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Canavera K, Marik P, Schneider NM, Smith J. The Role of Pediatric Psychologists in Critical Care: Lessons Learned and Future Directions in Integrating Mental Health Care Into PICUs. Chest 2024:S0012-3692(24)00398-2. [PMID: 38513964 DOI: 10.1016/j.chest.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Pediatric psychologists are essential staff in the PICU. Their role in caring for critically ill children aligns with clinical practice guidelines for the mental health care needs of this population of patients. This article highlights the role of pediatric psychology in the PICU through illustrative case examples. We discuss lessons learned and future directions for the development and provision of mental health services in PICUs. We address relevant ways for critical care providers to understand the importance of evidence-based psychological care and advocate for the inclusion of psychologists on multidisciplinary PICU teams. As the critical care field continues to focus on an improved understanding of post-intensive care syndrome in pediatrics and the psychological needs of critical care patients, it will be important to consider the vital roles of psychologists and to advocate for improved integration of mental health care in PICUs.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA.
| | - Patricia Marik
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
| | - Nicole M Schneider
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jacquelyn Smith
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI
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Canavera K, Ghafoor S, Fan K, Cheng C, Jeha S, Pui CH, Elliott A, Morrison RR, Jacola LM. Post-PICU Cognitive and Psychological Outcomes in Children Receiving Treatments for Acute Lymphoblastic Leukemia. Pediatr Crit Care Med 2023; 24:e584-e591. [PMID: 38055007 DOI: 10.1097/pcc.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To examine neurocognitive and psychological outcomes associated with post-PICU admissions in children treated for childhood acute lymphoblastic leukemia (ALL). DESIGN Observational study from October 2007 to March 2017. SETTING Pediatric onco-critical care unit. PATIENTS All patients in this study (n = 296; ages 3-21) were treated for ALL on the St. Jude Total Therapy 16 clinical trial (NCT00549848) from 2007 to 2017. Of these, 104 patients were admitted to the PICU during protocol-directed therapy. All patients completed protocol-directed neurocognitive monitoring prospectively, at the end of cancer-directed therapy. Data on PICU stays were abstracted retrospectively from the medical record. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic and critical illness variables were abstracted from institutional databases and medical records. Neurocognitive and psychosocial outcomes were prospectively obtained at the end of treatment. Children who had a PICU admission experienced significantly lower functioning compared to normative samples in several areas of cognitive functioning (working memory, processing speed, executive functions, inattention, math achievement, fine motor dexterity, and speed), daily living skills, and internalizing problems (all ps < 0.05). Compared with those without PICU admissions, patients with PICU admissions had worse performance on a measure of sustained attention (p = 0.017). The frequency of patients at risk for problems with learning and memory was significantly higher in the PICU group compared with the non-PICU group (25% vs 12%, p = 0.006). Critical illness symptom severity was not associated with neurocognitive or psychological outcomes. CONCLUSIONS Children with ALL, with or without a PICU admission, experienced lower cognitive and psychological outcomes following treatment. Future research is needed to continue identifying risk factors for post-intensive care syndrome (PICS-p) and post-PICU cognitive and psychological impairments in pediatric patients.
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Affiliation(s)
- Kristin Canavera
- Department of Pediatrics, Ochsner Hospital for Children, New Orleans, LA
| | - Saad Ghafoor
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Kimberly Fan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew Elliott
- Department of Pediatrics, St. Jude Children's Research Hospital, Memphis, TN
| | - R Ray Morrison
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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Patten JT, Hoag JA, Galtieri LR, Canavera K, Thompson AL. Suicidality in bereaved parents within pediatric institutions: Recommendations for managing ethical challenges. Clinical Practice in Pediatric Psychology 2022. [DOI: 10.1037/cpp0000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Canavera K. Rebuilding trust. Patient Educ Couns 2021; 104:996-997. [PMID: 33558110 DOI: 10.1016/j.pec.2021.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/12/2020] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
Lack of trust is a major problem in our current health care system and is increasingly becoming a focus in the literature and in national discussions on how to better understand, address, and resolve. In this narrative essay, I share how I wrestled with rebuilding trust after my own adverse experiences with medical error, surgery complications, and communication challenges. This perspective highlights the critical importance of physician communication and trust in the patient-physician relationship.
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Affiliation(s)
- Kristin Canavera
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Jurbergs N, Sellers J, Brown M, Canavera K, Crabtree V. Voices from the front line: Supporting staff during the COVID-19 pandemic. J Psychosoc Oncol 2021; 39:320-323. [PMID: 33750284 DOI: 10.1080/07347332.2021.1900483] [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: 10/21/2022]
Affiliation(s)
- Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Janet Sellers
- Resilience Center, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mark Brown
- Spiritual Care Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Canavera
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Ghafoor S, Fan K, Williams S, Brown A, Bowman S, Pettit KL, Gorantla S, Quillivan R, Schwartzberg S, Curry A, Parkhurst L, James M, Smith J, Canavera K, Elliott A, Frett M, Trone D, Butrum-Sullivan J, Barger C, Lorino M, Mazur J, Dodson M, Melancon M, Hall LA, Rains J, Avent Y, Burlison J, Wang F, Pan H, Lenk MA, Morrison RR, Kudchadkar SR. Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit. Front Oncol 2021; 11:645716. [PMID: 33763377 PMCID: PMC7982584 DOI: 10.3389/fonc.2021.645716] [Citation(s) in RCA: 6] [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: 12/23/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. Conclusions Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.
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Affiliation(s)
- Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kimberly Fan
- Department of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sarah Williams
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Brown
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Bowman
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kenneth L Pettit
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Shilpa Gorantla
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Rebecca Quillivan
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Schwartzberg
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Curry
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lucy Parkhurst
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marshay James
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Smith
- Department of Child Life, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kristin Canavera
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Andrew Elliott
- Division of Psychiatry, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Michael Frett
- Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Deni Trone
- Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jacqueline Butrum-Sullivan
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cynthia Barger
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Lorino
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Mazur
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mandi Dodson
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Morgan Melancon
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leigh Anne Hall
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jason Rains
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yvonne Avent
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jonathan Burlison
- Department of Pharmaceutical Sciences- Patient Safety, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Anne Lenk
- Department of Quality Improvement Education and Training, Cincinnati Children's Hospital- James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, United States
| | - R Ray Morrison
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Canavera K, Johnson LM. Integrating Mental Health Care for Medically Complex Children. Pediatrics 2020; 146:peds.2019-0898. [PMID: 32699070 DOI: 10.1542/peds.2019-0898] [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] [Accepted: 11/22/2019] [Indexed: 11/24/2022] Open
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Karol SE, Alexander TB, Budhraja A, Pounds SB, Canavera K, Wang L, Wolf J, Klco JM, Mead PE, Das Gupta S, Kim SY, Salem AH, Palenski T, Lacayo NJ, Pui CH, Opferman JT, Rubnitz JE. Venetoclax in combination with cytarabine with or without idarubicin in children with relapsed or refractory acute myeloid leukaemia: a phase 1, dose-escalation study. Lancet Oncol 2020; 21:551-560. [PMID: 32171069 PMCID: PMC7153631 DOI: 10.1016/s1470-2045(20)30060-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Outcomes for children with relapsed or refractory acute myeloid leukaemia remain poor. The BCL-2 inhibitor, venetoclax, has shown promising activity in combination with hypomethylating agents and low-dose cytarabine in older adults for whom chemotherapy is not suitable with newly diagnosed acute myeloid leukaemia. We aimed to determine the safety and explore the activity of venetoclax in combination with standard and high-dose chemotherapy in paediatric patients with relapsed or refractory acute myeloid leukaemia. METHODS We did a phase 1, dose-escalation study at three research hospitals in the USA. Eligible patients were aged 2-22 years with relapsed or refractory acute myeloid leukaemia or acute leukaemia of ambiguous lineage with adequate organ function and performance status. During dose escalation, participants received venetoclax orally once per day in continuous 28-day cycles at either 240 mg/m2 or 360 mg/m2, in combination with cytarabine received intravenously every 12 h at either 100 mg/m2 for 20 doses or 1000 mg/m2 for eight doses, with or without intravenous idarubicin (12 mg/m2) as a single dose, using a rolling-6 accrual strategy. The primary endpoint was the recommended phase 2 dose of venetoclax plus chemotherapy and the secondary endpoint was the proportion of patients treated at the recommended phase 2 dose who achieved complete remission or complete remission with incomplete haematological recovery. Analyses were done on patients who received combination therapy. The study is registered with ClinicalTrials.gov (NCT03194932) and is now enrolling to address secondary and exploratory objectives. FINDINGS Between July 1, 2017, and July 2, 2019, 38 patients were enrolled (aged 3-22 years; median 10 [IQR 7-13]), 36 of whom received combination therapy with dose escalation, with a median follow-up of 7·1 months (IQR 5·1-11·2). The recommended phase 2 dose of venetoclax was found to be 360 mg/m2 (maximum 600 mg) combined with cytarabine (1000 mg/m2 per dose for eight doses), with or without idarubicin (12 mg/m2 as a single dose). Overall responses were observed in 24 (69%) of the 35 patients who were evaluable after cycle 1. Among the 20 patients treated at the recommended phase 2 dose, 14 (70%, 95% CI 46-88) showed complete response with or without complete haematological recovery, and two (10%) showed partial response. The most common grade 3-4 adverse events were febrile neutropenia (22 [66%]), bloodstream infections (six [16%]), and invasive fungal infections (six [16%]). Treatment-related death occurred in one patient due to colitis and sepsis. INTERPRETATION The safety and activity of venetoclax plus chemotherapy in paediatric patients with heavily relapsed and refractory acute myeloid leukaemia suggests that this combination should be tested in newly diagnosed paediatric patients with high-risk acute myeloid leukaemia. FUNDING US National Institutes of Health, American Lebanese Syrian Associated Charities, AbbVie, and Gateway for Cancer Research.
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Affiliation(s)
- Seth E Karol
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Thomas B Alexander
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Amit Budhraja
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Stanley B Pounds
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Canavera
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lei Wang
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeffery M Klco
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paul E Mead
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Soumyasri Das Gupta
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Ahmed Hamed Salem
- AbbVie, North Chicago, IL, USA; Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Norman J Lacayo
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph T Opferman
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeffrey E Rubnitz
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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Canavera K, Parris K. Informed Consent in a Pragmatic Emergency Suicide Trial: Rejecting the Research-Practice Distinction. Am J Bioeth 2019; 19:103-105. [PMID: 31557103 DOI: 10.1080/15265161.2019.1654014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Karol SE, Alexander T, Das Gupta S, Pounds SB, Canavera K, Klco JM, Lacayo NJ, Pui CH, Opferman JT, Rubnitz JE. Safety and activity of venetoclax in combination with high-dose cytarabine in children with relapsed or refractory acute myeloid leukemia. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10004 Background: Venetoclax is an orally available BCL-2 antagonist with demonstrated activity in adults with newly diagnosed or relapsed acute myeloid leukemia (AML). Here, we describe the first use of venetoclax 1) in combination with high-dose cytarabine and idarubicin 2) in patients 2-22 years old with relapsed AML. Methods: Patients with relapsed AML or AML refractory to at least two courses of induction therapy were enrolled in this Phase 1 study with a rolling-six design. All patients received venetoclax (240 or 360 mg/m2) on days 1-28 and low-dose (LD: 100 mg/m2 every 12 hours x 20 doses) or high-dose (HD: 1000 mg/m2 every 12 hours x 8 doses) cytarabine beginning on day 8 (Table). Patients who had previously received < 270 mg/m2 of doxorubicin equivalents also received idarubicin 12 mg/m2 on day 8 in dose level 4; other patients were enrolled on the expansion cohort at dose level 3. Non-hematologic CTCAE grade 3 or higher toxicities were intensity limiting (ILT), excluding those anticipated with HD cytarabine. Results: Among 18 evaluable patients, a single ILT (prolonged hematological suppression beyond day 50) was observed (Table). Toxicities were consistent with the underlying cytotoxic chemotherapy, with 14 patients experiencing a total of 40 grade 3 toxicities including 6 documented infections and 23 episodes of febrile neutropenia. There was 1 grade 4 fungal sepsis. The recommended phase 2 dose of venetoclax was 360 mg/m2 (max 600 mg) when combined with HD cytarabine or HD cytarabine/idarubicin. Of the 12 patients with > 50% reduction in blasts following the 7-day venetoclax window therapy, end-of-cycle marrow responses included 7 CR/CRi and 3 PR. Minimal residual disease negative remissions occurred in 4 patients. BH3 profiling of samples and a phase 2 expansion of both dose levels 3 and 4 to further characterize the promising activity of these combinations are underway. Conclusions: Venetoclax combined with cytarabine or cytarabine/idarubicin is active and well tolerated in pediatric patients with relapsed/ refractory AML. Clinical trial information: NCT03194932. [Table: see text]
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Affiliation(s)
- Seth E Karol
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | | | | | | | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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Sisk BA, Canavera K, Sharma A, Baker JN, Johnson LM. Ethical issues in the care of adolescent and young adult oncology patients. Pediatr Blood Cancer 2019; 66:e27608. [PMID: 30623573 DOI: 10.1002/pbc.27608] [Citation(s) in RCA: 19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 12/12/2022]
Abstract
The diagnosis and treatment of cancer leads to short-term and long-term challenges for every patient. This is especially true for adolescents and young adults (AYAs) with cancer who strive to gain independence, autonomy, confidence, and social status while developing into adulthood. In this article, we review prominent ethical issues in AYA oncology that are related to autonomy, shared decision-making, care refusal or abandonment, end-of-life care, truth telling, and fertility preservation. Clinicians should recognize that AYA patients develop at their own pace; the onus lies with clinicians to determine the patient's interests, values, maturity, and desire to participate in decision-making.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristin Canavera
- Division of Psychology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Akshay Sharma
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Liza-Marie Johnson
- Division of Quality-of-Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Canavera K, Johnson LM, Harman J. Beyond Parenting: The Responsibility of Multidisciplinary Health Care Providers in Early Intervention Policy Guidance. Am J Bioeth 2018; 18:58-60. [PMID: 30475177 DOI: 10.1080/15265161.2018.1523499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Canavera K, Allen J, Johnson LM. The Need for Improved Access to Mental Health Services for Youth With Medically Unexplained Symptoms. Am J Bioeth 2018; 18:29-31. [PMID: 29697336 DOI: 10.1080/15265161.2018.1445316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Ollendick TH, Greene RW, Austin KE, Fraire MG, Halldorsdottir T, Allen KB, Jarrett MA, Lewis KM, Whitmore Smith M, Cunningham NR, Noguchi RJP, Canavera K, Wolff JC. Parent Management Training and Collaborative & Proactive Solutions: A Randomized Control Trial for Oppositional Youth. J Clin Child Adolesc Psychol 2015; 45:591-604. [PMID: 25751000 DOI: 10.1080/15374416.2015.1004681] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the efficacy of Collaborative & Proactive Solutions (CPS) in treating oppositional defiant disorder (ODD) in youth by comparing this novel treatment to Parent Management Training (PMT), a well-established treatment, and a waitlist control (WLC) group. One hundred thirty-four youth (ages 7-14, 61.9% male, 83.6% White) who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD were randomized to CPS, PMT, or WLC groups. ODD was assessed with semistructured diagnostic interviews, clinical global severity and improvement ratings, and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Responder and remitter analyses were undertaken using intent-to-treat mixed-models analyses. Chronological age, gender, and socioeconomic status as well as the presence of comorbid attention deficit/hyperactivity and anxiety disorders were examined as predictors of treatment outcome. Both treatment conditions were superior to the WLC condition but did not differ from one another in either our responder or remitter analyses. Approximately 50% of youth in both active treatments were diagnosis free and were judged to be much or very much improved at posttreatment, compared to 0% in the waitlist condition. Younger age and presence of an anxiety disorder predicted better treatment outcomes for both PMT and CPS. Treatment gains were maintained at 6-month follow-up. CPS proved to be equivalent to PMT and can be considered an evidence-based, alternative treatment for youth with ODD and their families.
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Affiliation(s)
| | | | | | - Maria G Fraire
- b Department of Psychiatry , McLean Hospital/Harvard Medical School
| | | | - Kristy Benoit Allen
- d Western Psychiatric Institute and Clinic , University of Pittsburgh School of Medicine
| | | | - Krystal M Lewis
- f Department of Psychiatry , University of Illinois at Chicago
| | | | - Natoshia R Cunningham
- g Division of Behavioral Medicine and Clinical Psychology , Cincinnati Children's Hospital and Medical Center
| | | | - Kristin Canavera
- i Department of Psychology , St. Jude's Children's Research Hospital
| | - Jennifer C Wolff
- j Bradley/Hasbro Research Center , Brown University School of Medicine
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Ollendick TH, Halldorsdottir T, Fraire MG, Austin KE, Noguchi RJP, Lewis KM, Jarrett MA, Cunningham NR, Canavera K, Allen KB, Whitmore MJ. Specific phobias in youth: a randomized controlled trial comparing one-session treatment to a parent-augmented one-session treatment. Behav Ther 2015; 46:141-55. [PMID: 25645164 PMCID: PMC4319561 DOI: 10.1016/j.beth.2014.09.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [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: 02/14/2014] [Revised: 09/03/2014] [Accepted: 09/08/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Examine the efficacy of a parent-augmented One-Session Treatment (A-OST) in treating specific phobias (SP) in youth by comparing this novel treatment to child-focused OST, a well-established treatment. METHOD A total of 97 youth (ages 6-15, 51.5% female, 84.5% White) who fulfilled diagnostic criteria for SP were randomized to either A-OST or OST. SPs were assessed with semistructured diagnostic interviews, clinician improvement ratings, and parent and child improvement ratings. In addition, measures of treatment satisfaction and parental self-efficacy were obtained. Blind assessments were completed pretreatment, posttreatment, and 1month and 6months following treatment. Analyses were undertaken using mixed models. In addition, gender, age, internalizing/externalizing problems, parent overprotection, and parent anxiety were examined as potential predictors and moderators of treatment outcome. RESULTS Both treatment conditions produced similar outcomes with approximately 50% of youth in both treatments diagnosis free and judged to be much or very much improved at posttreatment and 1-month follow-up. At 6-month follow-up, however, the treatments diverged with OST resulting in marginally superior outcomes to A-OST, contrary to predictions. Only age of child predicted treatment outcome across the two treatments (older children did better); unexpectedly, none of the variables moderated treatment outcomes. CONCLUSIONS Parent augmentation of OST produced no appreciable gains in treatment outcomes. Directions for future research are highlighted.
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Affiliation(s)
| | | | - Maria G Fraire
- Counseling and Psychological Services at George Mason University
| | - Kristin E Austin
- Counseling and Psychological Services at George Mason University
| | | | - Krystal M Lewis
- Department of Psychiatry at the University of Illinois at Chicago
| | | | | | | | - Kristy B Allen
- Department of Psychiatry at the University of Pittsburgh Medical School
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Evans DW, Canavera K, Kleinpeter FL, Maccubbin E, Taga K. The fears, phobias and anxieties of children with autism spectrum disorders and Down syndrome: comparisons with developmentally and chronologically age matched children. Child Psychiatry Hum Dev 2006; 36:3-26. [PMID: 16049642 DOI: 10.1007/s10578-004-3619-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compared the fears and behavior problems of 25 children with an autism spectrum disorder (ASD), 43 children with Down syndrome (DS), 45 mental age (MA) matched children, and 37 chronologically age (CA) matched children. Children's fears, phobias, anxieties and behavioral problems were assessed using parent reports. Significant differences emerged across the diagnostic groups on a variety of fears. Children with ASD were reported to have more situation phobias and medical fears, but fewer fears of harm/injury compared to all other groups. The groups also differed in terms of the pattern of correlations between fears, phobias, anxieties and behavior problems. For children with ASD, fears, phobias and anxieties were closely related to problem behaviors, whereas fears, phobias, and anxieties were less related to behavioral symptoms for the other groups of subjects. Such findings suggest that children with ASD exhibit a distinct profile of fear and anxiety compared to other mental age and chronologically age-matched children, and these fears are related to the symptoms associated with ASD.
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Affiliation(s)
- David W Evans
- Department of Psychology, Bucknell University, Lewisburg, PA 17837, USA.
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