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Neville AR, Tabaczynski A, Whitehorn A, Bastas D, Trinh L. Sedentary time transitions and associations with quality of life in cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2024:1-18. [PMID: 38693609 DOI: 10.1080/07347332.2024.2346560] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Patterns in sedentary time (SED) and its impact on quality of life (QoL) in cancer survivors during the COVID-19 pandemic remains unknown. The purpose of this study was to 1) compare total and domain-specific SED before and during the pandemic; and 2) examine its association with QoL in a global sample of cancer survivors. METHODS In an online survey, cancer survivors retrospectively self-reported domain-specific SED (e.g. transportation, television) before and during the pandemic via the Domain-Specific Sitting Time Questionnaire. QoL was assessed via the Functional Assessment of Cancer Therapy (FACT)-General and FACT-Fatigue. Paired t-tests compared daily SED before and during the pandemic. Analysis of covariance compared QoL among: those who remained high (>8 h/day), remained low (<8 h/day), increased (<8 h/day to >8 h/day), or decreased (>8 h/day to <8 h/day) daily SED. RESULTS Among cancer survivors (N = 477, Mage=48.5 ± 15.4), 60.8% reported that their SED remained high, 19.7% remained low, 7.5% increased SED, and 11.9% decreased SED. Computer and television screen time significantly increased (p's<.001), while SED during transportation significantly decreased (p<.001). Sub-group analyses revealed that those who reduced SED who were normal or underweight (p=.042) or were meeting physical activity guidelines (p=.031) had significantly less fatigue than those who increased or remained high in SED, respectively. Those who remained high in SED with <3 comorbidities (p's =.005) had significantly better social well-being than those who increased SED. CONCLUSIONS As we transition to a post-pandemic era, behavioral strategies for cancer survivors should focus on reducing screen time to improve QoL and fatigue.
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Affiliation(s)
- Alyssa R Neville
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Denise Bastas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Bastas D, Brandão LR, Vincelli J, Wilson D, Perrem L, Guerra V, Wong G, Bentley RF, Tole S, Schneiderman JE, Amiri N, Williams S, Avila ML. Long-term outcomes of pulmonary embolism in children and adolescents. Blood 2024; 143:631-640. [PMID: 38134357 DOI: 10.1182/blood.2023021953] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/24/2023] Open
Abstract
ABSTRACT Knowledge regarding the long-term consequences of pulmonary embolism (PE) in children is limited. This cohort study describes the long-term outcomes of PE in children who were followed-up at a single-center institution using a local protocol that included clinical evaluation, chest imaging, echocardiography, pulmonary function tests, and cardiopulmonary exercise tests at follow-up, starting 3 to 6 months after acute PE. Children objectively diagnosed with PE at age 0 to 18 years, who had ≥6 months of follow-up were included. Study outcomes consisted of PE resolution, PE recurrence, death, and functional outcomes (dyspnea, impaired pulmonary or cardiac function, impaired aerobic capacity, and post-PE syndrome). The frequency of outcomes was compared between patients with/without underlying conditions. In total, 150 patients were included; median age at PE was 16 years (25th-75th percentile, 14-17 years); 61% had underlying conditions. PE did not resolve in 29%, recurrence happened in 9%, and death in 5%. One-third of patients had at least 1 documented abnormal functional finding at follow-up (ventilatory impairments, 31%; impaired aerobic capacity, 31%; dyspnea, 26%; and abnormal diffusing capacity of the lungs to carbon monoxide, 22%). Most abnormalities were transient. When alternative explanations for the impairments were considered, the frequency of post-PE syndrome was lower, ranging between 0.7% and 8.5%. Patients with underlying conditions had significantly higher recurrence, more pulmonary function and ventilatory impairments, and poorer exercise capacity. Exercise intolerance was, in turn, most frequently because of deconditioning than to respiratory or cardiac limitation, highlighting the importance of physical activity promotion in children with PE.
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Affiliation(s)
- Denise Bastas
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leonardo R Brandão
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Vincelli
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Wilson
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lucy Perrem
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vitor Guerra
- Division of Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gina Wong
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert F Bentley
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Soumitra Tole
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jane E Schneiderman
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nour Amiri
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Suzan Williams
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - M Laura Avila
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Trinh L, Tabaczynski A, Bastas D, Neville AR, Voss ML, Whitehorn A. Changes in physical activity, sedentary behavior, and self-reported cognitive function in cancer survivors before and during the COVID-19 pandemic: A cross-sectional study. J Sport Health Sci 2023; 12:653-663. [PMID: 37279854 PMCID: PMC10658308 DOI: 10.1016/j.jshs.2023.06.001] [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] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/23/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Physical activity (PA) and reductions in sedentary behavior (SED) may mitigate cancer-related cognitive impairment. The purpose of this study was to examine (a) the associations between changes in PA, SED, and cognitive function in cancer survivors before and during the coronavirus disease 2019 (COVID-19) pandemic; and (b) clinical subgroups that moderate this association. METHODS A cross-sectional survey was administered online to adult cancer survivors globally between July and November of 2020. This was a secondary analysis of a cross-sectional survey examining changes in self-reported PA and quality of life in cancer survivors before and during the COVID-19 pandemic. Self-reported Questionnaires assessed moderate-to-vigorous PA (MVPA) using the modified Godin Leisure Time Exercise Questionnaire, cognitive function using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale, and SED using the Domain-specific Sitting Time questionnaire. Cancer survivors were classified into no change in behavior, desirable change (i.e., increase MVPA to meet PA guidelines or decrease SED by ≥60 min/day), and undesirable change (i.e., decrease MVPA to <150 min/week or increase SED by ≥60 min/day). Analysis of covariance examined differences in FACT-Cog scores across the activity change categories. Planned contrasts compared differences in FACT-Cog scores between cancer survivors with (a) no meaningful change vs. any change, and (b) a desirable change vs. an undesirable change. RESULTS There were no significant differences in FACT-Cog scores across activity-change categories in the full sample of cancer survivors (n = 371; age = 48.6 ± 15.3 years (mean ± SD)). However, cancer survivors who were diagnosed ≥5 years ago (t(160) = -2.15, p = 0.03) or who received treatment ≥5 years ago (t(102) = -2.23, p = 0.03) and who had a desirable change in activity reported better perceived cognitive abilities than those who had an undesirable change. CONCLUSION PA promotion efforts should consider reducing SED in addition to maintaining MVPA in long-term cancer survivors to mitigate cancer-related cognitive impairment during the COVID-19 pandemic.
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Affiliation(s)
- Linda Trinh
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada.
| | - Allyson Tabaczynski
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Denise Bastas
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Alyssa R Neville
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - M Lauren Voss
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, OT M5S 2W6, Canada
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Avila ML, Bentley RF, Bastas D, Brandão LR, Schneiderman JE, Ward L, Wong G, Stephens S, Liu K, Thomas S. Unraveling the pathophysiology of lower-limb postthrombotic syndrome in adolescents: a proof-of-concept study. Blood Adv 2023; 7:2784-2793. [PMID: 36763520 PMCID: PMC10275697 DOI: 10.1182/bloodadvances.2022009599] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
A better understanding of the pathophysiology of pediatric postthrombotic syndrome (PTS) is needed to develop strategies to treat this condition. We investigated calf pump function, exercise capacity, balance in power output, and changes in limb muscle oxygen saturation (SmO2) and fluid content during exercise in 10 pediatric patients with unilateral lower-limb PTS, and in age- and sex-matched controls (1:1-1:2 ratio). Outcomes were investigated using bioimpedance spectroscopy, torque-sensing pedals, and near-infrared spectroscopy during incremental- and constant-load cycling tests. The median age at participation was 17 years (25th-75th percentile, 15-18 years); 68% of participants were females. The median CAPTSure score in the affected leg of affected participants was 35 points (25th-75th percentile, 24-46 points), indicating moderate/severe PTS; 20% of patients had a history of central venous catheter-related thrombosis. Increasing PTS severity was associated with higher calf pump venous volume and higher ejection volume, leading to compensated calf pump performance. We found no evidence of PTS impact on exercise capacity. Leg contribution to power output was similar in affected and unaffected legs. However, the PTS-affected legs showed lower SmO2 during active cycling and recovery with increasing PTS severity, indicating impaired microvascular function in the muscle. These findings suggest that PTS severity is associated with impaired blood flow, presumably from elevated venous pressure during and after exercise. The fact that microvascular function is impaired in young patients with PTS underscores the relevance of developing strategies to mitigate the effects of this chronic vascular disease to minimize its deleterious effects as children grow older.
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Affiliation(s)
- M. Laura Avila
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert F. Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Denise Bastas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leonardo R. Brandão
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jane E. Schneiderman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leigh Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Gina Wong
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha Stephens
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kuan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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Bastas D, Tabaczynski A, Whitehorn A, Trinh L. Preferences and engagement with physical activity resources among cancer survivors during the COVID-19 pandemic. Support Care Cancer 2023; 31:374. [PMID: 37273005 DOI: 10.1007/s00520-023-07813-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has imposed additional barriers to physical activity (PA) in cancer survivors. Adaptations to PA programmes are needed during the pandemic. Therefore, the purpose of this study was to evaluate (1) the PA preferences of cancer survivors prior to and during the pandemic and (2) the available resources to engage in PA during the pandemic. METHODS Using a cross-sectional study design, cancer survivors were recruited globally to participate in a self-administered survey assessing their PA preferences and available PA resources during the pandemic. Descriptive statistics were used to determine trends in PA preferences and resources. A sub-group analysis was conducted for age, gender, education, and PA levels. RESULTS Cancer survivors (N = 493) were mainly women (70.4%) diagnosed with breast cancer (29.0%), with a mean age of 48.7 ± 15.8 years, and 87.1 ± 81.9 months since diagnosis. Since the start of the pandemic, cancer survivors were primarily walking (82.6%), and performing PA alone (62.7%) and at home (46.6%). Sub-group analysis revealed education level, PA levels, and age to be associated with significant differences in PA preferences. The most common equipment available to survivors in their homes were exercise mats (40.6%) and free weights (39.8%). Few survivors were made aware of at-home PA resources (19.1%), and approximately half indicated wanting to receive these resources (49.6%). CONCLUSIONS Understanding cancer survivors' preferences and resources for PA during the pandemic is critical to designing effective home-based interventions. Interventions and recommendations should be tailored based on the level of education and PA participation, as well as age.
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Affiliation(s)
- Denise Bastas
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
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Bastas D, Brandão LR, Vincelli J, Schneiderman JE, Cunningham J, Avila ML. Physical Activity for Children with Deep Vein Thrombosis and Pulmonary Embolism on Anticoagulation: A Scoping Review. Res Pract Thromb Haemost 2023; 7:100094. [PMID: 37063770 PMCID: PMC10099307 DOI: 10.1016/j.rpth.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
Context There are no clear pediatric guidelines on the return to physical activity following deep vein thrombosis (DVT) or pulmonary embolism (PE), particularly while being treated with anticoagulation. Objective This scoping review aimed to examine the current literature on physical activity beyond simple ambulation for patients with DVT/PE being treated with anticoagulation. Data Sources An electronic search for articles in MEDLINE, Epub Ahead of Print, In-Process, and Other Non-Indexed Citations, Daily (1946 to April 4, 2022), and Embase+Embase Classic (1946 to 2022, week 13) was conducted. Study Selection (1) Patients of any age with DVT/PE, treated with anticoagulation; (2) studies of any design providing information on physical activity (ie, sport, exercise) while on anticoagulation; and (3) studies in English. Data Extraction Data from eligible studies obtained included the study design, population, disease characteristics, and information on physical activity participation. Results A total of 26 eligible studies were included. Only 2 studies were specific to children. Studies recommend a gradual return to participation in noncontact or low-risk activities after the first 3-4 weeks of anticoagulation, with close monitoring of symptoms. Participation in contact sports and activities is typically delayed until after anticoagulants are discontinued. However, personalized anticoagulation with intermittent dosing schedules has been proposed for athletes after the first 3 months of anticoagulation treatment. Conclusions Physical activity participation guidelines for children with DVT/PE being treated with anticoagulation are needed, and the evidence currently available is limited. Largely based on evidence from adult patients, we present evidence-informed options to facilitate clinician recommendations for returning to activity.
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Affiliation(s)
- Denise Bastas
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leonardo R. Brandão
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Vincelli
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessie Cunningham
- SickKids Hospital Library, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M. Laura Avila
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Correspondence M. Laura Avila, Division of Paediatrics, Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. @didascalias_TO
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Bastas D, Brandão LR, Allen DD, Vincelli J, Amiri N, Abdul-Samad K, Liu K, Stephens S, Avila ML. Functional impact of pediatric postthrombotic syndrome. J Thromb Haemost 2023; 21:896-904. [PMID: 36739234 DOI: 10.1016/j.jtha.2023.01.004] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/09/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Postthrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) in children. OBJECTIVES We aimed to assess the impact of pediatric PTS on functioning as assessed by movement ability, mobility, functional disability, and physical activity levels in children after diagnosis of limb DVT. METHODS Patients aged 8-21 years in follow-up care after objectively documented limb DVT were prospectively recruited in this cross-sectional study. Measures of functioning (outcomes) included self-reported questionnaires that assessed: 1) movement ability, measured with the Movement Ability Measure-Computer Adaptive Test version; 2) mobility, evaluated with the Computer Adaptive Test version of the Patient-Reported Outcomes Measurement Information System Pediatric Physical Functioning, Mobility domain; 3) functional disability, evaluated with the Functional Disability Inventory; and 4) physical activity levels, evaluated with the Godin Leisure-Time Exercise Questionnaire. The main predictor was PTS severity, which was assessed using the index for the Clinical Assessment of PTS in children. The association between PTS and outcomes was analyzed using linear models. RESULTS Eighty-seven patients (median age, 16 years; 25th-75th percentile, 15-18 years; 56% boys) were enrolled. Adjusted for age, sex, and underlying condition, increasing PTS severity was associated with lower current movement ability, a wider gap between current vs preferred movement ability, lower mobility, and slightly higher functional disability scores. There was a nonsignificant effect of PTS severity on moderate-strenuous physical activity. CONCLUSION In children, increased PTS severity is associated with lower movement ability and impaired mobility. Reducing the gap between the patients' current vs preferred movement ability is a relevant aspect of PTS management in children.
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Affiliation(s)
- Denise Bastas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leonardo R Brandão
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Diane D Allen
- Graduate Program in Physical Therapy, University of California, San Francisco/San Francisco State University, USA
| | - Jennifer Vincelli
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nour Amiri
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karem Abdul-Samad
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kuan Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Stephens
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Laura Avila
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Bastas D, Vincelli J, De R, Benia E, Gairdner S, Brandão LR, Avila L. Impact of deep vein thrombosis on adolescent athletes: Navigating an invisible disability. Res Pract Thromb Haemost 2022; 6:e12779. [PMID: 35919876 PMCID: PMC9336208 DOI: 10.1002/rth2.12779] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/01/2022] [Accepted: 07/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background Injury in adolescent athletes that threatens their sport participation can result in a sense of identity loss during critical years for identity development, creating the potential for significant mental health challenges. The specific effect of deep vein thrombosis (DVT) in this vulnerable population has not been characterized. Purpose To describe the impact of DVT diagnosis, treatment, and long-term complications on the mental well-being of athletes who sustained a DVT during adolescence and to identify strategies to improve the quality of care for these patients. Methods Using a qualitative study design, athletes with a history of DVT during adolescence and their parents were recruited to participate in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. Participants were recruited until reaching thematic saturation. Results In total, 19 participants (12 athletes, 7 parents) were recruited. Athletes were mainly males (67%), median age at time of DVT was 15 years (range, 12-18 years), and median age at study participation was 19 years (range, 16-34 years). Thematic analysis revealed four main themes: Theme 1: DVT posed a threat to sport participation; Theme 2: at a personal level, there were significant mental health challenges; Theme 3: at a societal level, DVT is an invisible disability; and Theme 4: physical, psychological, and transition support are important to improve the care of these patients. Conclusion Deep vein thrombosis threatens an athlete's participation in sport, resulting in a significant and complex impact on their mental well-being. Heightened awareness and a multidisciplinary approach are needed to help young athletes navigate the consequences of DVT.
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Affiliation(s)
- Denise Bastas
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada.,Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto Ontario Canada
| | - Jennifer Vincelli
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada
| | - Riddhita De
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada.,Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto Ontario Canada
| | - Eliana Benia
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada
| | - Sarah Gairdner
- Faculty of Kinesiology and Physical Education University of Toronto Toronto Ontario Canada
| | - Leonardo R Brandão
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada.,Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Laura Avila
- Division of Haematology/Oncology The Hospital for Sick Children Toronto Ontario Canada.,Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto Ontario Canada.,Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
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Trinh L, Alibhai SMH, Culos-Reed N, Sabiston CM, Jones JM, Rosenberg DE, Whitehorn A, Bastas D, Faulkner GE. Associations of light physical activity, moderate-to-vigorous physical activity and sedentary behavior with quality of life in men on androgen deprivation therapy for prostate cancer: a quantile regression analysis. J Behav Med 2022; 45:533-543. [DOI: 10.1007/s10865-022-00285-7] [Citation(s) in RCA: 1] [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] [Received: 06/10/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
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Chang KJ, Soetikno RM, Bastas D, Tu C, Nguyen PT. Impact of endoscopic ultrasound combined with fine-needle aspiration biopsy in the management of esophageal cancer. Endoscopy 2003; 35:962-6. [PMID: 14606021 DOI: 10.1055/s-2003-43470] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasound (EUS) in combination with fine-needle aspiration biopsy (FNA) is a highly accurate method for the preoperative staging of esophageal cancer. Its impact on medical decision-making and the cost of care is unknown. This prospective case series was undertaken in order to determine the impact of EUS in combination with FNA on patients' choice of therapy and on the cost of care. PATIENTS AND METHODS Sixty consecutive patients with esophageal cancer, referred for preoperative EUS staging in a large tertiary-care academic medical center, were enrolled. The accuracy of EUS, the impact of EUS-based staging on the patients' choice of therapy, and costs were studied. RESULTS The accuracy rates for EUS combined with FNA in tumor and lymph-node staging were 83 % and 89 %, respectively. Twenty-five patients (42 %) had EUS stage I and II and were candidates for curative surgery. Twenty-eight patients (47 %) had stage III, and seven (12 %) had stage IV. All patients with stage I had surgery, while all patients with stage IV had medical therapy. The majority (62 %) of patients with stage II had surgery, while only a minority (25 %) of patients with stage III had surgery. Thirty-six patients (60 %) underwent medical therapy. Patients' medical decisions in favor of surgical or medical therapy correlated strongly with the results of their EUS staging ( P = 0.005), but not with age, sex, or referring physicians (surgeons vs. nonsurgeons). EUS-guided therapy potentially decreased the cost of care by $ 740 424 ($ 12 340/patient) by reducing the number of thoracotomies. CONCLUSIONS Patients' decisions regarding therapy correlated with their overall tumor staging, suggesting that the information provided by EUS played a significant role in patients' decision-making. The use of EUS in combination with FNA reduces the cost of managing patients with esophageal cancer.
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Affiliation(s)
- K J Chang
- Dept. of Medicine, Division of Gastroenterology, Gastrointestinal Oncology Section, University of California, Irvine Medical Center, Orange, California 92868, USA.
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