criteria were patients with de novo AML who were ≤18 years of age at diagnosis with a clinical specimen positive for adenovirus. RESULTS Among the 235 patients with AML, 12 (5.1%) had positive adenovirus testing. The most common site of isolation was stool (n = 11, 91.6 %), and the most frequent symptom was diarrhea (n = 11, 91.6 %). Two patients received specific treatment for adenovirus, namely intravenous immunoglobulin only in 1 patient and both intravenous immunoglobulin and inhaled ribavirin in a second patient. In 11 patients, adenovirus resolved uneventfully without recurrence, including 10 that received no adenovirus-specific therapy. However, 1 patient developed sepsis syndrome in the setting of disseminated adenoviral infection and died from multiorgan failure. CONCLUSION In children with AML, adenovirus infection was rare and typically not associated with severe disease, even without specific treatment. However, disseminated and fatal disease can occur in this population. Further investigations are needed to identify pediatric AML patients at particular risk for severe adenovirus infection and to determine optimal treatment approaches in these patients.
Collapse
|
23
|
Pinto CL, Markey K, Dix D, Browne P. Identification of candidate reference chemicals for in vitro steroidogenesis assays. Toxicol In Vitro 2017; 47:103-119. [PMID: 29146384 DOI: 10.1016/j.tiv.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/19/2017] [Accepted: 11/11/2017] [Indexed: 11/15/2022]
Abstract
The Endocrine Disruptor Screening Program (EDSP) is transitioning from traditional testing methods to integrating ToxCast/Tox21 in vitro high-throughput screening assays for identifying chemicals with endocrine bioactivity. The ToxCast high-throughput H295R steroidogenesis assay may potentially replace the low-throughput assays currently used in the EDSP Tier 1 battery to detect chemicals that alter the synthesis of androgens and estrogens. Herein, we describe an approach for identifying in vitro candidate reference chemicals that affect the production of androgens and estrogens in models of steroidogenesis. Candidate reference chemicals were identified from a review of H295R and gonad-derived in vitro assays used in methods validation and published in the scientific literature. A total of 29 chemicals affecting androgen and estrogen levels satisfied all criteria for positive reference chemicals, while an additional set of 21 and 15 chemicals partially fulfilled criteria for positive reference chemicals for androgens and estrogens, respectively. The identified chemicals included pesticides, pharmaceuticals, industrial and naturally-occurring chemicals with the capability to increase or decrease the levels of the sex hormones in vitro. Additionally, 14 and 15 compounds were identified as potential negative reference chemicals for effects on androgens and estrogens, respectively. These candidate reference chemicals will be informative for performance-based validation of in vitro steroidogenesis models.
Collapse
Affiliation(s)
- Caroline Lucia Pinto
- U.S. EPA, Office of Science Coordination and Policy, Washington, D.C. 20004, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37831-0117, United States.
| | - Kristan Markey
- U.S. EPA, Office of Science Coordination and Policy, Washington, D.C. 20004, United States
| | - David Dix
- U.S. EPA, Office of Chemical Safety and Pollution Prevention, Washington, D.C. 20004, United States
| | - Patience Browne
- U.S. EPA, Office of Science Coordination and Policy, Washington, D.C. 20004, United States
| |
Collapse
|
24
|
Mack P, Miao J, Banks K, Burich R, Politi K, Raymond V, Dix D, Lanman R, Moon J, Melnick M, Truini A, Redman M, Goldberg S, Gandara D, Kelly K. P3.01-046 Longitudinal Analysis of Plasma CtDNA in EGFR-Mutant NSCLC: SWOG S1403 Trial of Afatinib with or Without Cetuximab. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Wong J, Zaw W, Chew K, Tan C, Ahmad N, Dix D, Law W. An unusual cause of status epilepticus in end stage kidney disease: Star fruit intoxication. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Palmero R, Taus Á, Majem Tarruella M, Viteri S, Carcereny Costa E, Garde J, Felip Font E, Cassidy C, Dix D, Karachaliou N, Rosell R. Prospective comparison of liquid biopsy to standard of care tissue testing in metastatic, non-squamous, non-small cell lung cancer (NSCLC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Pole JD, Barber R, Bergeron RÉ, Carret AS, Dix D, Kulkarni K, Martineau E, Randall A, Stammers D, Strahlendorf C, Strother DR, Truong TH, Sung L. Most children with cancer are not enrolled on a clinical trial in Canada: a population-based study. BMC Cancer 2017; 17:402. [PMID: 28583094 PMCID: PMC5460360 DOI: 10.1186/s12885-017-3390-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/26/2017] [Indexed: 12/05/2022] Open
Abstract
Background Primary objective was to describe the proportion of children newly diagnosed with cancer enrolled on a therapeutic clinical trial. Secondary objectives were to describe reasons for non-enrollment and factors associated with enrollment on trials. Methods In this retrospective cohort study, we included children newly diagnosed with cancer between 0 and 14 years of age and diagnosed from 2001 to 2012. We used data from the Cancer in Young People in Canada (CYP-C) national pediatric cancer population-based database. CYP-C captures all cases of pediatric cancer (0–14 years) diagnosed and treated at one of the 17 tertiary pediatric oncology centers in Canada. Non-enrollment was evaluated using univariate and multiple logistic regression analysis. Results There were 9204 children with cancer included, of whom 2533 (27.5%) were enrolled on a clinical trial. The most common reasons cited for non-enrollment were lack of an available trial (52.2%) and physician choice (11.2%). In multiple regression, Asian and Arab/west Asian race were associated with lower enrollment (P = 0.006 and P = 0.032 respectively). All cancer diagnoses were more likely to be enrolled compared to astrocytoma and children with acute lymphoblastic leukemia had an almost 18-fold increased odds of enrollment compared to astrocytoma (P < 0.0001). Greater distance from the tertiary care center was independently associated with non-enrollment (P < 0.0001). Conclusions In Canada, 27.5% of children with cancer are enrolled onto therapeutic clinical trials and lack of an available trial is the most common reason contributing to non-enrollment. Future research should better understand reasons for lack of trial availability and physician preferences to not offer trials.
Collapse
Affiliation(s)
- Jason D Pole
- Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, M5G 1V2, Canada
| | - Randy Barber
- C17 Research Council, ECHA, 11405-87 Avenue, Edmonton, T6G 1C9, Canada
| | | | - Anne Sophie Carret
- Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin Cote Sainte-Catherine, Montreal, H1T 3C5, Canada
| | - David Dix
- BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada
| | - Ketan Kulkarni
- IWK Health Centre, 5850/5950 University Avenue, Halifax, B3K 6R8, Canada
| | - Emilie Martineau
- Centre Hospitalier Universitaire de Quebec-Universite Laval, 2705 Boulevard Laurier, Quebec City, G1V 4G2, Canada
| | - Alicia Randall
- IWK Health Centre, 5850/5950 University Avenue, Halifax, B3K 6R8, Canada
| | - David Stammers
- Royal University Hospital, 103 Hospital Drive, Saskatoon, S7N 0W8, Canada
| | - Caron Strahlendorf
- BC Children's Hospital, 4480 Oak Street Room B315, Vancouver, V6H 3V4, Canada
| | - Douglas R Strother
- Alberta Children's Hospital, 2888 Shaganappi Trail N.W, Calgary, T3B 6A8, Canada
| | - Tony H Truong
- Alberta Children's Hospital, 2888 Shaganappi Trail N.W, Calgary, T3B 6A8, Canada
| | - Lillian Sung
- The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada. .,Child Health Evaluative Sciences, 686 Bay Street, Toronto, M5G 0A4, Canada.
| |
Collapse
|
28
|
Gwinn MR, Axelrad DA, Bahadori T, Bussard D, Cascio WE, Deener K, Dix D, Thomas RS, Kavlock RJ, Burke TA. Chemical Risk Assessment: Traditional vs Public Health Perspectives. Am J Public Health 2017; 107:1032-1039. [PMID: 28520487 DOI: 10.2105/ajph.2017.303771] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Preventing adverse health effects of environmental chemical exposure is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and effects of environmentally induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Considering these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease.
Collapse
Affiliation(s)
- Maureen R Gwinn
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Daniel A Axelrad
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Tina Bahadori
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - David Bussard
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Wayne E Cascio
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Kacee Deener
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - David Dix
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Russell S Thomas
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Robert J Kavlock
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| | - Thomas A Burke
- At the time of the writing of this article, all of the authors were with the US Environmental Protection Agency, Washington, DC
| |
Collapse
|
29
|
Wegner S, Browne P, Dix D. Identifying reference chemicals for thyroid bioactivity screening. Reprod Toxicol 2016; 65:402-413. [PMID: 27589887 DOI: 10.1016/j.reprotox.2016.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/19/2016] [Accepted: 08/29/2016] [Indexed: 12/20/2022]
Abstract
Reference chemicals were selected based on thyroid bioactivity in 'Tier 1' screening assays used by the U.S. EPA's Endocrine Disruptor Screening Program. Active reference chemicals had significant effects on thyroid-responsive endpoints in the amphibian metamorphosis assay, and the male and female pubertal rat assays. In the absence of thyroid weight or histopathological effects, additional published studies providing mechanistic data on thyroid activity were required for active chemicals. Inactive reference chemicals had no significant effects on thyroid-responsive endpoints in Tier 1 assays, or in amphibian or rodent studies from several online databases. The 34 reference chemicals (29 active and five inactive) will be useful for performance-based validation of alternative, high throughput screening assays for thyroid bioactivity.
Collapse
Affiliation(s)
- Susanna Wegner
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States.
| | - Patience Browne
- Office of Science Coordination and Policy (OSCP), Office of Chemical Safety and Pollution Prevention, U.S. EPA, Washington, D.C., United States
| | - David Dix
- Office of Science Coordination and Policy (OSCP), Office of Chemical Safety and Pollution Prevention, U.S. EPA, Washington, D.C., United States
| |
Collapse
|
30
|
Wang JY, Brossard J, Cellot S, Dix D, Feusner J, Johnston DL, Lewis V, Mitchell D, Portwine C, Price V, Sung L, Ethier MC, Gillmeister B. Invasive Rothia infections in children with acute myeloid leukemia: A report from the Canadian infections in AML research group. Pediatr Hematol Oncol 2016; 33:277-281. [PMID: 27315594 DOI: 10.1080/08880018.2016.1187231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Rothia spp. (previously termed Stomatococcus) are normal flora that can cause invasive infections in immunocompromised hosts. The objective of this study was to describe infection characteristics and outcomes of Rothia spp. infections in a large cohort of children with newly diagnosed acute myeloid leukemia (AML). This retrospective chart review is a subanalysis of a larger study in which the aim was to identify factors associated with infection in pediatric patients with AML. Only sterile site infections occurring during chemotherapy were included. Among 578 children with AML, 17 (2.9%) children with at least 1 Rothia spp. infection were identified. All children were neutropenic at the time of infection. Eight (47%) had antecedent colitis or mucositis. Of the 17 infections, 16 were bacteremia and 1 was meningitis. Sepsis occurred in 4 patients, and 1 patient died due to infection. Rothia spp. infections are rare in pediatric AML but can cause significant morbidity and mortality. Future studies should describe trends in incidence and resistance patterns over time.
Collapse
Affiliation(s)
- Jane Y Wang
- a Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada.,b Faculty of Medicine , University of Toronto , St. George Campus , Ontario , Canada
| | - Josée Brossard
- c Service d'Hémato-Oncologie, Centre Hospitalier Universitaire de Sherbrooke, Hematology/Oncology , Centre Hospitalier Universitaire de Sherbrooke , Quebec , Canada
| | - Sonia Cellot
- d St. George Campus, Hematology/Oncology , Hospital Sainte-Justine , Montreal , Quebec , Canada
| | - David Dix
- e Division of Pediatric Hematology/Oncology , BC Children's Hospital , Vancouver , British Columbia , Canada
| | - Jim Feusner
- f Division of Hematology/Oncology , Children's Hospital & Research Center Oakland , Oakland , California , USA
| | - Donna L Johnston
- g Division of Hematology/Oncology , Children's Hospital of Eastern Ontario , Ottawa , Ontario , Canada
| | - Victor Lewis
- h Hematology/Oncology/Transplant Program , Alberta Children's Hospital , Calgary , Alberta , Canada
| | - David Mitchell
- i Division of Hematology/Oncology , Montreal Children's Hospital , Quebec , Canada
| | - Carol Portwine
- j Division of Haematology/Oncology , Chedoke-McMaster Hospitals , Hamilton , Ontario , Canada
| | - Victoria Price
- k Department of Pediatrics , IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Lillian Sung
- a Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada.,l Division of Haematology/Oncology , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Marie-Chantal Ethier
- a Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Biljana Gillmeister
- a Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
| |
Collapse
|
31
|
Wegner S, Heiger-Bernays W, Dix D. Spanning regulatory silos in the U.S. EPA's Endocrine Disruptor Screening Program: Letter to the Editor re: Evans et al. "Should the scope of human mixture risk assessment span legislative and regulatory silos for chemicals?". Sci Total Environ 2016; 553:671-672. [PMID: 26972864 DOI: 10.1016/j.scitotenv.2016.02.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/26/2016] [Accepted: 02/27/2016] [Indexed: 05/28/2023]
Affiliation(s)
- Susanna Wegner
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States.
| | - Wendy Heiger-Bernays
- American Association for the Advancement of Science (AAAS) Science and Technology Fellow, U.S. Environmental Protection Agency, Washington, DC, United States
| | - David Dix
- Office of Science Coordination and Policy, Office of Chemical Safety and Pollution Prevention, U.S. Environmental Protection Agency, Washington, DC, United States.
| |
Collapse
|
32
|
Dix D, Weber W. Letter to the Editor: Response to "Second Scientific Statement on Endocrine-Disrupting Chemicals" by Gore et al. Endocr Rev 2016; 37:L1-2. [PMID: 27049553 DOI: 10.1210/er.2016-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David Dix
- Director, Office of Science Coordination and Policy, Office of Chemical Safety and Pollution Prevention, U.S. Environmental Protection Agency, 1200 Pennsylvania Ave, NW (7201M), WA DC 20460; Program Participant-ASPPH Environmental Health Fellowship Program, Hosted by EPA Office of Science Coordination and Policy
| | - Whitney Weber
- Director, Office of Science Coordination and Policy, Office of Chemical Safety and Pollution Prevention, U.S. Environmental Protection Agency, 1200 Pennsylvania Ave, NW (7201M), WA DC 20460; Program Participant-ASPPH Environmental Health Fellowship Program, Hosted by EPA Office of Science Coordination and Policy
| |
Collapse
|
33
|
Sung L, Dix D, Cellot S, Gillmeister B, Ethier MC, Roslin NM, Johnston DL, Feusner J, Mitchell D, Lewis V, Aplenc R, Yanofsky R, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Traubici J, Allen U, Beyene J, den Hollander N, Paterson AD. Single nucleotide polymorphism in IL1B is associated with infection risk in paediatric acute myeloid leukaemia. Clin Microbiol Infect 2016; 22:563.e9-563.e17. [PMID: 26932518 DOI: 10.1016/j.cmi.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
We evaluated single nucleotide polymorphisms (SNPs) associated with infection risk in children with newly diagnosed acute myeloid leukaemia (AML). We conducted a multicentre, prospective cohort study that included children aged ≤18 years with de novo AML. DNA was isolated from blood lymphocytes or buccal swabs, and candidate gene SNP analysis was conducted. Primary outcome was the occurrence of microbiologically documented sterile site infection during chemotherapy. Secondary outcomes were Gram-positive and -negative infections, viridans group streptococcal infection and proven/probable invasive fungal infection. Interpretation was guided by consistency in risk alleles and microbiologic agent with previous literature. Over the study period 254 children and adolescents with AML were enrolled. Overall, 190 (74.8%) had at least one sterile site microbiologically documented infection. Among the 172 with inferred European ancestry and DNA available, nine significant associations were observed; two were consistent with previous literature. Allele A at IL1B (rs16944) was associated with decreased microbiologically documented infection, and allele G at IL10 (rs1800896) was associated with increased risk of Gram-positive infection. We identified SNPs associated with infection risk in paediatric AML. Genotype may provide insight into mechanisms of infection risk that could be used for supportive-care novel treatments.
Collapse
Affiliation(s)
- L Sung
- Division of Haematology/Oncology, Ontario, Canada; Child Health Evaluative Sciences, Ontario, Canada.
| | - D Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - S Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, Quebec, Canada
| | | | - M C Ethier
- Child Health Evaluative Sciences, Ontario, Canada
| | - N M Roslin
- Program in Genetics and Genome Biology, Ontario, Canada
| | - D L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center, Oakland, CA, USA
| | - D Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - V Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - R Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Yanofsky
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - C Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Canada
| | - V Price
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - S Zelcer
- Hematology/Oncology, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - M Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
| | - L Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - B Michon
- Pediatric Hematology/OncologyCentre, Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| | - K Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J Traubici
- Department of Diagnostic Imaging, Ontario, Canada
| | - U Allen
- Division of Infectious Diseases, Ontario, Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - N den Hollander
- Histocompatibility Laboratory, University Health Network, Ontario, Canada
| | - A D Paterson
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Niederhoffer KY, Dix D, Rehmus W, McGillivray B, Armstrong L. MG-116 Report of 2 families with emberger syndrome (GATA2 mutation): Recognition of variance in clinical phenotype allows detection prior to malignant presentation. J Med Genet 2015. [DOI: 10.1136/jmedgenet-2015-103577.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Chellapandian D, Shaikh F, van den Bos C, Somers GR, Astigarraga I, Jubran R, Degar B, Carret AS, Mandel K, Belletrutti M, Dix D, Visser J, Abuhadra N, Chang T, Rollins B, Whitlock J, Weitzman S, Abla O. Management and Outcome of Patients With Langerhans Cell Histiocytosis and Single-Bone CNS-Risk Lesions: A Multi-Institutional Retrospective Study. Pediatr Blood Cancer 2015; 62:2162-6. [PMID: 26179251 DOI: 10.1002/pbc.25645] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with Langerhans cell histiocytosis (LCH) and single-bone CNS-risk lesions have been reported to be at increased risk of diabetes insipidus (DI), central nervous system neurodegeneration (CNS-ND), and recurrence of disease. However, it is unknown whether the addition of chemotherapy or radiotherapy changes outcomes in these patients. METHODS Ten pediatric institutions across North America and Europe contributed data of their patients with LCH and single-bone CNS-risk lesions. Clinical information on age, sex, specific craniofacial site involvement, and intracranial extension at diagnosis, therapy, and disease course was collected for all eligible patients. RESULTS The final analysis included 93 eligible children who were either treated with systemic therapy (chemotherapy, chemo-radiotherapy, or radiotherapy) or local therapy (biopsy, curettage, and/or intralesional steroids). Fifty-nine patients had systemic and 34 had local therapy. The 5-year event-free survival (EFS) and overall survival (OS) were 80 ± 5% and 98 ± 2% in the systemic therapy group versus 85 ± 6% and 95 ± 5% in the local therapy group. There was no statistically significant difference between either group with regard to EFS (P = 0.26) and OS (P = 0.78). On multivariable analysis, there was no significant difference among the two treatment groups after adjusting for site and intracranial soft tissue extension, nor any trend favoring systemic therapy (HR = 2.26, 95% CI = 0.77-6.70; P = 0.14). CONCLUSION Systemic therapy may not reduce the risk of recurrence or late sequelae in children with LCH and single-bone CNS-risk lesions as compared to local treatment.
Collapse
Affiliation(s)
- Deepak Chellapandian
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Furqan Shaikh
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cor van den Bos
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Gino R Somers
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Itziar Astigarraga
- Servicio de Pediatria, Bio Cruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.,Departamento de Pediatria, Universidad del Pais Vasco UPV/EHU, Vizcaya, Spain
| | - Rima Jubran
- Children's Hospital of Los Angeles, Los Angeles, California
| | - Barbara Degar
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne-Sophie Carret
- Division of Hematology-Oncology, Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Karen Mandel
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Belletrutti
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - David Dix
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nour Abuhadra
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tiffany Chang
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Barret Rollins
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts
| | - James Whitlock
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sheila Weitzman
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oussama Abla
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Dix D, Aplenc R, Bowes L, Cellot S, Ethier MC, Feusner J, Gillmeister B, Johnston DL, Lewis V, Michon B, Mitchell D, Portwine C, Price V, Silva M, Stobart K, Yanofsky R, Zelcer S, Beyene J, Sung L. Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia. Int J Cancer 2015; 138:1785-91. [PMID: 26515793 DOI: 10.1002/ijc.29905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 11/11/2022]
Abstract
Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML.
Collapse
Affiliation(s)
- David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Richard Aplenc
- Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lynette Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, NFLD, Canada
| | - Sonia Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, QC, Canada
| | - Marie-Chantal Ethier
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jim Feusner
- Department of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA
| | - Biljana Gillmeister
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna L Johnston
- Hematology Oncology, Children's Hospital of Eastern Ontario, Otawa, ON, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Bruno Michon
- Pediatric Hematology/Oncology Centre, Hospitalier Universitaire De Quebec, Laval, QC, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Carol Portwine
- Hematology/Oncology, Chedoke-McMaster Hospitals, Hamilton, ON, Canada
| | | | - Mariana Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, ON, Canada
| | - Kent Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton, AB, Canada
| | | | - Shayna Zelcer
- Hematology/Oncology, London Health Sciences, London, ON, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
37
|
Leung E, Dix D, Ford J, Barnard D, McBride E. The pediatric hematology/oncology educational laboratory in-training examination (PHOELIX): A formative evaluation of laboratory skills for Canadian pediatric hematology/oncology trainees. Pediatr Blood Cancer 2015; 62:1952-5. [PMID: 26152339 DOI: 10.1002/pbc.25613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 05/04/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pediatric hematologists/oncologists need to be skilled clinicians, and must also be adept and knowledgeable in relevant areas of laboratory medicine. Canadian training programs in this subspecialty have a minimum requirement for 6 months of training in acquiring "relevant laboratory diagnostic skills." The Canadian pediatric hematology/oncology (PHO) national specialty society, C17, recognized the need for an assessment method in laboratory skills for fellows graduating from PHO training programs. PROCEDURE Canadian pediatric hematologists/oncologists were surveyed regarding what were felt to be the essential laboratory-related knowledge and skills deemed necessary for graduating pediatric hematology/oncology trainees. The PHOELIX (Pediatric hematology/oncology educational laboratory in-training examination) was then developed to provide an annual formative evaluation of laboratory skills in Canadian PHO trainees. RESULTS The majority of PHO respondents (89%) felt that laboratory skills are important in clinical practice. An annual formative examination including review of glass slides was implemented starting in 2010; this provides feedback regarding knowledge of laboratory medicine to both trainees and program directors (PDs). CONCLUSIONS We have successfully created a formative examination that can be used to evaluate and educate trainees, as well as provide PDs with a tool to gauge the effectiveness of their laboratory training curriculum. Feedback has been positive from both trainees and PDs.
Collapse
Affiliation(s)
- Elaine Leung
- Division of Hematology and Transfusion Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - David Dix
- Division of Pediatric Hematology/Oncology/Bone Marrow Transplant, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Ford
- Division of Hematopathology, Sidra Medical and Research Center, Doha, Qatar
| | - Dorothy Barnard
- IWK Health Center, Nova Scotia IWK Health Center, Halifax, Nova Scotia, Canada
| | - Eileen McBride
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario and Department of Pediatrics, Montfort Hospital and University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
38
|
Syed IA, Klassen AF, Barr R, Wang R, Dix D, Nelson M, Rosenberg-Yunger ZRS, Nathan PC. Factors associated with childhood cancer survivors’ knowledge about their diagnosis, treatment, and risk for late effects. J Cancer Surviv 2015; 10:363-74. [DOI: 10.1007/s11764-015-0482-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/21/2015] [Indexed: 12/14/2022]
|
39
|
Tran TH, Yanofsky R, Johnston DL, Dix D, Gillmeister B, Ethier MC, Portwine C, Price V, Mitchell D, Cellot S, Lewis V, Zelcer S, Silva M, Michon B, Bowes L, Stobart K, Brossard J, Beyene J, Sung L. Second Bacteremia During Antibiotic Treatment in Children With Acute Myeloid Leukemia: A Report From the Canadian Infections in Acute Myeloid Leukemia Research Group. J Pediatric Infect Dis Soc 2014; 3:228-33. [PMID: 26625386 DOI: 10.1093/jpids/pit086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 11/12/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Our objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). METHODS We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. RESULTS There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12; P < .0001), cumulative dose of corticosteroids (OR, 1.04; 95% CI, 1.00-1.08; P = .035), and days of neutropenia from start of course to initial bacteremia (OR, 1.07; 95% CI, 1.02-1.12; P = .007) were significantly associated with second bacteremia. CONCLUSIONS In pediatric AML, 6% of patients will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia.
Collapse
Affiliation(s)
- Thai Hoa Tran
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | | | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - Biljana Gillmeister
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Marie-Chantal Ethier
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Carol Portwine
- Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - Vicky Price
- Pediatrics, IWK Health Centre, Halifax, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Canada
| | - Sonia Cellot
- Hematology/Oncology, Hopital Sainte-Justine, Montreal, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Canada
| | - Shayna Zelcer
- Hematology/Oncology, London Health Sciences Centre, Canada
| | - Mariana Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Canada
| | - Bruno Michon
- Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Canada
| | - Lynette Bowes
- Hematology/Oncology, Janeway Child Health Centre, St John's, Canada
| | - Kent Stobart
- Stollery Children's Hospital, University of Alberta Edmonton, Canada
| | - Josée Brossard
- Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Canada
| | - Joseph Beyene
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
40
|
Farjou G, Sinha R, Dix D, Shahbaz A, Klaassen RJ, Klassen AF. Understanding the healthcare experiences of teenaged cancer patients and survivors. Child Care Health Dev 2014; 40:723-30. [PMID: 24117679 DOI: 10.1111/cch.12109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite literature supporting a client and family-centred approach to healthcare delivery in paediatric facilities, there is little information about healthcare delivery from the perspective of teenagers in the oncology setting. The objective of this study is to describe the healthcare experiences of teenagers with cancer. METHODS As part of a larger study on teen-centred care delivery in paediatric oncology, a survey included several open-ended questions to learn about the following: (1) what teenagers liked about the cancer care they received; (2) what they disliked about the cancer care received; and (3) what they would include if they could design the perfect cancer centre for teenagers. The survey was completed by 200 teenagers (aged 12-20 years) from three paediatric hospitals in Canada. Answers to these questions were coded and developed into themes and subthemes using a thematic analysis approach. RESULTS The number of patients providing answers was 89% for question 1, 63% for question 2 and 68.5% for question 3. Likes and dislikes were conceptualized in terms of four key themes as follows: (1) staff at the treatment centre; (2) the cancer care they received; (3) the treatment centre itself; and (4) social activities. The most common suggestions for the perfect cancer centre included having access to better entertainment, more social opportunities to interact with peers, and a more comfortable environment for themselves and their families. CONCLUSION Understanding teenagers' experiences in the paediatric oncology setting provides information that could be used to shape the delivery of healthcare in a way that is tailored to their needs. Further research in this area is required in order to improve existing oncology care.
Collapse
Affiliation(s)
- G Farjou
- McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | |
Collapse
|
41
|
Klassen AF, Rosenberg-Yunger ZRS, D'Agostino NM, Cano SJ, Barr R, Syed I, Granek L, Greenberg ML, Dix D, Nathan PC. The development of scales to measure childhood cancer survivors' readiness for transition to long-term follow-up care as adults. Health Expect 2014; 18:1941-55. [PMID: 25052198 PMCID: PMC5810698 DOI: 10.1111/hex.12241] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To develop and validate scales to measure constructs that survivors of childhood cancer report as barriers and/or facilitators to the process of transitioning from paediatric to adult‐oriented long‐term follow‐up (LTFU) care. Methods Qualitative interviews provided a dataset that were used to develop items for three new scales that measure cancer worry, self‐management skills and expectations about adult care. These scales were field‐tested in a sample of 250 survivors aged 15–26 years recruited from three Canadian hospitals between July 2011 and January 2012. Rasch Measurement Theory (RMT) analysis was used to identify the items that represent the best indicators of each scale using tests of validity (i.e. thresholds for item response options, item fit statistics, item locations, differential item function) and reliability (Person Separation Index). Traditional psychometric tests of measurement performance were also conducted. Results RMT led to the refinement of a 6‐item Cancer Worry scale (focused on worry about cancer‐related issues such as late effects), a 15‐item Self‐Management Skills scale (focused on skills an adolescent needs to acquire to manage their own health care), and a 12‐item Expectations scale (about the nature of adult LTFU care). Our study provides preliminary evidence about the reliability and validity of these new scales (e.g. Person Separation Index ≥ 0.81; Cronbach's α ≥ 0.81; test–retest reliability ≥ 0.85). Conclusion There is limited knowledge about the transition experience of childhood cancer survivors. These scales can be used to investigate barriers survivors face in the process of transition from paediatric to adult care.
Collapse
Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | - Stefan J Cano
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Iqra Syed
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Leeat Granek
- Faculty of Health Sciences, Department of Public Health, Ben Gurion University of the Negev, Tel Aviv, Israel
| | - Mark L Greenberg
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - David Dix
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Paul C Nathan
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| |
Collapse
|
42
|
Granek L, Rosenberg-Yunger ZRS, Dix D, Klaassen RJ, Sung L, Cairney J, Klassen AF. Caregiving, single parents and cumulative stresses when caring for a child with cancer. Child Care Health Dev 2014; 40:184-94. [PMID: 23121336 DOI: 10.1111/cch.12008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Single parents whose children have cancer are a marginalized group who report less family centred care, and therefore, less quality cancer care for their children. As such, the aims of this study were to explore how single parents of children with cancer describe their caregiving experiences and to understand their contextual life stressors. METHODS A constructivist grounded theory method was used. Qualitative interviews with 29 single parents of children with cancer who were at least 6 months post-diagnosis were recruited between November 2009 and April 2011 from four hospitals across Canada. Line-by-line coding was used to establish codes and themes and constant comparison was used to establish relationships among emerging codes and conceptual themes. RESULTS The first set of findings report on caregiving duties including: emotional tasks, informational tasks and physical tasks. The second set of findings report on the contextual picture of parent's lives including their living conditions, their physical and mental health and their family histories of disruption, trauma and disease. CONCLUSIONS Single parents caring for children with cancer were found to experience several cumulative stressors in addition to the current strain of caring for a child with cancer. The synergy of these cumulative stresses with the added strain of caregiving for a child with cancer may have long-term health and financial implications for parents. Broad-based policy interventions should focus on relieving the chronic strains associated with being a single parent of a child with cancer.
Collapse
Affiliation(s)
- L Granek
- Department of Public Health, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | | | | | | | | |
Collapse
|
43
|
Tran TH, Mitchell D, Dix D, Cellot S, Ethier MC, Gillmeister B, Hitzler J, Lewis V, Yanofsky R, Johnston DL, Portwine C, Price V, Zelcer S, Silva M, Michon B, Bowes L, Stobart K, Brossard J, Beyene J, Sung L. Infections in children with down syndrome and acute myeloid leukemia: a report from the Canadian infections in AML research group. Infect Agent Cancer 2013; 8:47. [PMID: 24289042 PMCID: PMC4174901 DOI: 10.1186/1750-9378-8-47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/30/2013] [Indexed: 12/02/2022] Open
Abstract
Background Children with Down syndrome (DS) are at high risk of infectious toxicity when treated with acute lymphoblastic leukemia chemotherapy protocols optimized in children without DS. Our objective was to determine if children with DS and acute myeloid leukemia (AML) have a different risk of infection when treated with chemotherapy protocols developed for children with DS compared to AML treatment protocols developed for children without DS. Methods We conducted a retrospective, population-based cohort study that included DS children ≤ 18 years of age with de novo, non-M3 AML diagnosed between January 1995 and December 2004, and treated at 15 Canadian centers. Patients were monitored for infection from initiation of AML treatment until recovery from the last cycle of chemotherapy, conditioning for hematopoietic stem cell transplantation, relapse, persistent disease or death (whichever occurred first). Trained research associates abstracted all information from each site. Results There were 31 children with DS included; median age was 1.7 (range 0.1-11.1) years. Eleven were treated according to a DS-specific protocol while 20 were treated with non-DS specific protocols. A total of 157 courses of chemotherapy were delivered. Microbiologically documented sterile site infection occurred in 11.9% and 14.3% of DS-specific and non-DS specific AML treatment courses respectively. Sepsis was rare and there were no infection-related deaths. In multiple regression, treatment with a DS-specific protocol was independently associated with a reduction in microbiologically documented sterile site infection (adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42-0.99; P = 0.044), and clinically documented infection (adjusted OR 0.36, 95% CI 0.14-0.91; P = 0.031) but not bacteremia (adjusted OR 0.73, 95% CI 0.44-1.22; P = 0.231). Conclusions Our study suggests that children with DS do not experience excessive infectious toxicity during treatment for AML compared to children without DS. Incorporation of DS-specific AML treatment protocols is associated with a more favorable infection profile for children with DS-AML.
Collapse
Affiliation(s)
- Thai Hoa Tran
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Klassen AF, Cano SJ, Sinha R, Shahbaz A, Klaassen R, Dix D. Is the Give Youth a Voice questionnaire an appropriate measure of teen-centred care in paediatric oncology: a Rasch measurement theory analysis. Health Expect 2013; 18:1686-97. [PMID: 24286522 DOI: 10.1111/hex.12161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adolescents have their own views about the cancer care they receive and how they feel they are treated, but their opinions are rarely solicited. OBJECTIVE To determine whether the 56-item Give Youth a Voice (GYV-56), its subscales and its 20-item short-form, are clinically meaningful and psychometrically sound instruments that can be used to measure teen-centred care (TCC) in paediatric oncology. DESIGN Qualitative interviews and a questionnaire survey. SETTING AND PARTICIPANTS Qualitative interviews with 38 childhood cancer survivors. GYV-56 data collected from 200 paediatric cancer patients and survivors. MAIN OUTCOME MEASURE The GYV-56, which measures the following four aspects of service delivery: Supportive and respectful relationships; Information sharing and communication; Supporting independence; and Teen-centred services. RESULTS Qualitative data provided broad support for the TCC conceptual framework and GYV-56 items. After post-hoc reduction of the response options from 7 to 3 (to correct for disordered thresholds), fit to the Rasch model was good, most items showed acceptable fit residuals and chi-square P-values, scale reliability were supported and item locations defined a continuum for TCC that was well-targeted to the sample. By calibrating the items for each subscale and the short-form to the full scale, the scores obtained on each measure are directly comparable. CONCLUSION Our study found initial support for use of the GYV with a reduced response option format for examining TCC in the adolescent oncology patients. in this paediatric population. Further research using the GYV is needed to elaborate upon our findings.
Collapse
Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Stefan J Cano
- Clinical Neurology Research Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Roona Sinha
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Robert Klaassen
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - David Dix
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
45
|
Rosenberg-Yunger ZRS, Granek L, Sung L, Klaassen R, Dix D, Cairney J, Klassen AF. Single-parent caregivers of children with cancer: factors assisting with caregiving strains. J Pediatr Oncol Nurs 2013; 30:45-55. [PMID: 23372040 DOI: 10.1177/1043454212471727] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Caring for a child with a cancer can result in significant financial strain on families, which in turn can affect parental emotional, physical, and social health. We explored the supportive factors and resources that helped single parents of children with cancer throughout the caregiving process. METHODS Using a constructivist grounded theory approach, we recruited 29 single parents of children with cancer that were at least 6 months postdiagnosis and 2 hospital social workers across 4 Canadian pediatric oncology centers. RESULTS Many parents had knowledge of, accessed, and received support from family, friends, community (eg, teachers, religious organizations) and cancer organizations and government programs. Nonetheless, they reported a number of unmet needs. CONCLUSIONS Participants reported their need for more social-emotional, practical, and financial support to assist them with their caregiving duties. We recommend that hospitals provide education to describe (a) supports available to families and (b) parental caregiver needs to families' support networks. Further research is needed to identify limitations of the current public benefit schemes for caregivers.
Collapse
|
46
|
Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
Collapse
|
47
|
Cellot S, Johnston D, Dix D, Ethier MC, Gillmeister B, Mitchell D, Yanofsky R, Lewis V, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Brossard J, Beyene J, Sung L. Infections in pediatric acute promyelocytic leukemia: from the Canadian infections in acute myeloid leukemia research group. BMC Cancer 2013; 13:276. [PMID: 23735034 PMCID: PMC3679857 DOI: 10.1186/1471-2407-13-276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Background It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non- APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. Methods We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL -specific protocols. Results Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. Conclusions One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non- APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.
Collapse
|
48
|
Portwine C, Mitchell D, Johnston D, Gillmeister B, Ethier MC, Yanofsky R, Dix D, Cellot S, Lewis V, Price V, Silva M, Zelcer S, Bowes L, Michon B, Stobart K, Brossard J, Beyene J, Sung L. Infectious events prior to chemotherapy initiation in children with acute myeloid leukemia. PLoS One 2013; 8:e61899. [PMID: 23637925 PMCID: PMC3637321 DOI: 10.1371/journal.pone.0061899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/14/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia. METHODS We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy. RESULTS Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation. CONCLUSION It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.
Collapse
Affiliation(s)
- Carol Portwine
- Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Donna Johnston
- Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Biljana Gillmeister
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marie-Chantal Ethier
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rochelle Yanofsky
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Sonia Cellot
- Hematology/Oncology, Hospital Sainte-Justine, Montreal, Quebec, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Victoria Price
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Mariana Silva
- Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, Ontario, Canada
| | - Shayna Zelcer
- Hematology/Oncology, London Health Sciences, London, Ontario, Canada
| | - Lynette Bowes
- Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland, Canada
| | - Bruno Michon
- Pediatric Hematology/Oncology Centre, Hospitalier Universitaire de Quebec Centre, Quebec City, Quebec, Canada
| | - Kent Stobart
- Stollery Children's Hospital, University of Alberta Hospital, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada
| | - Josee Brossard
- Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Joseph Beyene
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|
49
|
Kleinstreuer N, Dix D, Rountree M, Baker N, Sipes N, Reif D, Spencer R, Knudsen T. A computational model predicting disruption of blood vessel development. PLoS Comput Biol 2013; 9:e1002996. [PMID: 23592958 PMCID: PMC3616981 DOI: 10.1371/journal.pcbi.1002996] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 01/24/2013] [Indexed: 11/18/2022] Open
Abstract
Vascular development is a complex process regulated by dynamic biological networks that vary in topology and state across different tissues and developmental stages. Signals regulating de novo blood vessel formation (vasculogenesis) and remodeling (angiogenesis) come from a variety of biological pathways linked to endothelial cell (EC) behavior, extracellular matrix (ECM) remodeling and the local generation of chemokines and growth factors. Simulating these interactions at a systems level requires sufficient biological detail about the relevant molecular pathways and associated cellular behaviors, and tractable computational models that offset mathematical and biological complexity. Here, we describe a novel multicellular agent-based model of vasculogenesis using the CompuCell3D (http://www.compucell3d.org/) modeling environment supplemented with semi-automatic knowledgebase creation. The model incorporates vascular endothelial growth factor signals, pro- and anti-angiogenic inflammatory chemokine signals, and the plasminogen activating system of enzymes and proteases linked to ECM interactions, to simulate nascent EC organization, growth and remodeling. The model was shown to recapitulate stereotypical capillary plexus formation and structural emergence of non-coded cellular behaviors, such as a heterologous bridging phenomenon linking endothelial tip cells together during formation of polygonal endothelial cords. Molecular targets in the computational model were mapped to signatures of vascular disruption derived from in vitro chemical profiling using the EPA's ToxCast high-throughput screening (HTS) dataset. Simulating the HTS data with the cell-agent based model of vascular development predicted adverse effects of a reference anti-angiogenic thalidomide analog, 5HPP-33, on in vitro angiogenesis with respect to both concentration-response and morphological consequences. These findings support the utility of cell agent-based models for simulating a morphogenetic series of events and for the first time demonstrate the applicability of these models for predictive toxicology.
Collapse
Affiliation(s)
- Nicole Kleinstreuer
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - David Dix
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Michael Rountree
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Nancy Baker
- Lockheed-Martin, Research Triangle Park, North Carolina, United States of America
| | - Nisha Sipes
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - David Reif
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Richard Spencer
- Lockheed-Martin, Research Triangle Park, North Carolina, United States of America
| | - Thomas Knudsen
- National Center for Computational Toxicology, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| |
Collapse
|
50
|
Watt L, Dix D, Gulati S, Sung L, Klaassen RJ, Shaw NT, Klassen AF. Family-centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology. Child Care Health Dev 2013; 39:185-93. [PMID: 22066491 DOI: 10.1111/j.1365-2214.2011.01342.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the past two decades, there is increasing emphasis being placed upon providing family-centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada. METHODS This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post-diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line-by-line, focused and theoretical coding, and the use of the constant comparison method. RESULTS Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co-ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health-related information directly with their child. CONCLUSIONS In order to successfully provide family-centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit.
Collapse
Affiliation(s)
- L Watt
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | |
Collapse
|