1
|
Damer A, Hamilton L, Tu A, Johnston DL, Ramphal R, Wilson N. Primary intramedullary extradural Ewing sarcoma. Radiol Case Rep 2024; 19:2381-2389. [PMID: 38572274 PMCID: PMC10987877 DOI: 10.1016/j.radcr.2024.02.101] [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: 09/23/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
Ewing sarcoma is the second most frequent primary bone tumour of childhood and adolescence. The aim of this report is to describe the imaging, pathology, clinical findings, and treatment of a primary intradural extramedullary Ewing sarcoma with a unique intracranial metastatic component in a pediatric patient. A 14-year-old girl with a history of mood disorders presented to the emergency department with a 3-week history of neck torticollis, cervical pain, paresis, and paresthesia of the upper and lower extremities on the left side. Initially, non-organic causes such as somatization or conversion disorder were suspected. She returned 3 months later when her symptoms worsened. MRI of the head and spine was performed, and demonstrated the presence of a suprasellar, retro-chiasmatic mass lesion. There was also diffuse leptomeningeal enhancement, another well-defined intradural extramedullary lesion the sacral region and several multifocal cauda equina soft tissue nodules. The patient first underwent surgery. The patient was also treated with a combination of chemotherapy (vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide (VDC/IE)) and radiation as per the Children's Oncology Group AEWS1221 protocol. Most recent imaging conducted 22 months after the initial mass discovery revealed improvement of the suprasellar mass lesion with residual stable appearance of the prominence and enhancement of the pituitary stalk and tuber cinereum. There was interval improvement of the spinal lesions with no convincing residual. Clinically, at almost three years since initial imaging findings, and 25 months since completing treatment, she is stable from an oncology perspective.
Collapse
Affiliation(s)
- Alameen Damer
- University of Toronto, Department of Medical Imaging, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Leslie Hamilton
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Albert Tu
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Donna L. Johnston
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Division of Hematology/Oncology, Ottawa ON, Canada
| | - Raveena Ramphal
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO), Division of Hematology/Oncology, Ottawa ON, Canada
| | - Nagwa Wilson
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| |
Collapse
|
2
|
Longmuir PE, Chubbs Payne A, Beshara N, Brandão LR, Wright FV, Pohl D, Katz SL, McCormick A, De Laat D, Klaassen RJ, Johnston DL, Lougheed J, Roth J, McMillan HJ, Venkateswaran S, Sell E, Doja A, Boafo A, Macartney G, Matheson K, Feldman BM. Quick, Effective Screening Tasks Identify Children With Medical Conditions or Disabilities Needing Physical Literacy Support. Pediatr Exerc Sci 2024:1-11. [PMID: 38171358 DOI: 10.1123/pes.2023-0130] [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: 09/01/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study evaluated screening tasks able to identify children with medical conditions or disabilities who may benefit from physical literacy. METHOD Children completed ≤20 screening tasks during their clinic visit and then the Canadian Assessment of Physical Literacy (2nd edition) at a separate visit. Total Canadian Assessment of Physical Literacy scores <30th percentile were categorized as potentially needing physical literacy support. Receiver operator characteristic curves identified assessment cut points with 80% sensitivity and 40% specificity relative to total physical literacy scores. RESULTS 223 children (97 girls; 10.1 [2.6] y) participated. Physical activity adequacy, predilection, and physical competence achieved ≥80% sensitivity and ≥40% specificity in both data sets. Adequacy ≤ 6.5 had 86% to 100% sensitivity and 48% to 49% specificity. Daily screen time >4.9 hours combined with Adequacy ≤6.15 had 88% to 10% sensitivity and 53% to 56% specificity. CONCLUSIONS Activity adequacy, alone or with screen time, most effectively identified children likely to benefit from physical literacy support. Adequacy and screen time questionnaires are suitable for clinical use. Similar results regardless of diagnosis suggest physical competence deficits are not primary determinants of active lifestyles. Research to enhance screening specificity is required.
Collapse
Affiliation(s)
- Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
| | - Adam Chubbs Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
| | - Natalie Beshara
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
| | - Leonardo R Brandão
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON,Canada
- Faculty of Medicine, University of Toronto, Toronto, ON,Canada
| | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON,Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON,Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Denise De Laat
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Sunita Venkateswaran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Erick Sell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Addo Boafo
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Gail Macartney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON,Canada
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, PE,Canada
| | - Katherine Matheson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON,Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON,Canada
- Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON,Canada
| | - Brian M Feldman
- Faculty of Medicine, University of Toronto, Toronto, ON,Canada
- Division of Rheumatology, Department of Pediatrics, and the Institute of Health Policy and Evaluation, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON,Canada
| |
Collapse
|
3
|
Hebert R, Cullinan N, Armstrong L, Blood KA, Brossard J, Brunga L, Cacciotti C, Caswell K, Cellot S, Coltin H, Deyell RJ, Felton K, Fernandez CV, Fleming AJ, Gibson P, Hammad R, Jabado N, Johnston DL, Lafay-Cousin L, Larouche V, Leblanc-Desrochers C, Michaeli O, Perrier R, Pike M, Say J, Schiller I, Toupin AK, Vairy S, van Engelen K, Waespe N, Villani A, Foulkes WD, Malkin D, Reichman L, Goudie C. Performance of the eHealth decision support tool, MIPOGG, for recognising children with Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin syndromes. J Med Genet 2023; 60:1218-1223. [PMID: 37460202 DOI: 10.1136/jmg-2023-109376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cancer predisposition syndromes (CPSs) are responsible for at least 10% of cancer diagnoses in children and adolescents, most of which are not clinically recognised prior to cancer diagnosis. A variety of clinical screening guidelines are used in healthcare settings to help clinicians detect patients who have a higher likelihood of having a CPS. The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) is an electronic health decision support tool that uses algorithms to help clinicians determine if a child/adolescent diagnosed with cancer should be referred to genetics for a CPS evaluation. METHODS This study assessed MIPOGG's performance in identifying Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin (nevoid basal cell carcinoma) syndromes in a retrospective series of 84 children diagnosed with cancer and one of these four CPSs in Canadian hospitals over an 18-year period. RESULTS MIPOGG detected 82 of 83 (98.8%) evaluable patients with any one of these four genetic conditions and demonstrated an appropriate rationale for suggesting CPS evaluation. When compared with syndrome-specific clinical screening criteria, MIPOGG's ability to correctly identify children with any of the four CPSs was equivalent to, or outperformed, existing clinical criteria respective to each CPS. CONCLUSION This study adds evidence that MIPOGG is an appropriate tool for CPS screening in clinical practice. MIPOGG's strength is that it starts with a specific cancer diagnosis and incorporates criteria relevant for associated CPSs, making MIPOGG a more universally accessible diagnostic adjunct that does not require in-depth knowledge of each CPS.
Collapse
Affiliation(s)
- Robyn Hebert
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Genetic Counselling Services, Sudbury Regional Hospital, Sudbury, Ontario, Canada
| | - Noelle Cullinan
- Department of Paediatric Haematology-Oncology, Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linlea Armstrong
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine A Blood
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
- Hereditary Cancer Program, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Josee Brossard
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ledia Brunga
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Chantel Cacciotti
- Department of Pediatric Hematology-Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kimberly Caswell
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Cellot
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Hallie Coltin
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathleen Felton
- Pediatric Hematology/Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Conrad V Fernandez
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Paul Gibson
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Rawan Hammad
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Haematology, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Valérie Larouche
- Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Cassandra Leblanc-Desrochers
- Centre de recherche du CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Orli Michaeli
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Renee Perrier
- Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Meghan Pike
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jemma Say
- Paediatric Haematology/Oncology Programme, Bristol Royal Hospital for Children, Bristol, UK
| | - Ian Schiller
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Annie-Kim Toupin
- Department of Medicine, University Laval, Québec, Québec, Canada
| | - Stéphanie Vairy
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Nicolas Waespe
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatric Oncology and Hematology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Anita Villani
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William D Foulkes
- Departments of Human Genetics, Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lara Reichman
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Catherine Goudie
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| |
Collapse
|
4
|
Blain S, Payette N, Bittencourt H, Johnston DL. Gemtuzumab Ozogamicin Monotherapy Is a Well-tolerated Palliative Chemotherapy Option in Pediatric Multiply Relapsed Acute Myeloid Leukemia: A Multicenter Case Series and Review of the Literature. J Pediatr Hematol Oncol 2023; 45:436-444. [PMID: 37807192 DOI: 10.1097/mph.0000000000002760] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023]
Abstract
Gemtuzumab ozogamicin (GO) is an anti-CD33 antibody that is Food and Drug Administration approved in upfront acute myeloid leukemia (AML) for patients over 1-month old, and for relapsed or refractory AML in patients over 2 years old. GO is now integrated in upfront pediatric AML treatment, and often in CD33+ relapse treatment combined with intensive conventional chemotherapy. Although GO was initially tested as a monotherapeutic agent in relapsed or refractory AML, there are few data in pediatric patients supporting this indication. In this review, we report 4 cases of multiply relapsed pediatric AML patients who were treated with GO monotherapy with palliative intent. Three of 4 patients obtained a complete response with GO reinduction, either as monotherapy or paired with conventional chemotherapy. Three patients remained in remission respectively for 5, 17, and 9 months with GO continuation monotherapy. The literature was reviewed regarding the use of GO in pediatric AML relapse settings.
Collapse
Affiliation(s)
- Sarah Blain
- Faculty of Medicine, University of Ottawa
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON
| | | | - Henrique Bittencourt
- Faculy of Medicine, Université de Montréal
- Division of Pediatric Hematology/Oncology, CHU Sainte-Justine, Montreal, QC, Canada
| | - Donna L Johnston
- Faculty of Medicine, University of Ottawa
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON
| |
Collapse
|
5
|
Johnston DL, Samson L, Jabbour M. A Needs Assessment Survey of Division Chiefs at an Academic Children's Hospital. J Healthc Leadersh 2023; 15:11-18. [PMID: 36691566 PMCID: PMC9863463 DOI: 10.2147/jhl.s393177] [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: 10/18/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose The Division Chief at an academic health sciences centre has many leadership roles and responsibilities. There are no data on leadership training needs for Division Chiefs, and so we sought to design and implement a needs assessment for pediatric Division Chiefs at CHEO, a pediatric academic health sciences centre in Eastern Ontario, Canada. Methods A needs assessment survey was developed with the aim to document demographics, preparedness for the role of Division Chief and desired leadership training for the role. This survey was piloted, revised and then distributed to all the Division Chiefs at our institution. The results of each question were collated, and simple descriptive statistics were calculated. Results The survey was completed by 22 of 31 Division Chiefs. The majority of respondents were from the Department of Pediatrics (63.6%), followed by Surgery (20%), Psychiatry (3.3%) and Laboratory Medicine (3.3%). Their mean length of time as Division Chief was 5.5 years. Seventy-seven percent had concurrent leadership roles in addition to the role of Division Chief. None felt they were very well prepared for the role, five felt they were somewhat well prepared, nine were neutral, five were somewhat unprepared and three were very unprepared for the role. Half of the respondents received mentoring, either formal or informal, for their role and all but one felt that formal mentoring would have been useful. In terms of desired training, the Division Chiefs felt they had the most knowledge and skills in patient safety. All wanted training in developing divisional budgets, and many desired training in supporting the academic mission of the Division. Conclusion Overall, this needs assessment identified an unmet need for leadership training and development among Division Chiefs. The findings are being used to optimize onboarding of Division Chiefs and an ongoing leadership development program targeted at this group.
Collapse
Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, CHEO, University of Ottawa, Ottawa, ON, Canada,Correspondence: Donna L Johnston, Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada, Tel +1-613-737-7600 ext 2210, Fax +1-613-738-4828, Email
| | | | | |
Collapse
|
6
|
Breakey VR, Gupta A, Johnston DL, Portwine C, Laverdiere C, May SL, Dick B, Hundert A, Nishat F, Killackey T, Nguyen C, Lalloo C, Stinson J. A Pilot Randomized Control Trial of Teens Taking Charge: A Web-based Self-management Program for Adolescents with Cancer. J Pediatr Hematol Oncol Nurs 2022; 39:366-378. [PMID: 35759365 DOI: 10.1177/27527530211068778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: There is a lack of self-management tools for adolescents with cancer (AWC). This study evaluated the feasibility of Teens Taking Charge Cancer, a web-based self-management program. Methods: A pilot randomized control trial (RCT) was conducted across 4 pediatric oncology clinics. AWC (12-18 years) and their caregivers were randomized to either the intervention or control group. All were asked to complete 12 website modules over 12 weeks (at their own pace) and received monthly calls from health coaches. The intervention website was based on cognitive behavioral principals, designed as an interactive self-guided online program, while the control consisted of education and included links to 12 general cancer websites. Outcome assessments occurred at enrollment and 12 weeks post-intervention. The primary outcomes included rate of accrual and retention, adherence to the protocol, acceptability and satisfaction with intervention using questionnaire and semi-structured interviews, adverse events and engagement with the intervention. Results: Eighty-one teen-caregiver dyads were enrolled with a retention rate of 33%. In the intervention group 46% (n = 18) logged in at least once over the 12-week period. A mean of 2.4 of 12 modules (SD 3.0) were completed; and no one completed the program. Thirty-three percent of caregivers in the intervention logged into the website at least once and none completed the full program. Discussion: The results from this pilot study suggest that the current design of the Teens Taking Charge Cancer RCT lacks feasiblity. Future web-based interventions for this group should include additional features to promote uptake and engagement with the program.
Collapse
Affiliation(s)
| | - Abha Gupta
- 7315The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | | | - Carol Portwine
- 103398McMaster Children's Hospital, Hamilton, ON, Canada
| | - Caroline Laverdiere
- Department of Pediatrics, 5622University of Montreal, Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine), Montréal, QC, Canada
| | - Sylvie Le May
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
| | - Bruce Dick
- Department of Anesthesiology & Pain Medicine, Division of Pain and Medicine, 7979University of Alberta, Edmonton, AB, Canada
| | - Amos Hundert
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Fareha Nishat
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Tieghan Killackey
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Cynthia Nguyen
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Chitra Lalloo
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Jennifer Stinson
- 7315The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Wilson J, Liebman MF, Johnston DL. The expense of sending cerebrospinal fluid for analysis on all lumbar punctures in pediatric acute lymphoblastic leukemia patients. Pediatr Blood Cancer 2022; 69:e29585. [PMID: 35147285 DOI: 10.1002/pbc.29585] [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: 10/15/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Central nervous system (CNS) relapse in pediatric acute lymphoblastic leukemia (ALL) patients is uncommon. The cerebrospinal fluid (CSF) of patients with ALL is routinely sampled at each intrathecal chemotherapy treatment to screen for CNS relapse. The analysis of CSF is both time consuming and resource intensive and must be completed approximately 20 times per patient throughout treatment. Our objective was to examine the expense of routine screening on all CSF samples for CNS relapse in ALL patients, and to identify if CNS relapse can be detected clinically. METHODS We identified all patients diagnosed with ALL at the Children's Hospital of Eastern Ontario (CHEO) between January 2001 and June 2021. We collected the total number of CSF samples in these patients and the number of CSF samples positive for CNS relapse. An in-depth chart review on the patients who relapsed in the CNS was completed to identify symptoms at relapse. RESULTS Over the study period, 351 patients were diagnosed with ALL and underwent a total of 6515 lumbar punctures (LPs), each of which examined the CSF. The cost of CSF sample analysis is $14.32 (Canadian dollars [CDN]); thus, the total cost for the study sample was $93,294.80 (CDN). There were 14 CNS relapses and although symptoms including headache, vomiting, and fatigue were common, two patients were asymptomatic at relapse. CONCLUSIONS Given the marginal cost of routine CSF screening and the lack of specific and sensitive symptoms for CNS relapse, we conclude that the routine practice of sending all CSF samples for analysis of CNS relapse in ALL patients is relatively inexpensive and beneficial.
Collapse
Affiliation(s)
- Janet Wilson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mira F Liebman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Donna L Johnston
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Tomlinson D, Dupuis LL, Johnston DL, Kuczynski S, Patel S, Schechter T, Vettese E, Mairs M, Tomlinson GA, Sung L. Reliability and validity of proxy-SSPedi and mini-SSPedi in pediatric patients 2-7 years receiving cancer treatments. BMC Cancer 2022; 22:730. [PMID: 35787263 PMCID: PMC9254487 DOI: 10.1186/s12885-022-09814-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom Screening in Pediatrics Tool (SSPedi) was developed for symptom screening by children 8-18 years. Objectives were to evaluate the reliability and validity of proxy-SSPedi and self-report mini-SSPedi for younger children. Methods This multi-center study enrolled guardians of children 2-7 years receiving cancer treatments (proxy-SSPedi) and their children 4-7 years (mini-SSPedi). The two populations were: (1) More symptomatic group where children were receiving active cancer treatment and were in hospital or clinic for four consecutive days; and (2) Less symptomatic group where children were receiving maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Proxy-SSPedi or mini-SSPedi were completed with measures of mucositis, nausea, pain, quality of life and overall symptoms. Respondents in the more symptomatic group repeated proxy-SSPedi/mini-SSPedi and a global symptom change scale 3 days later. Results There were 402 guardians and 326 children included in the analysis. Test re-test reliability of proxy-SSPedi showed intraclass correlation coefficient (ICC) 0.83 (95% confidence interval (CI) 0.72-0.90). Mean difference in proxy-SSPedi between more and less symptomatic groups was 9.7 (95% CI 8.3-11.1). Proxy-SSPedi was responsive to change and hypothesized relationships between measures were observed. With a priori threshold ≥0.6, inter-rater ICC among all dyads and those 6-7 years were 0.54 (95% CI 0.45-0.62) and 0.62 (95% CI 0.50-0.71) respectively. Among participating children, other hypothesized reliability and validity thresholds were generally met. Conclusions Proxy-SSPedi is reliable, valid and responsive in children 2-7 years old receiving cancer treatments. Mini-SSPedi can be used for children 6-7 years of age. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09814-8.
Collapse
Affiliation(s)
- 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
| | - 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 Children555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Serina Patel
- Division of Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Emily Vettese
- 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
| | - Mark Mairs
- 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
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, 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
|
9
|
Goudie C, Witkowski L, Cullinan N, Reichman L, Schiller I, Tachdjian M, Armstrong L, Blood KA, Brossard J, Brunga L, Cacciotti C, Caswell K, Cellot S, Clark ME, Clinton C, Coltin H, Felton K, Fernandez CV, Fleming AJ, Fuentes-Bolanos N, Gibson P, Grant R, Hammad R, Harrison LW, Irwin MS, Johnston DL, Kane S, Lafay-Cousin L, Lara-Corrales I, Larouche V, Mathews N, Meyn MS, Michaeli O, Perrier R, Pike M, Punnett A, Ramaswamy V, Say J, Somers G, Tabori U, Thibodeau ML, Toupin AK, Tucker KM, van Engelen K, Vairy S, Waespe N, Warby M, Wasserman JD, Whitlock JA, Sinnett D, Jabado N, Nathan PC, Shlien A, Kamihara J, Deyell RJ, Ziegler DS, Nichols KE, Dendukuri N, Malkin D, Villani A, Foulkes WD. Performance of the McGill Interactive Pediatric OncoGenetic Guidelines for Identifying Cancer Predisposition Syndromes. JAMA Oncol 2021; 7:1806-1814. [PMID: 34617981 DOI: 10.1001/jamaoncol.2021.4536] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Prompt recognition of a child with a cancer predisposition syndrome (CPS) has implications for cancer management, surveillance, genetic counseling, and cascade testing of relatives. Diagnosis of CPS requires practitioner expertise, access to genetic testing, and test result interpretation. This diagnostic process is not accessible in all institutions worldwide, leading to missed CPS diagnoses. Advances in electronic health technology can facilitate CPS risk assessment. Objective To evaluate the diagnostic accuracy of a CPS prediction tool (McGill Interactive Pediatric OncoGenetic Guidelines [MIPOGG]) in identifying children with cancer who have a low or high likelihood of having a CPS. Design, Setting, and Participants In this international, multicenter diagnostic accuracy study, 1071 pediatric (<19 years of age) oncology patients who had a confirmed CPS (12 oncology referral centers) or who underwent germline DNA sequencing through precision medicine programs (6 centers) from January 1, 2000, to July 31, 2020, were studied. Exposures Exposures were MIPOGG application in patients with cancer and a confirmed CPS (diagnosed through routine clinical care; n = 413) in phase 1 and MIPOGG application in patients with cancer who underwent germline DNA sequencing (n = 658) in phase 2. Study phases did not overlap. Data analysts were blinded to genetic test results. Main Outcomes and Measures The performance of MIPOGG in CPS recognition was compared with that of routine clinical care, including identifying a CPS earlier than practitioners. The tool's test characteristics were calculated using next-generation germline DNA sequencing as the comparator. Results In phase 1, a total of 413 patients with cancer (median age, 3.0 years; range, 0-18 years) and a confirmed CPS were identified. MIPOGG correctly recognized 410 of 412 patients (99.5%) as requiring referral for CPS evaluation at the time of primary cancer diagnosis. Nine patients diagnosed with a CPS by a practitioner after their second malignant tumor were detected by MIPOGG using information available at the time of the first cancer. In phase 2, of 658 children with cancer (median age, 6.6 years; range, 0-18.8 years) who underwent comprehensive germline DNA sequencing, 636 had sufficient information for MIPOGG application. When compared with germline DNA sequencing for CPS detection, the MIPOGG test characteristics for pediatric-onset CPSs were as follows: sensitivity, 90.7%; specificity, 60.5%; positive predictive value, 17.6%; and negative predictive value, 98.6%. Tumor DNA sequencing data confirmed the MIPOGG recommendation for CPS evaluation in 20 of 22 patients with established cancer-CPS associations. Conclusions and Relevance In this diagnostic study, MIPOGG exhibited a favorable accuracy profile for CPS screening and reduced time to CPS recognition. These findings suggest that MIPOGG implementation could standardize and rationalize recommendations for CPS evaluation in children with cancer.
Collapse
Affiliation(s)
- Catherine Goudie
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Leora Witkowski
- McGill University Health Centre, Department of Human Genetics, Montreal, Quebec, Canada
| | - Noelle Cullinan
- Department of Haematology-Oncology, Children's Health Ireland, Crumlin, Dublin, Ireland.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lara Reichman
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,McGill University Health Centre, Department of Human Genetics, Montreal, Quebec, Canada
| | - Ian Schiller
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Melissa Tachdjian
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Linlea Armstrong
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine A Blood
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
| | - Josée Brossard
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada
| | - Ledia Brunga
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Chantel Cacciotti
- Department of Pediatric Oncology-Hematology, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - Kimberly Caswell
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Cellot
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Mary Egan Clark
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine Clinton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Hallie Coltin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathleen Felton
- Pediatric Hematology/Oncology, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Conrad V Fernandez
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Noemi Fuentes-Bolanos
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Paul Gibson
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ronald Grant
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rawan Hammad
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Haematology, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Lynn W Harrison
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Meredith S Irwin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah Kane
- Division of Clinical Genetics, Department of Hereditary Cancer and Genetics, Memorial Sloan-Kettering Cancer Center, Basking Ridge, New Jersey
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Larouche
- Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Québec City, Quebec, Canada
| | - Natalie Mathews
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Stephen Meyn
- Center for Human Genomics and Precision Medicine, University of Wisconsin School of Medicine and Public Health, Madison.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, and Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Orli Michaeli
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Renée Perrier
- Department of Medical Genetics, Alberta Children's Hospital and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Meghan Pike
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Angela Punnett
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jemma Say
- Paediatric Haematology/Oncology Programme, Bristol Children's Hospital, Bristol, United Kingdom
| | - Gino Somers
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - My Linh Thibodeau
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Annie-Kim Toupin
- Faculty of Medicine, Université Laval, Quebec, Canada.,Northern Ontario School of Medicine Residency Program, Sudbury, Ontario, Canada
| | - Katherine M Tucker
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Vairy
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, CIUSSS de l'Estrie - CHUS, Sherbrooke, Quebec, Canada.,Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Nicolas Waespe
- CANSEARCH Research Platform in Pediatric Oncology and Hematology of the University of Geneva, Geneva, Switzerland.,Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Meera Warby
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Jonathan D Wasserman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A Whitlock
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Sinnett
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Nada Jabado
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul C Nathan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Shlien
- Department of Genetics and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Junne Kamihara
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Centre, University of New South Wales Sydney, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Kim E Nichols
- Cancer Predisposition Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nandini Dendukuri
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anita Villani
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William D Foulkes
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Oncology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Cullinan N, Schiller I, Di Giuseppe G, Mamun M, Reichman L, Cacciotti C, Wheaton L, Caswell K, Di Monte B, Gibson P, Johnston DL, Fleming A, Pole JD, Malkin D, Foulkes WD, Dendukuri N, Goudie C, Nathan PC. Utility of a Cancer Predisposition Screening Tool for Predicting Subsequent Malignant Neoplasms in Childhood Cancer Survivors. J Clin Oncol 2021; 39:3207-3216. [PMID: 34383599 DOI: 10.1200/jco.21.00018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Childhood cancer survivors (CCS) are at risk of developing subsequent malignant neoplasms (SMNs) resulting from exposure to prior therapies. CCS with underlying cancer predisposition syndromes are at additional genetic risk of SMN development. The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) tool identifies children with cancer at increased likelihood of having a cancer predisposition syndrome, guiding clinicians through a series of Yes or No questions that generate a recommendation for or against genetic evaluation. We evaluated MIPOGG's ability to predict SMN development in CCS. METHODS Using the provincial cancer registry (Ontario, Canada), and adopting a nested case-control approach, we identified CCS diagnosed and/or treated for a primary malignancy before age 18 years (1986-2015). CCS who developed an SMN (cases) were matched, by primary cancer and year of diagnosis, with CCS who did not develop an SMN (controls) over the same period (1:5 ratio). Potential predictors for SMN development (chemotherapy, radiation, and MIPOGG output) were applied retrospectively using clinical data pertaining to the first malignancy. Conditional logistic regression models estimated hazard ratios and 95% CIs associated with each covariate, alone and in combination, for SMN development. RESULTS Of 13,367 children with a primary cancer, 317 (2.4%) developed an SMN and were matched to 1,569 controls. A MIPOGG output recommending evaluation was significantly associated with SMN development (hazard ratio 1.53; 95% CI, 1.06 to 2.19) in a multivariable model that included primary cancer therapy exposures. MIPOGG was predictive of SMN development, showing value in nonhematologic malignancies and in CCS not exposed to radiation. CONCLUSION MIPOGG has additional value for SMN prediction beyond treatment exposures and may be beneficial in decision making for enhanced individualized SMN surveillance strategies for CCS.
Collapse
Affiliation(s)
- Noelle Cullinan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Haematology/Oncology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Ian Schiller
- Centre for Outcomes Research (CORE), Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Giancarlo Di Giuseppe
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Mamun
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lara Reichman
- Research Institute of the McGill University Health Centre, Child Health and Human Development, McGill University, Montreal, Quebec, Canada
| | - Chantel Cacciotti
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Laura Wheaton
- Division of Hematology/Oncology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Kimberly Caswell
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Bruna Di Monte
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Paul Gibson
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Adam Fleming
- Division of Hematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - David Malkin
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - William D Foulkes
- Department of Human Genetics, Cancer Research Program, McGill University Health Centre and Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research (CORE), Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Goudie
- Research Institute of the McGill University Health Centre, Child Health and Human Development, McGill University, Montreal, Quebec, Canada.,Division of Hematology/Oncology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Jibb LA, Chartrand J, Masama T, Johnston DL. Home-Based Pediatric Cancer Care: Perspectives and Improvement Suggestions From Children, Family Caregivers, and Clinicians. JCO Oncol Pract 2021; 17:e827-e839. [PMID: 33914620 DOI: 10.1200/op.20.00958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although the hospital remains the dominant site for delivering most pediatric cancer care, home-based care is increasingly provided. To effectively deliver comprehensive, relevant, and acceptable care in children's homes, the voices of these key informants must be considered. We examined the views of children with cancer, their family caregivers, and clinicians on home-based cancer care to identify necessary strategies to improve the delivery of care. METHODS Children with cancer, their family caregivers, and multiprofessional clinicians who provide care at a tertiary pediatric care center or in the community participated in audio-recorded, semistructured interviews in French and English. Interviews were conducted until data saturation in each participant group was achieved. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS Thirteen children, 20 family caregivers, and 22 clinicians participated. Home-based care was endorsed as a means to improve child health-, family social- and financial-, and system-level outcomes. The success of a home-based model is built on care that addresses child and family informational, treatment and care, material, and psychosocial needs. Mechanisms to improve care include enhanced homecare agency-hospital-family communication, training for homecare nurses in pediatric cancer care, virtual solutions, and an expanded breadth of services provided in-home. Child-, family-, and system-related factors affect the delivery of optimal home-based care. CONCLUSION Children, families, and clinicians value a model of pediatric cancer care that incorporates home-based services. The insights of these key informants should be reflected in the principles that become the basis of home-based cancer care best practices.
Collapse
Affiliation(s)
- Lindsay A Jibb
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Chartrand
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Tatenda Masama
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
12
|
Empringham B, Jennings WJ, Rajan R, Fleming AJ, Portwine C, Johnston DL, Zelcer SM, Rassekh SR, Tran V, Burrow S, Thabane L, Samaan MC. Leptin is Associated with the Tri-Ponderal Mass Index in Children: A Cross-Sectional Study. Adolesc Health Med Ther 2021; 12:9-15. [PMID: 33727877 PMCID: PMC7955735 DOI: 10.2147/ahmt.s289973] [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] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
Background Obesity is characterized by the disproportionate expansion of the fat mass and is most commonly diagnosed using the Body Mass Index (BMI) z-score or percentile in children. However, these measures associate poorly with the fat mass. This is important, as adiposity is a more robust predictor of cardiometabolic risk than BMI-based measures, but there are limited clinical measures of adiposity in children. A new measure, the Tri-ponderal Mass Index (TMI, kg/m3) has recently demonstrated robust prediction of adiposity in children. The aim of this study is to explore the association of leptin, a validated biomarker of the fat mass, with TMI. Methods One hundred and eight children and adolescents were included in this cross-sectional study. Height and weight were used to calculate TMI. Plasma leptin was measured using ELISA. Multivariable regression analysis was applied to determine the predictors of TMI. Results The age range of participants included in this study was 8.00-16.90 years (female n=48, 44%). Leptin correlated with BMI percentile (r=0.64, p-value <0.0001) and TMI (r=0.71, p-value <0.0001). The multivariable regression analysis revealed that BMI percentile (Estimated Beta-coefficient 0.002, 95% CI 0.002-0.003, p-value <0.0001) and Leptin (Estimated Beta-coefficient 0.05, 95% CI 0.02-0.07, p-value 0.013) were associated with TMI. Conclusion Leptin is associated with TMI in healthy children. The TMI is a feasible clinical measure of adiposity that may be used to stratify children and adolescents for further assessments and interventions to manage and attempt to prevent cardiometabolic comorbidities.
Collapse
Affiliation(s)
- Brianna Empringham
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - William J Jennings
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Raeesha Rajan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adam J Fleming
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Carol Portwine
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Victoria Tran
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
13
|
Do J, Blais A, Feldman B, Brandão LR, Lougheed J, Pohl D, Klaassen RJ, Johnston DL, De Laat D, Roth J, Katz SL, McCormick A, Wright FV, Macartney G, McMillan HJ, Venkateswaran S, Sell E, Doja A, Matheson K, Boafo A, Longmuir PE. Characterization of physical literacy in children with chronic medical conditions compared with healthy controls: a cross-sectional study. Appl Physiol Nutr Metab 2021; 46:1073-1082. [PMID: 33689492 DOI: 10.1139/apnm-2020-0957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/22/2022]
Abstract
To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8-12 years (N = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ (t(498) = -0.67; p = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). Children with medical conditions had lower mean physical competence scores (/30; -6.5 [-7.44 to -5.51]; p < 0.001) but higher mean motivation/confidence scores (/30; 2.6 [1.67 to 3.63]; p < 0.001). Mean daily behaviour and knowledge/understanding scores did not differ from matches (/30; 1.8 [0.26 to 3.33]; p = 0.02;/10; -0.04 [-0.38 to 0.30]; p = 0.81; respectively). Children with medical conditions are motivated to be physically active but demonstrate impaired movement skills and fitness, suggesting the need for targeted interventions to improve their physical competence. Novelty: Physical literacy in children with diverse chronic medical conditions is similar to healthy peers. Children with medical conditions have lower physical competence than healthy peers, but higher motivation and confidence. Physical competence (motor skill, fitness) interventions, rather than motivation or education, are needed for these youth.
Collapse
Affiliation(s)
- Jeffrey Do
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angelica Blais
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Brian Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leonardo R Brandão
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jane Lougheed
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Denise De Laat
- Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sherri Lynne Katz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Respirology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anna McCormick
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Developmental Pediatrics and Rehabilitation Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - F Virginia Wright
- Holland Bloorview Children's Rehab Hospital, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Ottawa, ON, Canada
| | - Gail Macartney
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Faculty of Nursing, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sunita Venkateswaran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erick Sell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Asif Doja
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Matheson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Addo Boafo
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
14
|
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
|
15
|
Fonseca A, Afzal S, Bowes L, Crooks B, Larouche V, Jabado N, Perreault S, Johnston DL, Zelcer S, Fleming A, Scheinemann K, Silva M, Vanan MI, Mpofu C, Wilson B, Eisenstat DD, Lafay-Cousin L, Hukin J, Hawkins C, Bartels U, Bouffet E. Pontine gliomas a 10-year population-based study: a report from The Canadian Paediatric Brain Tumour Consortium (CPBTC). J Neurooncol 2020; 149:45-54. [PMID: 32632896 DOI: 10.1007/s11060-020-03568-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/13/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diffuse intrinsic pontine gliomas (DIPG) are midline gliomas that arise from the pons and the majority are lethal within a few months after diagnosis. Due to the lack of histological diagnosis the epidemiology of DIPG is not completely understood. The aim of this report is to provide population-based data to characterize the descriptive epidemiology of this condition in Canadian children. PATIENTS AND METHODS A national retrospective study of children and adolescents diagnosed with DIPG between 2000 and 2010 was undertaken. All cases underwent central review to determine clinical and radiological diagnostic characteristics. Crude incidence figures were calculated using age-adjusted (0-17 year) population data from Statistics Canada. Survival analyses were performed using the Kaplan-Meier method. RESULTS A total of 163 patients with pontine lesions were identified. Central review determined one-hundred and forty-three patients who met clinical, radiological and/or histological criteria for diagnosis. We estimate an incidence rate of 1.9 DIPG/1,000,000 children/year in the Canadian population over a 10 years period. Median age at diagnosis was 6.8 years and 50.3% of patients were female. Most patients presented with cranial nerve palsies (76%) and ataxia (66%). Despite typical clinical and radiological characteristics, histological confirmation reported three lesions to be low-grade gliomas and three were diagnosed as CNS embryonal tumor not otherwise specified (NOS). CONCLUSIONS Our study highlights the challenges associated with epidemiology studies on DIPG and the importance of central review for incidence rate estimations. It emphasizes that tissue biopsies are required for accurate histological and molecular diagnosis in patients presenting with pontine lesions and reinforces the limitations of radiological and clinical diagnosis in DIPG. Likewise, it underscores the urgent need to increase the availability and accessibility to clinical trials.
Collapse
Affiliation(s)
- Adriana Fonseca
- Division of Haematology Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G 1X8, Canada.
| | - Samina Afzal
- IWK Health Center, Dalhousie University, Halifax, B3K 6R8, Canada.,Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Lynette Bowes
- Janeway Child Health Center, Memorial University, St. John's, A1B 3V6, Canada
| | - Bruce Crooks
- IWK Health Center, Dalhousie University, Halifax, B3K 6R8, Canada
| | - Valerie Larouche
- CHU de Québec- Université Laval, Laval University, Québec, G1V 4G2, Canada
| | - Nada Jabado
- Montreal Children's Hospital, McGill University, Montreal, H4A 3J1, Canada
| | - Sebastien Perreault
- Centre Hospitalier Universitaire Sainte, Justine, Université de Montreal, Montreal, H3T 1C5, Canada
| | - Donna L Johnston
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, K1H 8L1, Canada
| | - Shayna Zelcer
- London Health Sciences Children's Hospital, Western University, London, N6A 5A5, Canada
| | - Adam Fleming
- McMaster Children's Hospital, McMaster University, Hamilton, L8P 1H1, Canada
| | - Katrin Scheinemann
- McMaster Children's Hospital, McMaster University, Hamilton, L8P 1H1, Canada.,Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland.,University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Mariana Silva
- Kingston General Hospital, Queens University, Kingston, K7L 2V7, Canada
| | - Magimairajan Issai Vanan
- Cancer Care Manitoba, Pediatrics and Child Health, University of Manitoba, Winnipeg, R3E 0V9, Canada
| | - Chris Mpofu
- Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, S7N 0W8, Canada
| | - Beverly Wilson
- Stollery Children's Hospital, University of Alberta, Edmonton, T6G 2B7, Canada
| | - David D Eisenstat
- Stollery Children's Hospital, University of Alberta, Edmonton, T6G 2B7, Canada
| | - Lucie Lafay-Cousin
- Alberta Children's Hospital, University of Calgary, Calgary, T3B 6A8, Canada
| | - Juliette Hukin
- BC Children's Hospital, University of British Columbia, Vancouver, V6H 3N1, Canada
| | - Cynthia Hawkins
- Division of Haematology Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Ute Bartels
- Division of Haematology Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Eric Bouffet
- Division of Haematology Oncology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M5G 1X8, Canada
| |
Collapse
|
16
|
Sims ED, Jennings WJ, Empringham B, Fleming A, Portwine C, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Thabane L, Samaan MC. Circulating leptin levels are associated with adiposity in survivors of childhood brain tumors. Sci Rep 2020; 10:4711. [PMID: 32170116 PMCID: PMC7070034 DOI: 10.1038/s41598-020-61520-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/22/2019] [Accepted: 02/28/2020] [Indexed: 11/16/2022] Open
Abstract
Survivors of Childhood Brain Tumors (SCBT) are at a higher risk of developing cardiovascular disease and type 2 diabetes compared to the general population. Adiposity is an important risk factor for the development of these outcomes, and identifying biomarkers of adiposity may help the stratification of survivors based on their cardiovascular risk or allow for early screening and interventions to improve cardiometabolic outcomes. Leptin is an adipokine that positively correlates with the adipose mass in the general population and is a predictor of adverse cardiometabolic outcomes, yet its association with adiposity in SCBT has not been studied. The aim of this study was to determine if leptin levels are associated with the adipose mass in SCBT, and to define its predictors. This cross-sectional study included 74 SCBT (n = 32 females) with 126 non-cancer controls (n = 59 females). Total adiposity was measured using Bioelectrical Impendence Analysis (BIA) and central adiposity was measured using waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). We used multivariable linear regression analysis to determine if leptin predicts adiposity in SCBT and adjusted for age, sex, puberty, and cancer status. Leptin correlated strongly with total (p < 0.001) and central (WHR p = 0.001; WHtR p < 0.001) adiposity in SCBT and non-cancer controls. In conclusion, leptin is a potential biomarker for adiposity in SCBT, and further investigation is needed to clarify if leptin is a predictor of future cardiometabolic risk in SCBT.
Collapse
Affiliation(s)
- E Danielle Sims
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - William J Jennings
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Brianna Empringham
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Adam Fleming
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Carol Portwine
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. .,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
17
|
Guerreiro Stucklin AS, Ryall S, Fukuoka K, Zapotocky M, Lassaletta A, Li C, Bridge T, Kim B, Arnoldo A, Kowalski PE, Zhong Y, Johnson M, Li C, Ramani AK, Siddaway R, Nobre LF, de Antonellis P, Dunham C, Cheng S, Boué DR, Finlay JL, Coven SL, de Prada I, Perez-Somarriba M, Faria CC, Grotzer MA, Rushing E, Sumerauer D, Zamecnik J, Krskova L, Garcia Ariza M, Cruz O, Morales La Madrid A, Solano P, Terashima K, Nakano Y, Ichimura K, Nagane M, Sakamoto H, Gil-da-Costa MJ, Silva R, Johnston DL, Michaud J, Wilson B, van Landeghem FKH, Oviedo A, McNeely PD, Crooks B, Fried I, Zhukova N, Hansford JR, Nageswararao A, Garzia L, Shago M, Brudno M, Irwin MS, Bartels U, Ramaswamy V, Bouffet E, Taylor MD, Tabori U, Hawkins C. Alterations in ALK/ROS1/NTRK/MET drive a group of infantile hemispheric gliomas. Nat Commun 2019; 10:4343. [PMID: 31554817 PMCID: PMC6761184 DOI: 10.1038/s41467-019-12187-5] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [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: 01/18/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
Infant gliomas have paradoxical clinical behavior compared to those in children and adults: low-grade tumors have a higher mortality rate, while high-grade tumors have a better outcome. However, we have little understanding of their biology and therefore cannot explain this behavior nor what constitutes optimal clinical management. Here we report a comprehensive genetic analysis of an international cohort of clinically annotated infant gliomas, revealing 3 clinical subgroups. Group 1 tumors arise in the cerebral hemispheres and harbor alterations in the receptor tyrosine kinases ALK, ROS1, NTRK and MET. These are typically single-events and confer an intermediate outcome. Groups 2 and 3 gliomas harbor RAS/MAPK pathway mutations and arise in the hemispheres and midline, respectively. Group 2 tumors have excellent long-term survival, while group 3 tumors progress rapidly and do not respond well to chemoradiation. We conclude that infant gliomas comprise 3 subgroups, justifying the need for specialized therapeutic strategies. Infant gliomas behave differently to their childhood or adult counterparts. Here, the authors perform a large-scale genetic analysis of these tumours, revealing genetic alterations which may offer therapeutic opportunities.
Collapse
Affiliation(s)
- Ana S Guerreiro Stucklin
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Scott Ryall
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kohei Fukuoka
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michal Zapotocky
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alvaro Lassaletta
- Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Christopher Li
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Taylor Bridge
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Byungjin Kim
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Anthony Arnoldo
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul E Kowalski
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yvonne Zhong
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Monique Johnson
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Claire Li
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arun K Ramani
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Siddaway
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Liana Figueiredo Nobre
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Pasqualino de Antonellis
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher Dunham
- Division of Anatomic Pathology, British Columbia Children's Hospital, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Cheng
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada.,Division of Hematology/Oncology/BMT, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jonathan L Finlay
- Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Scott L Coven
- Division of Hematology/Oncology/Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Marta Perez-Somarriba
- Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Claudia C Faria
- Division of Neurosurgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michael A Grotzer
- Department of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Rushing
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - David Sumerauer
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Josef Zamecnik
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lenka Krskova
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | | | - Ofelia Cruz
- Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Palma Solano
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Keita Terashima
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshiko Nakano
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | | | - Roberto Silva
- Department of Pathology, University Hospital de São João, Porto, Portugal
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jean Michaud
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bev Wilson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Angelica Oviedo
- Department of Anatomic Pathology, Dalhousie University, Halifax, NS, Canada.,Department of Pathology Laboratory Medicine, IWK Health Centre, Halifax, NS, Canada
| | - P Daniel McNeely
- Division of Neurosurgery, IWK Health Centre, Halifax, NS, Canada
| | - Bruce Crooks
- Division of Hematology-Oncology, IWK Health Centre, Halifax, NS, Canada
| | - Iris Fried
- The Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Nataliya Zhukova
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Livia Garzia
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Mary Shago
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Brudno
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Meredith S Irwin
- Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ute Bartels
- Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael D Taylor
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Developmental and Stem Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada. .,The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. .,Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
| |
Collapse
|
18
|
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
|
19
|
Athale U, Hijiya N, Patterson BC, Bergsagel J, Andolina JR, Bittencourt H, Schultz KR, Burke MJ, Redell MS, Kolb EA, Johnston DL. Management of chronic myeloid leukemia in children and adolescents: Recommendations from the Children's Oncology Group CML Working Group. Pediatr Blood Cancer 2019; 66:e27827. [PMID: 31330093 PMCID: PMC6944522 DOI: 10.1002/pbc.27827] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 12/16/2022]
Abstract
Chronic myeloid leukemia (CML) accounts for 2-3% of leukemias in children under 15 and 9% in adolescents aged 15-19. The diagnosis and management of CML in children, adolescents, and young adults have several differences compared to that in adults. This review outlines the diagnosis and management of the underlying disease as well as challenges that can occur when dealing with CML in this patient population.
Collapse
Affiliation(s)
- Uma Athale
- Division of Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Nobuko Hijiya
- Division of Hematology/Oncology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Briana C Patterson
- Division of Pediatric Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia
- Division of Hematology/Oncology, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - John Bergsagel
- Division of Hematology/Oncology, Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey R Andolina
- Division of Hematology/Oncology, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Henrique Bittencourt
- Division of Hematology/Oncology, Ste Justine University Hospital Center, Montreal, Quebec, Canada
| | - Kirk R Schultz
- Division of Hematology/Oncology/BMT, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Michael J Burke
- Division of Hematology/Oncology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michele S Redell
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I DuPont Hospital for Children, Wilmington, Delaware
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|
20
|
Nagarajan R, Gerbing R, Alonzo T, Johnston DL, Aplenc R, Kolb EA, Meshinchi S, Barakat LP, Sung L. Quality of life in pediatric acute myeloid leukemia: Report from the Children's Oncology Group. Cancer Med 2019; 8:4454-4464. [PMID: 31190442 PMCID: PMC6675729 DOI: 10.1002/cam4.2337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Objectives were used to describe guardian proxy-report and child self-report quality of life (QoL) during chemotherapy for pediatric acute myeloid leukemia (AML) patients. METHODS Patients enrolled on the phase 3 AML trial AAML1031 who were 2-18 years of age with English-speaking guardians were eligible. Instruments used were the PedsQL Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. Assessments were obtained at the beginning of Induction 1 and following completion of cycles 2-4. Potential predictors of QoL included the total number of nonhematological grade 3-4 Common Terminology Criteria for Adverse Event (CTCAE) submissions. RESULTS There were 505 eligible guardians who consented to participate and 348 of their children provided at least one self-report assessment. The number of submitted CTCAE toxicities was significantly associated with worse physical health summary scores (β ± standard error (SE) -3.00 ± 0.69; P < 0.001) and general fatigue (β ± SE -2.50 ± 0.66; P < 0.001). Older age was significantly associated with more fatigue (β ± SE -0.58 ± 0.25; P = 0.022). Gender, white race, Hispanic ethnicity, private insurance status, risk status, bortezomib assignment, and duration of neutropenia were not significantly associated with QoL. DISCUSSION The number of CTCAE toxicities was the primary factor influencing QoL among children with AML. Reducing toxicities should improve QoL; identifying approaches to ameliorate them should be a priority.
Collapse
Affiliation(s)
- Rajaram Nagarajan
- Division of OncologyCincinnati Children's Hospital Medical CenterCincinnatiOhio
| | | | - Todd Alonzo
- The Children's Oncology GroupMonroviaCalifornia
- Division of BiostatisticsUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Donna L. Johnston
- Division of OncologyChildren's Hospital of Eastern OntarioOttawaOntario
| | - Richard Aplenc
- Division of OncologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | | | - Soheil Meshinchi
- Division of OncologySeattle Children's HospitalSeattleWashington
| | - Lamia P. Barakat
- Division of OncologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | - Lillian Sung
- Division of Haematology/OncologyThe Hospital for Sick ChildrenTorontoOntario
| |
Collapse
|
21
|
Johnston DL, Zupanec S, Nicksy D, Morgenstern D, Narendran A, Deyell RJ, Samson Y, Wu B, Baruchel S. Phase I dose-finding study for melatonin in pediatric oncology patients with relapsed solid tumors. Pediatr Blood Cancer 2019; 66:e27676. [PMID: 30786157 DOI: 10.1002/pbc.27676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 11/06/2018] [Revised: 01/07/2019] [Accepted: 02/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Melatonin is a natural health product used for sleep disturbances. In preliminary studies of adults with advanced cancer, 20 mg of melatonin daily was associated with reduction in anorexia and weight loss-symptoms that also impact pediatric oncology patients. High doses of melatonin have not been studied in pediatrics. METHODS This was a multicenter single-arm phase I dose-escalation study utilizing a 3 + 3 design to determine the safety and tolerability of escalating doses of melatonin in pediatric oncology patients with relapsed solid tumors. Melatonin was given for 8 weeks at three dose levels-0.075 mg/kg (maximum 5 mg), 0.15 mg/kg (maximum 10 mg), and 0.3 mg/kg (maximum 20 mg). RESULTS Melatonin was well tolerated at all three dose levels with no significant adverse events or dose-limiting toxicities. The only grade 3/4 toxicities were myelosuppression, which was attributed to the concomitant chemotherapy and occurred at all dose levels. Weight gain occurred in seven of nine patients, with a median increase of 1.1 kg (range -3.3 to 4.5) or 3.4% (range -10.2 to 8.7), with two patients losing weight (one in dose level 1 and one level 3). CONCLUSIONS Melatonin is well tolerated at a dose of 0.3 mg/kg (maximum 20 mg), in the pediatric population. This study provides the background for further study of high-dose melatonin in pediatric oncology patients.
Collapse
Affiliation(s)
- Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Susan Zupanec
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Darcy Nicksy
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Daniel Morgenstern
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Aru Narendran
- Division of Pediatric Hematology/Oncology, Alberta Children's Hospital, Calgary, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - Yvan Samson
- Division of Pediatric Hematology/Oncology, Ste. Justine Hospital, Montreal, Canada
| | - Bing Wu
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Sylvain Baruchel
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| |
Collapse
|
22
|
Sims ED, Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Thabane L, Samaan MC. Tri-ponderal mass index in survivors of childhood brain tumors: A cross-sectional study. Sci Rep 2018; 8:16336. [PMID: 30397217 PMCID: PMC6218522 DOI: 10.1038/s41598-018-34602-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023] Open
Abstract
Survivors of childhood brain tumors (SCBT) face a higher risk of cardiometabolic disorders and premature mortality compared to the general population. Excess adiposity is a known risk factor for these comorbidities. However, while SCBT have higher adiposity compared to healthy controls, measuring adiposity in clinical practice involves access to specialized equipment and may impact busy clinical services. Tri-ponderal Mass Index (TMI; kg/m3) may be a superior measure of adiposity when compared to Body Mass Index (BMI; kg/m2). However, its use in determining adiposity in SCBT has not been assessed. This study aims to validate TMI as a clinical measure of adiposity in SCBT. This was a cross-sectional study including 44 SCBT (n = 20 female) and 137 (n = 64 female) non-cancer control children, 5-17 years of age. BMI and TMI were calculated from height and weight measurements. Fat mass percentage was assessed using bioelectrical impedance analysis and waist to hip and waist to height ratios were used to assess central adiposity. Regression analyses were adjusted for age, sex, puberty and treatment. TMI demonstrated strong correlations to measures of total and central adiposity and predicted adiposity in SCBT and non-cancer controls, with stronger trends in the latter group. TMI may serve as a reliable clinical measure of adiposity in both SCBT and healthy children.
Collapse
Affiliation(s)
- E Danielle Sims
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Adam Fleming
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
23
|
Johnston DL, Murray S, Irwin MS, Doyle J, Schechter T. Autologous stem cell transplantation for refractory opsoclonus myoclonus ataxia syndrome. Pediatr Blood Cancer 2018; 65:e27110. [PMID: 29693780 DOI: 10.1002/pbc.27110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/21/2018] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Abstract
Opsoclonus, myoclonus, ataxia syndrome (OMA) is a severe neurologic disorder often associated with neuroblastoma. It is challenging to treat and can have long-term neurologic sequelae. Current recommended therapies include intravenous immunoglobulin, corticosteroids, rituximab, and chemotherapy (cyclophosphamide). We present two cases who were refractory to conventional therapy and underwent autologous stem cell transplantation (ASCT). One patient had complete resolution of symptoms following ASCT and the other patient had minimal change in symptoms with this therapy. These findings support consideration of ASCT as a therapeutic option for patients with refractory OMA after failure of known effective therapies.
Collapse
Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sean Murray
- Department of Pediatrics, Health Sciences North, Sudbury, Ontario, Canada
| | - Meredith S Irwin
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Doyle
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Tal Schechter
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
24
|
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
|
25
|
Michaiel G, Strother D, Gottardo N, Bartels U, Coltin H, Eisenstat DD, Hukin J, Johnston DL, Wilson B, Zelcer S, Hansford JR, Wells O, AbdelBaki MS, Abu-Arja MH, Cole KA, Dhall G, Fisher PG, Hoffman L, Leary SES, Pickle EEO, Smiley NP, Smith A, Vinitsky A, Vitanza NA, Wright A, Yeo KK, Chow LML, Kirby M, Valvi S, Vanan MI, Wong G, Ziegler D, Bouffet E, Lafay-Cousin L. GERM-23. INTRACRANIAL GROWING TERATOMA SYNDROME (IGTS): AN INTERNATIONAL RETROSPECTIVE STUDY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.270] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Hallie Coltin
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Juliette Hukin
- British Columbia Children’s Hospital, Vancouver, BC, Canada
| | | | | | | | - Jordan R Hansford
- Royal Children’s Hospital, Murdoch Children’s Research Institute, Melbourne, Australia
| | | | | | | | | | - Girish Dhall
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Paul G Fisher
- Lucile Packard Children’s Hospital Stanford, Stanford, CA, USA
| | | | | | | | - Natasha P Smiley
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Amy Smith
- Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Anna Vinitsky
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Avery Wright
- Lucile Packard Children’s Hospital Stanford, Stanford, CA, USA
| | - Kee K Yeo
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Lionel M L Chow
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Maria Kirby
- Adelaide Women’s and Children’s Hospital, Adelaide, Australia
| | - Santosh Valvi
- Princess Margaret Hospital for Children, Perth, Australia
| | | | - Grace Wong
- Sydney Children’s Hospital, Sydney, Australia
| | | | - Eric Bouffet
- The Hospital for Sick Children, Toronto, ON, Canada
| | | |
Collapse
|
26
|
Kilday JP, Caldarelli M, Massimi L, Chen RHH, Lee YY, Liang ML, Parkes J, Naiker T, van Veelen ML, Michiels E, Mallucci C, Pettorini B, Meijer L, Dorfer C, Czech T, Diezi M, Schouten-van Meeteren AYN, Holm S, Gustavsson B, Benesch M, Müller HL, Hoffmann A, Rutkowski S, Flitsch J, Escherich G, Grotzer M, Spoudeas HA, Azquikina K, Capra M, Jiménez-Guerra R, MacDonald P, Johnston DL, Dvir R, Constantini S, Kuo MF, Yang SH, Bartels U. Intracystic interferon-alpha in pediatric craniopharyngioma patients: an international multicenter assessment on behalf of SIOPE and ISPN. Neuro Oncol 2018; 19:1398-1407. [PMID: 28499018 DOI: 10.1093/neuonc/nox056] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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] [Indexed: 11/12/2022] Open
Abstract
Background Craniopharyngiomas are frequent hypothalamo-pituitary tumors in children, presenting predominantly as cystic lesions. Morbidity from conventional treatment has focused attention on intracystic drug delivery, hypothesized to cause fewer clinical consequences. However, the efficacy of intracystic therapy remains unclear. We report the retrospective experiences of several global centers using intracystic interferon-alpha. Methods European Société Internationale d'Oncologie Pédiatrique and International Society for Pediatric Neurosurgery centers were contacted to submit a datasheet capturing pediatric patients with cystic craniopharyngiomas who had received intracystic interferon-alpha. Patient demographics, administration schedules, adverse events, and outcomes were obtained. Progression was clinical or radiological (cyst reaccumulation, novel cysts, or solid growth). Results Fifty-six children (median age, 6.3 y) from 21 international centers were identified. Median follow-up from diagnosis was 5.1 years (0.3-17.7 y). Lesions were cystic (n = 22; 39%) or cystic/solid (n = 34; 61%). Previous progression was treated in 43 (77%) patients before interferon use. In such cases, further progression was delayed by intracystic interferon compared with the preceding therapy for cystic lesions (P = 0.0005). Few significant attributable side effects were reported. Progression post interferon occurred in 42 patients (median 14 mo; 0-8 y), while the estimated median time to definitive therapy post interferon was 5.8 (1.8-9.7) years. Conclusions Intracystic interferon-alpha can delay disease progression and potentially offer a protracted time to definitive surgery or radiotherapy in pediatric cystic craniopharyngioma, yet demonstrates a favorable toxicity profile compared with other therapeutic modalities-important factors for this developing age group. A prospective, randomized international clinical trial assessment is warranted.
Collapse
Affiliation(s)
- John-Paul Kilday
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Massimo Caldarelli
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Luca Massimi
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Robert Hsin-Hung Chen
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Yi Yen Lee
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Muh-Lii Liang
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Jeanette Parkes
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Thuran Naiker
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Marie-Lise van Veelen
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Erna Michiels
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Conor Mallucci
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Benedetta Pettorini
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Lisethe Meijer
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Christian Dorfer
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Czech
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Manuel Diezi
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Antoinette Y N Schouten-van Meeteren
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Stefan Holm
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Bengt Gustavsson
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Martin Benesch
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Hermann L Müller
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Anika Hoffmann
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Stefan Rutkowski
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Joerg Flitsch
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Gabriele Escherich
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael Grotzer
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Helen A Spoudeas
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Kristian Azquikina
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael Capra
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Rolando Jiménez-Guerra
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Patrick MacDonald
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Donna L Johnston
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Rina Dvir
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Shlomi Constantini
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Meng-Fai Kuo
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Shih-Hung Yang
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Children's Brain Tumour Research Network (CBTRN), Royal Manchester Children's Hospital, Oxford Road, Manchester, England, UK; The Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, The University of Manchester, England, UK; Department of Pediatric Neurosurgery, A Gemelli Hospital, Rome, Italy; Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Groote Schuur Hospital, University of Cape Town, South Africa; Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands; Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, England, UK ; Beatrix Childrens' Hospital, University MC, Groningen, Netherlands; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Pediatric Haemato-Oncology Unit, University Hospital Lausanne, Switzerland; Pediatric Oncology Department, Emma Children's Hospital of the Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria; Department of Pediatrics, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, Oldenburg, Germany; Departments of Neurosurgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Children's Hospital Zurich, Switzerland; Departments of Paediatric Neuroendocrinology and Neurosurgery, Great Ormond Street Hospital, London, England, UK; Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Ireland; Department of Pediatric Neurosurgery, Hospital Angeles Mexico, Mexico City,Mexico; Department of Neurosurgery, Winnipeg Children's Hospital, Canada; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Israel; Department of Neurosurgery, National Taiwan University Hospital, Taiwan; Department of Paediatric Oncology, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
27
|
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
|
28
|
Lassaletta A, Strother D, Laperriere N, Hukin J, Vanan MI, Goddard K, Lafay-Cousin L, Johnston DL, Zelcer S, Zapotocky M, Rajagopal R, Ramaswamy V, Hawkins C, Tabori U, Huang A, Bartels U, Bouffet E. Reirradiation in patients with diffuse intrinsic pontine gliomas: The Canadian experience. Pediatr Blood Cancer 2018; 65:e26988. [PMID: 29369515 DOI: 10.1002/pbc.26988] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 10/22/2017] [Accepted: 12/18/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Clinical trials have failed to demonstrate a survival benefit of adjuvant chemotherapy in diffuse intrinsic pontine gliomas (DIPG). Radiation therapy (RT) is the only effective treatment thus far and reirradiation (rRT) has become an option at the time of progression. The aim of this study was to review the Canadian experience of DIPG rRT with a focus on the safety and possible efficacy of this approach. METHOD We retrospectively reviewed the demographic, clinical, and RT data of patients with DIPG treated in Canada with rRT. RESULTS Since January 2011, we identified 16 patients with progressive DIPG who received rRT. Median time from diagnosis to progression was 10.5 months (range, 4-37 months). rRT was given focally in 14 patients at a dose ranging from 21.6 to 36 Gy. rRT was well tolerated by all children but one. All but three patients showed neurological improvement. With a median follow-up from original diagnosis of 19.2 months, all patients died, with a median time from rRT to death of 6.48 months (range, 3.83-13.26 months). When compared to a historic cohort of 46 consecutive patients, the median time from progression to death was 92 days in the non-reirradiated patients versus 218 days in the reirradiated ones (P = 0.0001). CONCLUSION In this limited experience, rRT was safe and feasible in patients with progressive DIPG, providing neurological improvement and a prolonged life span in most patients. Prospective Canadian rRT protocols are ongoing to further assess the benefit of this approach, including quality of life assessment.
Collapse
Affiliation(s)
| | - Douglas Strother
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Juliette Hukin
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Karen Goddard
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Lucie Lafay-Cousin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Shayna Zelcer
- Children's Hospital of Western Ontario, London, Ontario, Canada
| | | | | | | | | | - Uri Tabori
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Johnston DL, Hum V, Stinson JN. Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e80. [PMID: 29625951 PMCID: PMC5910537 DOI: 10.2196/mhealth.9319] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/31/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. OBJECTIVE The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. METHODS Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. RESULTS Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents' lives, and recommendations for intervention improvement. CONCLUSIONS Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes.
Collapse
Affiliation(s)
- Lindsay A Jibb
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Evidence-to-Practice Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Bonnie J Stevens
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Donna L Johnston
- Evidence-to-Practice Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vanessa Hum
- Think Research Corporation, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
30
|
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
|
31
|
Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, Ladhani S, Socha A, Shinuda J, Jaber S, Burrow S, Singh SK, Banfield L, de Souza RJ, Thabane L, Samaan MC. Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta-analysis. Clin Obes 2018; 8:55-67. [PMID: 29024558 DOI: 10.1111/cob.12224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/22/2022]
Abstract
Survivors of childhood brain tumours (SCBT) have increased cardiometabolic risks, but the determinants of these risks are unclear. This systematic review aims to compare the prevalence of overweight and obesity as well as adiposity measures between SCBT and non-cancer controls. The PubMed, EMBASE, MEDLINE, CINAHL and the Cochrane Library databases were searched. The primary outcomes were the prevalence of overweight and obesity based on body mass index. The secondary outcomes were adiposity measures including percent fat mass, waist-to-hip and waist-to-height ratios. Forty-one studies were included in the meta-analysis. The prevalence of overweight and obesity combined was similar between overall SCBT, SCBT excluding craniopharyngioma and non-cancer controls (42.6%, 95% CI 30.1-55.1 vs. 31.7%, 95% CI 20.4-43.0 vs. 40.4%, 95% CI 34.0-46.8). We also found that SCBT have higher percent fat mass (mean difference 4.1%, 95% CI 2.0-6.1), waist-to-hip ratio (mean difference 0.07, 95% CI 0.02-0.13) and waist-to-height ratio (mean difference 0.06, 95% CI 0.01-0.10) than non-cancer controls. We conclude that SCBT have similar overweight and obesity distribution but higher adiposity than non-cancer controls. More studies were needed to explore the determinants of adiposity and its contribution to cardiometabolic outcomes in SCBT.
Collapse
Affiliation(s)
- K-W Wang
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
| | - A Fleming
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Canada
| | - S R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
| | - S Ladhani
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - A Socha
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - J Shinuda
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Jaber
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
| | - S Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Canada
| | - S K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Canada
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Canada
| | - L Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - R J de Souza
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - L Thabane
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Canada
- Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - M C Samaan
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Canada
- Medical Sciences Graduate Program, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| |
Collapse
|
32
|
Johnston DL, Alonzo TA, Gerbing RB, Aplenc R, Woods WG, Meshinchi S, Gamis AS. Central nervous system disease in pediatric acute myeloid leukemia: A report from the Children's Oncology Group. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26612. [PMID: 28453910 PMCID: PMC5647219 DOI: 10.1002/pbc.26612] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/10/2017] [Revised: 03/19/2017] [Accepted: 03/27/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognostic impact of central nervous system (CNS) involvement in children with acute myeloid leukemia (AML) has varied in past trials, and controversy exists over the degree of involvement requiring intensified CNS therapy. Two recent Children's Oncology Group protocols, AAML03P1 and AAML0531, directed additional intrathecal (IT) therapy to patients with CNS2 (≤5 white blood cell [WBC] with blasts) or CNS3 (>5 WBC with blasts or CNS symptoms) disease at diagnosis. METHODS We examined disease characteristics and outcomes of the 1,344 patients on these protocols, 949 with CNS1 (no blasts), 217 with CNS2, and 178 with CNS3, with the latter two receiving additional IT therapy. RESULTS Young age (P = 0.003), hyperleukocytosis (P < 0.001), and the presence of inversion 16 (P < 0.001) were the only factors more prevalent in patients with CNS2 or CNS3 disease. Complete remission at the end of induction (EOI) 2 was achieved less often in patients with CNS involvement (P < 0.001). From diagnosis, event-free survival (EFS) for patients with CNS involvement was significantly worse (P < 0.001), whereas overall survival (OS) was not (P = 0.16). From the EOI1, there was a higher relapse rate (RR) and worse disease-free survival (DFS), but less impact on OS (CNS1:DFS 58.9%, RR 34.1%, OS 69.3%; CNS2:DFS 53.2%, RR 40.9%, OS 74.7%; CNS3:DFS 45.2%, RR 48.8%, OS 60.8%; P = 0.006, P < 0.001, P = 0.045, respectively). Multivariable analysis showed that independently CNS2 and CNS3 status adversely affected RR and DFS. Traumatic diagnostic lumbar puncture was not associated with worse outcome. CONCLUSIONS CNS leukemia confers greater relapse risk despite more aggressive locally directed therapy. Novel approaches need to be investigated in this group of patients.
Collapse
Affiliation(s)
- Donna L. Johnston
- Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Todd A. Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Richard Aplenc
- Division of Hematology/Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William G. Woods
- Aflac Cancer Center and Blood Disorders Service, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Soheil Meshinchi
- Division of Hematology Oncology, Seattle Children’s Hospital, Seattle, Washington
| | - Alan S. Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinic, Kansas City, Missouri
| |
Collapse
|
33
|
Sjoberg I, Pole JD, Cassidy M, Boilard C, Costantini S, Johnston DL. The Impact of School Visits on Siblings of Children With Cancer. J Pediatr Oncol Nurs 2017; 35:110-117. [PMID: 29117847 DOI: 10.1177/1043454217735897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
BACKGROUND Childhood cancer affects the entire family. Siblings experience similar stress to that of the ill child, including anger, depression, jealousy, guilt, and social isolation. School reentry programs are shown to be positive interventions for patients, it is hypothesized that similar outcomes exist for siblings. OBJECTIVE To examine the feasibility of studying the impact of the Ontario Oncology Nurse School Visitation Program on the well-being and school adjustment of siblings of pediatric cancer patients. METHODS Fourteen sibling participants and parents completed a semistructured interview and the PedsQL® questionnaire before and after a nurse school visit. School attendance was also compared and data were collected for logistics of study procedures. RESULTS The mode of data collection was agreeable and easy to plan and execute. School attendance showed a reduction of days missed; there was no significant impact on PedsQL results but the interviews yielded positive feedback. CONCLUSIONS The outlook for siblings improves with the support of family members and health care professionals. This pilot study provides hypotheses and design for future research.
Collapse
Affiliation(s)
- Isabelle Sjoberg
- 1 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jason D Pole
- 2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Cassidy
- 1 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Donna L Johnston
- 1 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|
34
|
Jibb LA, Stevens BJ, Nathan PC, Seto E, Cafazzo JA, Johnston DL, Hum V, Stinson JN. Implementation and preliminary effectiveness of a real-time pain management smartphone app for adolescents with cancer: A multicenter pilot clinical study. Pediatr Blood Cancer 2017; 64. [PMID: 28423223 DOI: 10.1002/pbc.26554] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [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: 10/15/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pain in adolescents with cancer (12-18 years) is common and negatively impacts health-related quality of life (HRQL). The Pain Squad+ smartphone app, which provides adolescents with real-time pain self-management support, was developed to address this issue. This study evaluated the implementation of the app to inform a future randomized controlled trial (RCT) and obtain treatment effect estimates for pain intensity, pain interference, HRQL, and self-efficacy. PROCEDURE A one-group baseline/poststudy design with 40 adolescents recruited from two pediatric tertiary care centers was used. Baseline questionnaires were completed and adolescents used the app at least twice daily for 28 days, receiving algorithm-informed self-management advice depending on their reported pain. A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care. Poststudy questionnaires were completed. Descriptive analyses, with exploratory inferential testing conducted on health outcome data, were used to address study aims. RESULTS Most (40/52; 77%) eligible adolescents participated. Two participants withdrew participation. Intervention fidelity was impacted by technical difficulties (occurring for 15% of participants) and a prolonged time for nurse contact in the event of sustained pain. Adherence to pain reporting was 68.8 ± 38.1%. Outcome measure completion rates were high and the intervention was acceptable to participants. Trends in improvements in pain intensity, pain interference, and HRQL were significant, with effect sizes of 0.23-0.67. CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer. A multicenter RCT will be undertaken to examine app effectiveness.
Collapse
Affiliation(s)
| | - Bonnie J Stevens
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Emily Seto
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Joseph A Cafazzo
- University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Donna L Johnston
- University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jennifer N Stinson
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| |
Collapse
|
35
|
Lassaletta A, Scheinemann K, Zelcer SM, Hukin J, Wilson BA, Jabado N, Carret AS, Lafay-Cousin L, Larouche V, Hawkins CE, Pond GR, Poskitt K, Keene D, Johnston DL, Eisenstat DD, Krishnatry R, Mistry M, Arnoldo A, Ramaswamy V, Huang A, Bartels U, Tabori U, Bouffet E. Phase II Weekly Vinblastine for Chemotherapy-Naïve Children With Progressive Low-Grade Glioma: A Canadian Pediatric Brain Tumor Consortium Study. J Clin Oncol 2017; 34:3537-3543. [PMID: 27573663 DOI: 10.1200/jco.2016.68.1585] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Vinblastine monotherapy has shown promising activity and a low-toxicity profile in patients with pediatric low-grade glioma (PLGG) who experienced treatment failure after initial treatment with chemotherapy and/or radiation. The aim of this study was to assess the activity of vinblastine in therapy-naïve children. Patients and Methods Patients < 18 years old with unresectable and/or progressive therapy-naïve PLGG were eligible. Vinblastine was administered once per week at a dose of 6 mg/m2 intravenously over a period of 70 weeks. Vision, quality of life, neurofibromatosis type 1 (NF1) status, and BRAF mutation/fusion status were also determined and correlated with outcome. Results Fifty-four patients were enrolled onto the study, with a median age of 8 years (range, 0.7 to 17.2 years). Most patients had chiasmatic/hypothalamic tumors (55.5%), and 13 patients (24.1%) had NF1. The most common histology was pilocytic astrocytoma (46.3%). Seventeen patients were diagnosed using radiologic criteria alone. Best response to chemotherapy was centrally reviewed with a response rate (complete, partial, or minor response) of 25.9%. Disease stabilization (complete, partial, or minor response or stable disease) was achieved in 47 patients (87.0%). Visual improvement was observed in 20% of patients with optic pathway glioma. Five-year overall survival and progression-free survival (PFS) rates were 94.4% (95% CI, 88.5% to 100%) and 53.2% (95% CI, 41.3% to 68.5%), respectively, for the entire cohort. Patients with NF1 had a significantly better PFS (85.1%; 95% CI, 68.0% to 100%) when compared with patients without NF1 (42.0%; 95% CI, 29.1% to 60.7%; P = .012). Age< 3 years or > 10 years was not associated with poor outcome. Treatment was well tolerated, and quality of life was not affected during treatment. In this trial, there was no correlation between BRAF alterations and outcome. Conclusion Vinblastine administered once per week is well tolerated in children with treatment naïve PLGG. Overall survival and PFS are comparable to current therapies, with a favorable toxicity profile and a maintained quality of life.
Collapse
Affiliation(s)
- Alvaro Lassaletta
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Katrin Scheinemann
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Shayna M Zelcer
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Juliette Hukin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Beverley A Wilson
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Nada Jabado
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anne Sophie Carret
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Lucie Lafay-Cousin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Valerie Larouche
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Cynthia E Hawkins
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Russell Pond
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Poskitt
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Keene
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Donna L Johnston
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - David D Eisenstat
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rahul Krishnatry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Mistry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Arnoldo
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Vijay Ramaswamy
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Annie Huang
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ute Bartels
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Uri Tabori
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Bouffet
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
36
|
Wang KW, Chau R, Fleming A, Banfield L, Singh SK, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Valencia M, de Souza RJ, Thabane L, Samaan MC. The effectiveness of interventions to treat hypothalamic obesity in survivors of childhood brain tumours: a systematic review. Obes Rev 2017; 18:899-914. [PMID: 28544764 DOI: 10.1111/obr.12534] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Survivors of childhood brain tumours (SCBT) are at risk of type 2 diabetes and cardiovascular diseases. Obesity is a major driver of cardiometabolic diseases in the general population, and interventions that tackle obesity may lower the risk of these chronic diseases. The goal of this systematic review was to summarize current evidence for the presence of interventions to manage obesity, including hypothalamic obesity, in SCBT. METHODS The primary outcome of this review was the body mass index z-score change from baseline to the end of the intervention and/or follow-up. Literature searches were conducted in PsycINFO, CINAHL, the Cochrane Library, Medline, SPORTDiscus, EMBASE and PubMed. Two reviewers completed study evaluations independently. RESULTS Eleven publications were included in this systematic review (lifestyle intervention n = 2, pharmacotherapy n = 6 and bariatric surgery n = 3). While some studies demonstrated effectiveness of interventions to manage obesity in SCBT and alter markers of obesity and cardiometabolic risk, the evidence base was limited and of low quality, and studies focused on hypothalamic obesity. We conclude that there is urgent need to conduct adequately powered trials of sufficient duration, using existing and novel therapies to manage obesity, reduce the burden of cardiometabolic disorders and improve outcomes in SCBT.
Collapse
Affiliation(s)
- K-W Wang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - R Chau
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - A Fleming
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - L Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - S K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.,McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - S M Zelcer
- Pediatric Hematology Oncology, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - S R Rassekh
- Division of Pediatric Hematology/ Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - S Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - M Valencia
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - R J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - L Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - M C Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
37
|
Story E, Johnston DL, Bartels U, Carret AS, Crooks B, Eisenstat DD, Fryer C, Lafay-Cousin L, Larouche V, Wilson B, Zelcer S, Silva M, Brossard J, Bouffet E, Keene DL. Embryonal tumors in Canadian children less than 36 months of age: results from the Canadian Pediatric Brain Tumor Consortium (CPBTC). J Neurooncol 2017; 133:581-587. [PMID: 28508928 DOI: 10.1007/s11060-017-2468-y] [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: 10/22/2016] [Accepted: 05/06/2017] [Indexed: 01/19/2023]
Abstract
Embryonal tumors are a heterogeneous group of central nervous system (CNS) tumors whose subgroups have varying incidence and outcome. Despite these differences, they are often grouped as a single entity for study purposes. To date, there are no Canadian multi-institutional studies examining the incidence and outcome of all embryonal subtypes. The current study is an observational study reviewing embryonal tumors in all patients less than 36 months of age diagnosed with a CNS tumor in Canada from 1990 to 2005. Embryonal tumors accounted for 26.9% of all CNS tumors. Medulloblastomas were the highest proportion of the embryonal tumors at 61.5%. Atypical teratoid/rhabdoid tumors (AT/RT) had the second highest proportion of embryonal tumors at 18%. The proportion of primitive neuroectodermal tumors (PNET) was 16%, with 2.6 and 1.9% for congenital medulloepithelioma and ependymoblastoma tumors, respectively. AT/RT and PNET were more common in younger age groups. Medulloblastoma became more prevalent with increasing age, with its highest prevalence in the 25 to 36 month age group. Survival rates for our Canadian population at 18 and 24 months were 0.74 and 0.68 for medulloblastoma, 0.64 and 0.60 for PNET, and 0.36 and 0.29 for AT/RT, respectively. Overall, our data are comparable with published international rates for embryonal tumors. These incidence and outcome figures can guide future research into these rare tumors.
Collapse
Affiliation(s)
- E Story
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - U Bartels
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - A S Carret
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - B Crooks
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, NS, Canada
| | - D D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Fryer
- Division of Pediatric Hematology/Oncology, BC Children's Hospital, Vancouver, BC, Canada
| | - L Lafay-Cousin
- Division of Oncology, Alberta Children's Hospital, Calgary, AB, Canada
| | - V Larouche
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada
| | - B Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - S Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital of Western Ontario, London, ON, Canada
| | - M Silva
- Division of Pediatric Hematology/Oncology, Kingston General Hospital, Kingston, ON, Canada
| | - J Brossard
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - E Bouffet
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - D L Keene
- Division of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| |
Collapse
|
38
|
Wang KW, Souza RJD, Fleming A, Singh SK, Johnston DL, Zelcer SM, Rassekh SR, Burrow S, Scheinemann K, Thabane L, Samaan MC. Adiposity in childhood brain tumors: A report from the Canadian Study of Determinants of Endometabolic Health in Children (CanDECIDE Study). Sci Rep 2017; 7:45078. [PMID: 28327649 PMCID: PMC5361156 DOI: 10.1038/srep45078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023] Open
Abstract
Children with brain tumors (CBT) are at high risk of cardiovascular diseases and type 2 diabetes compared to the general population. Recently, adiposity has been reported to be more informative for cardiometabolic risk stratification than body mass index (BMI) in the general population. The goal of this study is to describe the adiposity phenotype in CBT, and to establish adiposity determinants. We recruited CBT (n = 56) and non-cancer controls (n = 106). Percent body fat (%FM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured to determine total and central adiposity, respectively. Regression analyses were used to evaluate adiposity determinants. CBT had higher total and central adiposity compared to non-cancer controls despite having similar BMI measurements. Those with tumors at the supratentorial region had increased total and central adiposity, while those who received radiotherapy had increased total adiposity. In conclusion, CBT have increased total and central adiposity in the presence of similar BMI levels when compared to non-cancer controls. Adiposity, especially central adiposity, is a potential cardiometabolic risk factor present relatively early in life in CBT. Defining interventions to target adiposity may improve long-term outcomes by preventing cardiometabolic disorders in CBT.
Collapse
Affiliation(s)
- Kuan-Wen Wang
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adam Fleming
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sheila K Singh
- Division of Neurosurgery, Department of Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada.,McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Donna L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shayna M Zelcer
- Pediatric Hematology Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shahrad Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Burrow
- Division of Orthopedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Hematology/Oncology, University Children's Hospital, Basel, Switzerland
| | - Lehana Thabane
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.,Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare-Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Medical Sciences Program, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
39
|
Pole JD, Gibson P, Ethier MC, Lazor T, Johnston DL, Portwine C, Silva M, Alexander S, Sung L. Evaluation of treatment-related mortality among paediatric cancer deaths: a population based analysis. Br J Cancer 2017; 116:540-545. [PMID: 28095399 PMCID: PMC5318976 DOI: 10.1038/bjc.2016.443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/26/2016] [Revised: 12/02/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Objectives were to describe the proportion of deaths due to treatment-related mortality (TRM) and to identify risk factors and probable causes of TRM among paediatric cancer deaths in a population-based cohort. Methods: We included children with cancer ⩽18 years diagnosed and treated in Ontario who died between January 2003 and December 2012. Deaths were identified using a provincial registry, the Pediatric Oncology Group of Ontario Networked Information System. Probable causes of TRM were described. Results: Among the 964 deaths identified, 821 were included. The median age at diagnosis was 6.6 years (range 0–18.8) and 51.8% had at least one relapse. Of the deaths examined, TRM occurred in 217/821 (26.4%) while 604/821 (73.6%) were due to progressive cancer. Deaths from TRM did not change over time. Using multiple regression, younger age, leukaemia diagnosis and absence of relapse were independently positively associated with TRM. The most common probable causes of TRM were respiratory, infection and haemorrhage. Conclusions: TRM was responsible for 26.4% of deaths in paediatric cancer. Underlying diagnosis, younger age and absence of relapse were associated with TRM and causes of TRM differed by diagnosis group. Future work should evaluate TRM rate and risk factors among newly diagnosed cancer patients.
Collapse
Affiliation(s)
- Jason D Pole
- Pediatric Oncology Group of Ontario, 480 University Ave., Toronto, Ontario, M5G 1V2, Canada
| | - Paul Gibson
- Division of Haematology/Oncology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd. E., London, Ontario, N6A 5W9, Canada
| | - Marie-Chantal Ethier
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada
| | - Tanya Lazor
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, Ontario, M5G 0A4, Canada
| | - Donna L Johnston
- Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
| | - Carol Portwine
- Department of Pediatrics, McMaster Children's Hospital, 1280 Main St West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Mariana Silva
- Department of Pediatrics, Kingston General Hospital, 76 Stuart St, Kingston, Ontario, K7L 2V7, Canada
| | - Sarah Alexander
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave., 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 St., Toronto, Ontario, M5G 0A4, Canada.,Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada
| |
Collapse
|
40
|
Torchia J, Golbourn B, Feng S, Ho KC, Sin-Chan P, Vasiljevic A, Norman JD, Guilhamon P, Garzia L, Agamez NR, Lu M, Chan TS, Picard D, de Antonellis P, Khuong-Quang DA, Planello AC, Zeller C, Barsyte-Lovejoy D, Lafay-Cousin L, Letourneau L, Bourgey M, Yu M, Gendoo DMA, Dzamba M, Barszczyk M, Medina T, Riemenschneider AN, Morrissy AS, Ra YS, Ramaswamy V, Remke M, Dunham CP, Yip S, Ng HK, Lu JQ, Mehta V, Albrecht S, Pimentel J, Chan JA, Somers GR, Faria CC, Roque L, Fouladi M, Hoffman LM, Moore AS, Wang Y, Choi SA, Hansford JR, Catchpoole D, Birks DK, Foreman NK, Strother D, Klekner A, Bognár L, Garami M, Hauser P, Hortobágyi T, Wilson B, Hukin J, Carret AS, Van Meter TE, Hwang EI, Gajjar A, Chiou SH, Nakamura H, Toledano H, Fried I, Fults D, Wataya T, Fryer C, Eisenstat DD, Scheinemann K, Fleming AJ, Johnston DL, Michaud J, Zelcer S, Hammond R, Afzal S, Ramsay DA, Sirachainan N, Hongeng S, Larbcharoensub N, Grundy RG, Lulla RR, Fangusaro JR, Druker H, Bartels U, Grant R, Malkin D, McGlade CJ, Nicolaides T, Tihan T, Phillips J, Majewski J, Montpetit A, Bourque G, Bader GD, Reddy AT, Gillespie GY, Warmuth-Metz M, Rutkowski S, Tabori U, Lupien M, Brudno M, Schüller U, Pietsch T, Judkins AR, Hawkins CE, Bouffet E, Kim SK, Dirks PB, Taylor MD, Erdreich-Epstein A, Arrowsmith CH, De Carvalho DD, Rutka JT, Jabado N, Huang A. Integrated (epi)-Genomic Analyses Identify Subgroup-Specific Therapeutic Targets in CNS Rhabdoid Tumors. Cancer Cell 2016; 30:891-908. [PMID: 27960086 PMCID: PMC5500911 DOI: 10.1016/j.ccell.2016.11.003] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/19/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
We recently reported that atypical teratoid rhabdoid tumors (ATRTs) comprise at least two transcriptional subtypes with different clinical outcomes; however, the mechanisms underlying therapeutic heterogeneity remained unclear. In this study, we analyzed 191 primary ATRTs and 10 ATRT cell lines to define the genomic and epigenomic landscape of ATRTs and identify subgroup-specific therapeutic targets. We found ATRTs segregated into three epigenetic subgroups with distinct genomic profiles, SMARCB1 genotypes, and chromatin landscape that correlated with differential cellular responses to a panel of signaling and epigenetic inhibitors. Significantly, we discovered that differential methylation of a PDGFRB-associated enhancer confers specific sensitivity of group 2 ATRT cells to dasatinib and nilotinib, and suggest that these are promising therapies for this highly lethal ATRT subtype.
Collapse
Affiliation(s)
- Jonathon Torchia
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Brian Golbourn
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Shengrui Feng
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - King Ching Ho
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Patrick Sin-Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Alexandre Vasiljevic
- Department of Pathology, Groupement Hospitalier Est, CHU de Lyon, Lyon-Bron 69677, France
| | - Joseph D Norman
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Paul Guilhamon
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Livia Garzia
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Natalia R Agamez
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mei Lu
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiffany S Chan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Daniel Picard
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Pasqualino de Antonellis
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Dong-Anh Khuong-Quang
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Aline C Planello
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Constanze Zeller
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Dalia Barsyte-Lovejoy
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Lucie Lafay-Cousin
- Division of Pediatric Hematology/Oncology, Alberta Children's Hospital, AB T3B6A8, Canada
| | - Louis Letourneau
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Mathieu Bourgey
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Man Yu
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Deena M A Gendoo
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Misko Dzamba
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Mark Barszczyk
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Tiago Medina
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Alexandra N Riemenschneider
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - A Sorana Morrissy
- Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Young-Shin Ra
- Department of Neurosurgery, Asan Medical Center, Seoul 138-736, Korea
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Marc Remke
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Christopher P Dunham
- Division of Anatomic Pathology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, V6T1Z3, Canada
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Jian-Qiang Lu
- Laboratory Medicine and Pathology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Steffen Albrecht
- Department of Pathology, McGill University, Montreal, QC H3Z2Z3, Canada
| | - Jose Pimentel
- Divison of Pathology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Jennifer A Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N1N4, Canada
| | - Gino R Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Claudia C Faria
- Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon 1649-035, Portugal
| | - Lucia Roque
- Cytometry and Cytogenetic Laboratory, CIPM, Portuguese Cancer Institute, Lisbon 1099-023, Portugal
| | - Maryam Fouladi
- Division of Oncology, Department of Cancer and Blood Diseases, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Lindsey M Hoffman
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | - Andrew S Moore
- Oncology Service, Children's Health Queensland Hospital; University of Queensland Diamantina Institute, Brisbane, QLD 4102, Australia
| | - Yin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China
| | - Seung Ah Choi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Jordan R Hansford
- Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Daniel Catchpoole
- Children's Cancer Research Unit, Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Diane K Birks
- Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
| | | | - Doug Strother
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Almos Klekner
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Laszló Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen 4032, Hungary
| | - Miklós Garami
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Péter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest 1094, Hungary
| | - Tibor Hortobágyi
- Department of Histopathology, University of Szeged, Szeged 6720, Hungary
| | - Beverly Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Juliette Hukin
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - Anne-Sophie Carret
- Department of Pediatrics, Division of Hematology-Oncology, Université de Montréal/CHU Sainte-Justine, Montreal, QC H3T1C5, Canada
| | - Timothy E Van Meter
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA 23298-0631, USA
| | - Eugene I Hwang
- Department of Oncology, Children's National Medical Center, Washington, DC 20010, USA
| | - Amar Gajjar
- Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shih-Hwa Chiou
- Department of Medical Research, Taipei Veterans General Hospital and National Yang-Ming University, Taipei 112, Taiwan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University, Kumamoto 860-8556, Japan
| | - Helen Toledano
- Department of Pediatric Hematology Oncology, Children's Medical Center of Israel, Petach Tikva 49202, Isreal
| | - Iris Fried
- Department of Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Daniel Fults
- Department of Neurosurgery, University of Utah, School of Medicine, Salt Lake City, UT 84132, USA
| | - Takafumi Wataya
- Department of Neurosurgery, Shizuoka Children's Hospital, Shizuoka 420-8660, Japan
| | - Chris Fryer
- Division of Hematology and Oncology, Children's and Women's Health Centre of B.C, University of British Columbia, Vancouver, BC V6H3N1, Canada
| | - David D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, University of Alberta, Edmonton, AB T2W3N2, Canada
| | - Katrin Scheinemann
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Adam J Fleming
- Department of Pediatrics, McMaster University, Hamilton, ON L8S4K1, Canada
| | - Donna L Johnston
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Jean Michaud
- Pathology and Laboratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H8L1, Canada
| | - Shayna Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital, London Health Sciences Center, London, ON N6A5A5, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Samina Afzal
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H4R2, Canada
| | - David A Ramsay
- Department of Pathology and Laboratory Medicine, Children's Hospital of Western Ontario, University of Western Ontario, London, ON N6A5W9, Canada
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10300, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham NG72RD, England
| | - Rishi R Lulla
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jason R Fangusaro
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Harriet Druker
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ronald Grant
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - David Malkin
- Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - C Jane McGlade
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Theodore Nicolaides
- Department of Pediatrics (Hematology/Oncology), University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Tarik Tihan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Joanna Phillips
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Alexandre Montpetit
- Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Guillaume Bourque
- Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada; Genome Quebec Innovation Centre, McGill University, Montreal, QC H3A1A4, Canada
| | - Gary D Bader
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5G0A4, Canada
| | - Alyssa T Reddy
- Department of Pediatric Hematology and Oncology, University of Alabama, Birmingham, AL 35233, USA
| | - G Yancey Gillespie
- Department of Neurosurgery, University of Alabama, Birmingham, AL 35233, USA
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University of Würzburg, Würzburg 97070, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Uri Tabori
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Mathieu Lupien
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, ON M5G0A4, Canada; Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Ulrich Schüller
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Torsten Pietsch
- Institute for Neuropathology, University of Bonn Medical Center, Bonn 53105, Germany
| | - Alexander R Judkins
- Department of Pathology & Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, USA
| | - Cynthia E Hawkins
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Pathology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul 03080, Korea
| | - Peter B Dirks
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Program in Developmental & Stem Cell Biology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Anat Erdreich-Epstein
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Cheryl H Arrowsmith
- Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada
| | - Daniel D De Carvalho
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G0A4, Canada; Princess Margaret Cancer Center, University Health Network, Toronto, ON M5G1L7, Canada.
| | - James T Rutka
- Department of Surgery, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| | - Nada Jabado
- Department of Pediatrics, McGill University, Montreal, QC H3Z2Z3, Canada; Department of Human Genetics, McGill University, Montreal, QC H3Z2Z3, Canada.
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5G0A4, Canada; Department of Paediatrics, University of Toronto, Toronto, ON M5G0A4, Canada; Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON M5G1X8, Canada; Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| |
Collapse
|
41
|
O'Sullivan C, Lee Dupuis L, Gibson P, Johnston DL, Baggott C, Portwine C, Spiegler B, Kuczynski S, Tomlinson D, Tomlinson GA, Sung L. Evaluation of the electronic self-report Symptom Screening in Pediatrics Tool (SSPedi). BMJ Support Palliat Care 2016; 8:110-116. [DOI: 10.1136/bmjspcare-2015-001084] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/18/2016] [Accepted: 10/17/2016] [Indexed: 11/04/2022]
Abstract
ObjectiveWe previously developed the paper-based Symptom Screening in Pediatrics Tool (SSPedi) designed for paediatric cancer symptom screening. Objectives were to evaluate and refine the electronic mobile application (app) of SSPedi using the opinions of children with cancer.MethodsParticipants were children 8–18 years of age with cancer. Participants completed electronic SSPedi on their own and then responded to semistructured questions to determine whether they found electronic SSPedi easy or difficult to complete and understand, understood and liked the app features (audio and animation), and understood previously difficult to understand concepts with the introduction of a help menu. After each group of 10 children, responses were reviewed to determine whether modifications were required.Results20 children evaluated electronic SSPedi. None found electronic SSPedi difficult to complete or understand. All children understood the app features and each of the 4 more difficult to understand concepts after using the help menu. 19 of 20 children thought the app was a good way to communicate with doctors and nurses.ConclusionsWe finalised an electronic version of SSPedi that is easy to use and understand with features specifically designed to facilitate child self-report. Future work will evaluate the psychometric properties of electronic SSPedi.
Collapse
|
42
|
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
|
43
|
Di Battista A, Dupuis LL, Cassidy M, Portwine C, Johnston DL, Pradier Silva M, Sung L, Barrera M. Parent Attributions About Child Symptoms Related to Cancer Therapy. J Pediatr Oncol Nurs 2016; 34:44-50. [DOI: 10.1177/1043454215628002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Symptom assessment is an emergent area of research in pediatric cancer. Our team previously reported on the development of a questionnaire to be completed by parents to determine symptom prevalence and bother. This exploratory study examined parental nonprobed, free-text comments about their child’s treatment-related symptoms reported on the questionnaire. Method: Participants were parents of children aged 4 to 18 years who had been diagnosed with cancer at least 2 months prior to enrolment and had received intravenous chemotherapy within the past month at 1 of 5 pediatric cancer centers. The questionnaire consisted of 69 or 71 items (based on child’s age) addressing physical and psychological sequelae. Each symptom query was accompanied by a blank space in which parents could comment on their response. Comments were analyzed guided by content analysis methodology. Results: Five major themes emerged: parental attributions for the symptoms experienced in their child; coping patterns and communication styles within the family; evidence of anticipatory, procedural, and other anxieties; interruption of daily life; and changes in the child’s physical appearance. Conclusions: These exploratory findings provide context to parental perception of their child’s treatment-related symptoms and may contribute to a better understanding of parental perception of child and the family coping and communicating style. These findings may assist in the development of psychoeducational interventions aimed at promoting open communication styles within the family and reducing child and parent burden during treatment procedures.
Collapse
Affiliation(s)
- Ashley Di Battista
- Community Head Injury Resource Services of Toronto, Toronto, Ontario, Canada
| | - Lee L. Dupuis
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marilyn Cassidy
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Carol Portwine
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Donna L. Johnston
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Mariana Pradier Silva
- Kingston General Hospital, Kingston, Ontario, Canada
- Queen’s University in Kingston, Ontario, Canada
| | - Lillian Sung
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
44
|
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
|
45
|
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
|
46
|
Johnston DL, Keene D, Kostova M, Lafay-Cousin L, Fryer C, Scheinemann K, Carret AS, Fleming A, Percy V, Afzal S, Wilson B, Bowes L, Zelcer S, Mpofu C, Silva M, Larouche V, Brossard J, Strother D, Bouffet E. Survival of children with medulloblastoma in Canada diagnosed between 1990 and 2009 inclusive. J Neurooncol 2015; 124:247-53. [DOI: 10.1007/s11060-015-1831-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
|
47
|
Johnston DL, Keene D, Bartels U, Carret AS, Crooks B, Eisenstat DD, Fryer C, Lafay-Cousin L, Larouche V, Moghrabi A, Wilson B, Zelcer S, Silva M, Bouffet E. Low grade astrocytoma in children under the age of three years: a report from the Canadian pediatric brain tumour consortium. J Neurooncol 2015; 124:95-100. [DOI: 10.1007/s11060-015-1806-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/06/2015] [Indexed: 11/24/2022]
|
48
|
Tomlinson D, de Mol Van Otterloo S, O'Sullivan C, Gibson P, Johnston DL, Portwine C, Spiegler B, Baggott C, Tolend M, Dupuis LL, Sung L. Methodological issues identified during cognitive interviews in the development of a pediatric cancer symptom screening tool. Psychooncology 2015; 25:349-53. [PMID: 25920596 DOI: 10.1002/pon.3821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/09/2015] [Accepted: 03/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Cathy O'Sullivan
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Gibson
- Paediatric Haematology/Oncology Program, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Donna L Johnston
- Department of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Carol Portwine
- Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Mirkamal Tolend
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Lee Dupuis
- Division of Haematology/Oncology, The Hospital for Sick Children, 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
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
49
|
Johnston DL, Rowan-Legg A, Hamstra SJ. Examining the educational value of a CanMEDS roles framework in pediatric morbidity and mortality rounds. BMC Med Educ 2014; 14:262. [PMID: 25511475 PMCID: PMC4271321 DOI: 10.1186/s12909-014-0262-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND In order to determine whether the CanMEDS roles could be helpful in solidifying knowledge during clinical training, we examined quality of care issues identified during morbidity and mortality (M&M) rounds. METHODS During the M&M rounds, following the case presentation, there was a pause and attendees were asked to identify quality of care issues that were present in the case. The attendees were assigned to a CanMEDS prompted group or non-prompted group. Following the rounds, the issues were identified, coded according to CanMEDS role, and compared between groups. RESULTS A total of 111 individuals identified a total of 350 issues; 57 individuals were in the CanMEDS-prompted group and 54 were in the unprompted group. The mean number of issues identified was significantly higher in the CanMEDS-prompted group compared to the unprompted group (3.7 versus 2.6, p = 0.039). There were significantly more issues raised in the prompted group for the roles of communicator, collaborator, scholar and professional. CONCLUSIONS Using CanMEDS roles as prompts, attendees at M&M rounds identify more quality of care issues than if not given a prompt. Use of the CanMEDS framework may assist learners to consolidate the linkage between expected training objectives and the complexities of clinical practice.
Collapse
Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Anne Rowan-Legg
- Division of Pediatric Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Stanley J Hamstra
- Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| |
Collapse
|
50
|
Johnston DL, Story E, Matzinger MA, Halton J. Periorbital ecchymosis ("raccoon eyes") on a bone scan. J Pediatr 2014; 165:1271. [PMID: 25152256 DOI: 10.1016/j.jpeds.2014.07.032] [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] [Received: 06/28/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eden Story
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mary-Ann Matzinger
- Department of Diagnostic Imaging, Children's Hospital of Eastern Ontario Ottawa, Ontario, Canada
| | - Jacqueline Halton
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|