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Oberoi S, Garland A, Yan AP, Lambert P, Xue L, Decker K, Israels SJ, Banerji S, Bolton JM, Deleemans JM, Garand-Sheridan B, Louis D, Lix LM, Mahar AL. Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population-Based and Sibling Cohort Study. J Clin Oncol 2024; 42:1509-1519. [PMID: 38335465 DOI: 10.1200/jco.23.01615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/01/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings. METHODS A retrospective, population-based, matched cohort design was used to investigate the impact of cancer diagnosis on mental disorders among individuals age 15-39 diagnosed between 1989 and 2019. Two cancer-free cohorts were identified: matched population-based and sibling cohorts. Outcomes included incidence of mood and anxiety disorders, substance use disorders, suicide outcomes, psychotic disorders, and any of the preceding four categories within 5 years of cancer diagnosis. Competing risk regression was used to estimate adjusted subhazard ratios (aSHR) and 95% CIs. RESULTS Among 3,818 AYAs with cancer matched to the population-based cancer-free cohort, individuals with cancer were more likely to be diagnosed with incident mental disorders than those without cancer; the risk was highest immediately after a cancer diagnosis and decreased over time with aSHR [95% CI] for mood and anxiety disorders at 0-6 months (11.27 [95% CI, 6.69 to 18.97]), 6-12 months (2.35 [95% CI, 1.54 to 3.58]), and 12-24 months (2.06 [95% CI, 1.55 to 2.75]); for substance use disorders at 0-6 months (2.73 [95% CI, 1.90 to 3.92]); for psychotic disorders at 0-6 months (4.69 [95% CI, 2.07 to 10.65]); and for any mental disorder at 0-6 months (4.46 [95% CI, 3.41 to 5.85]), 6-12 months (1.56 [95% CI, 1.14 to 2.14]), and 12-24 months (1.7 [95% CI, 1.36 to 2.13]) postcancer diagnosis. In sibling comparison, cancer diagnosis was associated with a higher incidence of mood and anxiety and any mental disorder during first 6 months of cancer diagnosis. CONCLUSION AYAs with cancer experience a greater incidence of mental disorders after cancer diagnosis relative to population-based and sibling cohorts without cancer, primarily within first 2 years, underscoring the need to address mental health concerns during this period.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Allan Garland
- Department of Internal Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Adam P Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Lin Xue
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Julie M Deleemans
- Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | | | - Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
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Metts J, Xue W, Gao Z, Oberoi S, Weiss AR, Venkatramani R, Harrison DJ. Event-free survival in relapsed and refractory rhabdomyosarcoma treated on cooperative group phase II trials: A report from the Children's Oncology Group. Pediatr Blood Cancer 2024:e31009. [PMID: 38627882 DOI: 10.1002/pbc.31009] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Novel therapies are needed for relapsed and refractory rhabdomyosarcoma (RRMS). Phase II clinical trials in RRMS have typically utilized radiologic response as the primary activity endpoint, an approach that poses several limitations in RRMS. In this analysis, we aimed to estimate an event-free survival (EFS) endpoint for RRMS that could be used as a benchmark for future studies. PROCEDURE We performed a retrospective study of patients with RRMS enrolling on 13 single-agent phase II Children's Oncology Group and legacy group trials from 1997 to 2016. All included trials used radiographic response as their primary activity endpoint. Six-month EFS was estimated from time of trial enrollment with 95% confidence intervals. Clinical characteristics, including trial of enrollment, sex, age, race, histology, number of prior chemotherapies, and radiographic response were evaluated for their impact on 6-month EFS. RESULTS We identified 175 patients across 13 trials. The 6-month EFS was 16.8% (11.6%-22.8%). No differences were seen in 6-month EFS based on age, sex, race, or histology. There were nonsignificant trends toward improved 6-month EFS for patients with less than or equal to two prior lines of therapy versus higher than two, for patients enrolled on trials that achieved their primary radiographic response endpoint versus trials that did not, and for patients who achieved complete or partial response compared to those achieving stable disease. CONCLUSIONS The prognosis of RRMS enrolled on single-agent phase II trials is poor. This pooled 6-month EFS of RRMS on single-agent trials may be used as a RRMS-specific benchmark for future single-agent phase II trials.
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Affiliation(s)
- Jonathan Metts
- Sarcoma Department, Moffitt Cancer Center, Tampa, Florida, USA
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Wei Xue
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Zhengya Gao
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Sapna Oberoi
- Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
| | | | - Douglas J Harrison
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ricci C, Subburaj D, Lim K, Shukla N, Kaur J, Xie L, Laverty M, Zakaria D, Pole J, Pelland-Marcotte MC, Barber R, Israels SJ, Tran TH, Oberoi S, Renzi S, MacDonald T, Sung L, Kulkarni K. Second malignant neoplasms within 5 years from first primary diagnosis in pediatric oncology patients in Canada: a population-based retrospective cohort study. Front Oncol 2024; 14:1376652. [PMID: 38606094 PMCID: PMC11006957 DOI: 10.3389/fonc.2024.1376652] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction From the advancement of treatment of pediatric cancer diagnosis, the five-year survival rate has increased significantly. However, the adverse consequence of improved survival rate is the second malignant neoplasm. Although previous studies provided information on the incidence and risk of SMN in long term survivors of childhood cancer, there is still scarce information known for short term (< 5 years) prognosis. This study aims to assess the incidence, characteristics, management, and outcome of children who develop SMN malignancies within 5 years of diagnosis of their initial cancer. Method This is a retrospective cohort study of early Second Malignant Neoplasms (SMN) in pediatric oncology patients. The Cancer in Young People - Canada (CYP-C) national pediatric cancer registry was used and reviewed pediatric patients diagnosed with their first cancer from 2000-2015. Results A total of 20,272 pediatric patients with a diagnosis of a first malignancy were analyzed. Of them, 0.7% were diagnosed with a SMN within the first 5 years following their first cancer diagnosis. Development of a SMN impacted survival, shown by an inferior survival rate in the SMN cohort (79.1%) after three years compared to that of the non-SMN cohort (89.7%). Several possible risk factors have been identified in the study including the use of epipodophyllotoxins, exposure to radiation, and hematopoietic stem cell 169 transplant. Discussion This is the first national study assessing the incidence, 170 characteristics, risk factors and outcome of early SMN in Canadian children 171 from age 0-15 from 2000-2015.
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Affiliation(s)
- Christina Ricci
- Lifespan Chronic Disease and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Divya Subburaj
- Department of Pediatrics, Division of Hematology-Oncology, Izzak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
| | - Kate Lim
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Neetu Shukla
- Lifespan Chronic Disease and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Jaskiran Kaur
- Surveillance Systems and Data Management Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Lin Xie
- Lifespan Chronic Disease and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Meghan Laverty
- Lifespan Chronic Disease and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Dianne Zakaria
- Lifespan Chronic Disease and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Jason Pole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Health Sciences Research, University of Queensland, Brisbane, QLD, Australia
| | - Marie-Claude Pelland-Marcotte
- Division of Pediatric Hematology-Oncology, CHU de Québec-Centre Mère-Enfant Soleil, Quebec City, QC, Canada
- Research Centre of the CHU de Québec, Axe Reproduction, Santé de la Mère et de l’Enfant, Quebec City, QC, Canada
| | - Randy Barber
- C17 Research Network, C17 Council, Edmonton, AB, Canada
| | - Sara J. Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Thai-Hoa Tran
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montréal, QC, Canada
- Immune Diseases and Cancers Axis, CHU Sainte-Justine Research Center, Montréal, QC, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Samuele Renzi
- Division of Hematology Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tamara MacDonald
- Department of Pharmacy, Izzak Walton Killam (IWK) Health, Halifax, NS, Canada
- Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada
| | - Lillian Sung
- Division of Hematology Oncology, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ketan Kulkarni
- Department of Pediatrics, Division of Hematology-Oncology, Izzak Walton Killam (IWK) Health Centre, Halifax, NS, Canada
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Oberoi S, Qumseya A, Xue W, Venkatramani R, Weiss AR. Outcome of patients with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcomas enrolled in phase 2 cooperative group clinical trials: A report from the Children's Oncology Group. Cancer 2024. [PMID: 38470405 DOI: 10.1002/cncr.35276] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The aim of this study was to estimate the event-free survival (EFS) of children and young adults with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) treated in nonrandomized phase 2 studies conducted by the Children's Oncology Group (COG) and predecessor groups to establish a benchmark EFS for future phase 2 NRSTS trials evaluating the activity of novel agents. METHODS A retrospective analysis of patients with recurrent or refractory NRSTS prospectively enrolled in nonrandomized phase 2 COG and predecessor group trials between 1994 and 2015 was conducted. EFS was defined as disease progression/relapse or death and calculated via the Kaplan-Meier method. The log-rank test and relative risk regression were used to compare EFS distribution by age at enrollment, sex, race, NRSTS histology, prior lines of therapy, calendar year of trial, and type of radiographic response. RESULTS In total, 137 patients were enrolled in 13 phase 2 trials. All trials used radiographic response rate as a primary outcome, and none of the agents used were considered active on the basis of trial-specified thresholds. The estimated median EFS and 6-month EFS of the entire study cohort was 1.5 months (95% confidence interval [CI], 1.3-1.8 months) and 19.4% (95% CI, 12.7%-26%), respectively. No difference in EFS was observed by age at enrollment, sex, race, NRSTS histology subtype, prior lines of therapies, and trial initiation year. EFS significantly differed by radiographic response. CONCLUSIONS The EFS for children and young adults with relapsed or refractory NRSTS remains suboptimal. Established EFS can be referenced as a benchmark for future single-agent phase 2 trials incorporating potentially active novel agents in this population.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Amira Qumseya
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron R Weiss
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
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Louis D, Akil H, Oberoi S, Sirski M, Alvaro R, Seshia M, Moddemann D, Lix LM, Ruth C, Garland A. Grade 7 school performance of children born preterm: a retrospective Canadian Cohort study. J Perinatol 2024:10.1038/s41372-024-01911-9. [PMID: 38438788 DOI: 10.1038/s41372-024-01911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
IMPORTANCE Data on the middle school outcomes of preterm children are limited and have methodologic issues. OBJECTIVE To study the association between preterm birth and grade 7 school performance. METHODS A retrospective population-based cohort study of children born in Manitoba, Canada between 1994 and 2006 using their grade 7 school performance data. A secondary sibling cohort was created comprising children born preterm and their full-term siblings. Primary exposure was preterm birth categorized as <28, 28-33 and 34-36 weeks gestation. The two co-primary grade 7 outcome measures were: not meeting the mathematics competencies, and not meeting the student engagement competencies. Multivariable logistic regression models tested the association between preterm birth and both co-primary outcomes; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS 7653 preterm (gestational age median [IQR]: 35 weeks [34,36]) and 110,313 term (40 [39,40]) were included. 43% of < 28 weeks, 18% of 28-33 weeks and 17% of 34-36 weeks had the mathematics co-primary outcome compared to 13% of term children. The corresponding % for the student engagement outcome were 42%, 24%, 24% and 24% respectively. Preterm birth was associated with the mathematics (<28 weeks: 5.48, 3.89-7.70; 28-33 weeks: 1.47, 1.27-1.70; 34-36 weeks: 1.26, 1.16-1.35) and student engagement outcomes (<28 weeks: 2.49, 1.76-3.51; 28-33 weeks: 1.21, 1.06-1.39; 34-36 weeks: 1.09, 1.01-1.16). However, there was no difference in outcomes among the sibling cohort. CONCLUSIONS AND RELEVANCE Children born preterm had lower grade 7 performance compared to children born term in this population-based cohort. Screening and supports for them in their middle school years are warranted.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Hammam Akil
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sapna Oberoi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Monica Sirski
- Data analyst, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Ruben Alvaro
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mary Seshia
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Diane Moddemann
- Neonatal Follow-up Program, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Department of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Chhabra M, Ben-Eltriki M, Paul A, Lê ML, Herbert A, Oberoi S, Bradford N, Bowers A, Rassekh SR, Kelly LE. Cannabinoids for symptom management in children with cancer: A systematic review and meta-analysis. Cancer 2023; 129:3656-3670. [PMID: 37635461 DOI: 10.1002/cncr.34920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Despite the widespread use of medical cannabis, little is known regarding the safety, efficacy, and dosing of cannabis products in children with cancer. The objective of this study was to systematically appraise the existing published literature for the use of cannabis products in children with cancer. METHODS This systematic review, registered with the International Prospective Register of Systematic Reviews (CRD42020187433), searched four databases: MEDLINE, Embase, PsycINFO, and the Cochrane Library. Abstracts and full texts were screened in duplicate. Data on types of cannabis products, doses, formulations, frequencies, routes of administration, indications, and clinical and demographic details as well as reported efficacy outcomes were extracted. Data on cannabinoid-related adverse events were also summarized. RESULTS Out of 34,611 identified citations, 19 unique studies with a total of 1927 participants with cancer were included: eight retrospective chart reviews, seven randomized controlled trials, two open-label studies, and two case reports. The included studies reported the use of various cannabis products for the management of symptoms. Cannabinoids were commonly used for the management of chemotherapy-induced nausea and vomiting (11 of 19 [58%]). In controlled studies, somnolence, dizziness, dry mouth, and withdrawal due to adverse events were more commonly associated with the use of cannabinoids. Across all included studies, no serious cannabis-related adverse events were reported. CONCLUSIONS Although there is evidence to support the use of cannabis for symptom management, in children with cancer, there is a lack of rigorous evidence to inform the dosing, safety, and efficacy of cannabinoids. Because of the increasing interest in using cannabis, there is an urgent need for more research on medical cannabis in children with cancer.
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Affiliation(s)
- Manik Chhabra
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed Ben-Eltriki
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arun Paul
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Herbert
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Alison Bowers
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Manitoba, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Totadri S, Bansal D, Donaldson SS, Binitie O, Teot L, Gupta AA, Oberoi S. Common queries in managing rhabdomyosarcoma in low- and middle-income countries: An Indo-North American collaboration. Pediatr Blood Cancer 2023; 70:e30616. [PMID: 37574816 DOI: 10.1002/pbc.30616] [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: 04/09/2023] [Revised: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma among children and adolescents. The management of RMS involves risk stratification of the patients based on various clinicopathological characteristics. The multimodality treatment approach requires chemotherapy, surgery, and/or radiation. The treatment of RMS necessitates the involvement of multiple disciplines, such as pathology, pediatric oncology, surgery, and radiation oncology. The disease heterogeneity, molecular testing, evolving treatment regimens, and limited resources are some of the challenges faced by clinicians while treating a patient with RMS in low- and middle-income countries (LMICs). In this review, we endeavor to bring experts from varying fields to address clinicians' common questions while managing a child or adolescent with RMS in LMICs. This review is most applicable to level 2 centers in LMICs as per the levels of services described by the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology.
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Affiliation(s)
- Sidharth Totadri
- Department of Paediatrics, Paediatric Haematology-Oncology Unit, Christian Medical College, Vellore, India
| | - Deepak Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Odion Binitie
- Department of Sarcoma, Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lisa Teot
- Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Abha A Gupta
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Muthumuni D, Scott I, Chochinov HM, Mahar AL, Garland SN, Schulte F, Lambert P, Lix L, Garland A, Oberoi S. Feasibility and Acceptability of a Virtual "Coping with Brain Fog" Intervention for Improving Cognitive Functioning in Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12:662-673. [PMID: 37158780 DOI: 10.1089/jayao.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Purpose: Cancer-related cognitive deficits (CRCDs) are common among young adults (YAs) (ages: 18-39) with cancer and can be debilitating. We aimed to determine the feasibility and acceptability of a virtual Coping with Brain Fog intervention among YAs with cancer. Our secondary aims were to explore the intervention's effect on cognitive functioning and psychological distress. Methods: This prospective feasibility study involved eight weekly, 90-minute virtual group sessions. Sessions focused on psychoeducation on CRCD, memory skills, task management, and psychological well-being. The primary outcomes were feasibility and acceptability of the intervention evaluated through attendance (>60% not missing >2 consecutive sessions) and satisfaction (Client Satisfaction Questionnaire [CSQ] score >20). Secondary outcomes included the following: cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog] Scale) and symptoms of distress (Patient-Reported Outcomes Measurement Information System [PROMIS] Short Form-Anxiety/Depression/Fatigue) and participants' experiences using semistructured interviews. Paired t-tests and summative content analysis were used for quantitative and qualitative data analyses. Results: Twelve participants (five male, mean age = 33 years) were enrolled. All but one participant met feasibility criteria of not missing >2 consecutive sessions (11/12 = 92%). The mean CSQ score was 28.1 (standard deviation 2.5). Significant improvement in cognitive function as measured by FACT-Cog Scale was observed postintervention (p < 0.05). Ten participants adopted strategies from the program to combat CRCD, and eight reported CRCD symptom improvement. Conclusion: A virtual Coping with Brain Fog intervention is feasible and acceptable for the symptoms of CRCD among YAs with cancer. The exploratory data indicate subjective improvement in cognitive function, and will inform the design and implementation of a future clinical trial. ClinicalTrials.gov Registration: NCT05115422.
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Affiliation(s)
- Dhasni Muthumuni
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alyson L Mahar
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Fiona Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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9
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Oberoi S, Crane JN, Haduong JH, Rudzinski ER, Wolden SL, Dasgupta R, Linardic CM, Weiss AR, Venkatramani R. Children's Oncology Group's 2023 blueprint for research: Soft tissue sarcomas. Pediatr Blood Cancer 2023; 70 Suppl 6:e30556. [PMID: 37430436 PMCID: PMC10519430 DOI: 10.1002/pbc.30556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
In the United States, approximately 850-900 children and adolescents each year are diagnosed with soft tissue sarcomas (STS). STS are divided into rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma STS (NRSTS). RMS and NRSTS are risk stratified into low-, intermediate-, and high-risk categories, with 5-year survival rates of approximately 90%, 50%-70%, and 20%, respectively. Recent key achievements from the Children's Oncology Group (COG) STS Committee include the identification of new molecular prognostic factors for RMS, development and validation of a novel risk stratification system for NRSTS, successful completion of a collaborative NRSTS clinical trial with adult oncology consortia, and collaborative development of the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT). Current COG trials for RMS are prospectively evaluating a new risk stratification system that incorporates molecular findings, de-intensification of therapy for a very low-risk subgroup, and augmented therapy approaches for intermediate- and high-risk RMS. Trials for NRSTS exploring novel targets and local control modalities are in development.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jacquelyn N Crane
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Josephine H Haduong
- Division of Oncology, Hyundai Cancer Institute, Children’s Hospital Orange County, Orange, California, USA
| | - Erin R. Rudzinski
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, USA
- Department of Laboratories, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Corinne M Linardic
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacology & Cancer Biology, Duke University School of Medicine, Durham, NC, USA
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Main, USA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
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10
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Peretz Soroka H, Vora T, Noujaim J, Marcoux N, Cohen‐Gogo S, Alcindor T, Holloway C, Rodrigues C, Karachiwala H, Alvi S, Lee U, Cheng S, Banerji S, Oberoi S, Feng X, Smrke A, Simmons C, Razak AA, Gupta AA. Real-world experience of tyrosine kinase inhibitors in children, adolescents and adults with relapsed or refractory bone tumours: A Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) study. Cancer Med 2023; 12:18872-18881. [PMID: 37724607 PMCID: PMC10557866 DOI: 10.1002/cam4.6515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES We conducted a retrospective multi-centre study to assess the real-world outcome of regorafenib (REGO) and cabozantinib (CABO) in recurrent/refractory bone tumours (BTs) including osteosarcoma (OST), Ewing sarcoma (EWS) and chondrosarcoma (CS)/extra-skeletal mesenchymal CS (ESMC). METHODS After regulatory approval, data from patients with recurrent BT (11 institutions) were extracted from CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration) database. Patient characteristics, treatment and outcomes were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS From July 2018 to May 2022, 66 patients received REGO or CABO; 39 OST, 18 EWS, 4 CS and 5 ESMC. Median age was 27.8 years (range 12-76); median starting dose was 60 mg for CABO (n = 37, range 40-60) and 120 mg for REGO (n = 29, range 40-160). Twenty-eight (42.4%) patients required dose reduction: hand-foot syndrome 7 (10.6%), nausea/vomiting 1 (1.5%), diarrhoea 1 (1.5%), 2 elevated LFTs (3%), elevated bilirubin 1 (1.5%) and mucositis 1 (1.5%). The median OS for patients with OST, EWS, CS and ESMC was 8.5 months (n = 39, 95% CI 7-13.1); 13.4 months (n = 18, 95% CI 3.4-27.2), 8.1 (n = 4, 95% CI 4.1-9.3) and 18.2 (n = 5, 95% CI (10.4-na), respectively. Median PFS for OST, EWS, CS and ECMS was 3.5 (n = 39, 95% CI 2.8-5), 3.9 (n = 18, 95% CI 2.1-5.9), 5.53 (n = 4. 95% CI 2.13-NA) and 11.4 (n = 5, 95% CI 1.83-14.7), respectively. Age, line of therapy, REGO versus CABO, or time from diagnosis to initiation of TKI were not associated with PFS on univariable analysis. CONCLUSION Our real-world data show that TKIs have meaningful activity in recurrent BT with acceptable toxicities when started at modified dosing. Inclusion of TKIs in earlier lines of treatment and/or maintenance therapy could be questions for future research.
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Affiliation(s)
- Hagit Peretz Soroka
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Tushar Vora
- Division of Hematology/Oncology, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Jonathan Noujaim
- Division of Medical Oncology, Hôpital Maisonneuve RosemontUniversity of MontrealMontrealQuebecCanada
| | - Nicolas Marcoux
- Division of Hematology‐OncologyCentre Hospitalier Universitaire de QuébecQuebecCanada
| | - Sarah Cohen‐Gogo
- Division of Hematology/Oncology, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Thierry Alcindor
- Division of Medical OncologyMcGill University Health CentreMontrealQuebecCanada
| | - Caroline Holloway
- Division of Radiation Oncology, BC CancerUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Caroline Rodrigues
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Hatim Karachiwala
- Division of Medical Oncology, Cross Cancer InstituteAlberta Health ServicesEdmontonAlbertaCanada
| | - Saima Alvi
- Division of Pediatric Hematology/OncologyJim Pattison Children's Hospital SaskatoonSaskatoonSaskatchewanCanada
| | - Ursula Lee
- Division of Medical Oncology, BC CancerUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sylvia Cheng
- Division of Pediatric Hematology/Oncology/BMTB.C. Children's Hospital, BC CancerVancouverBritish ColumbiaCanada
| | - Shantanu Banerji
- Department of Pediatric Hematology‐Oncology, CancerCare Manitoba Research Institute, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Sapna Oberoi
- Department of Pediatric Hematology‐Oncology, CancerCare Manitoba Research Institute, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Xiaolan Feng
- Division of Medical Oncology, BC CancerUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alannah Smrke
- Division of Medical Oncology, BC CancerUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Christine Simmons
- Division of Medical Oncology, BC CancerUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Albiruni Abdul Razak
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
- Division of Medical Oncology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Abha A. Gupta
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
- Division of Hematology/Oncology, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
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11
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Patel P, Robinson PD, van der Torre P, Tomlinson D, Seelisch J, Oberoi S, Morgan JE, Hinds PS, Götte M, Gibson F, Duong N, Davis H, Culos-Reed SN, Cataudella D, Miranda V, Dupuis LL, Sung L. Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. EClinicalMedicine 2023; 63:102147. [PMID: 37609066 PMCID: PMC10440444 DOI: 10.1016/j.eclinm.2023.102147] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
Objective was to update a clinical practice guideline (CPG) for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients. We reconvened a multi-disciplinary and multi-national panel. While the previous 2018 CPG evaluated adult and pediatric randomized controlled trials (RCTs) to manage fatigue, this 2023 update revised previous recommendations based only on pediatric RCTs. Twenty RCTs were included in the updated systematic review. Physical activity significantly reduced fatigue (standardized mean difference -0.44, 95% confidence interval -0.64 to -0.24; n = 8 RCTs). Using the 2018 recommendations as a basis, the panel continued to make strong recommendations to use physical activity, and to offer relaxation, mindfulness or both, to manage fatigue in pediatric patients. Cognitive or cognitive behavioral therapies may be offered. Pharmacological approaches should not be routinely used. The panel made a new good practice statement to routinely assess for fatigue, ideally using a validated scale.
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Affiliation(s)
- Priya Patel
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Paula D. Robinson
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
| | - Patrick van der Torre
- Sport and Exercise Center, Princess Máxima Center for Pediatric Oncology, Utrecht 3584CS, the Netherlands
| | - Deborah Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Jennifer Seelisch
- Division of Hematology/Oncology, Children’s Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, CancerCare Manitoba, University of Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada
| | - Jessica E. Morgan
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds LS1 3EX, UK
| | - Pamela S. Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children's National Health System, Washington, DC, USA
- Department of Pediatrics, George Washington University, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Miriam Götte
- University Hospital Essen, West German Cancer Center, Hufelandstraße 55, Essen 45147, Germany
| | - Faith Gibson
- Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK
| | | | | | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Danielle Cataudella
- Department of Pediatric Psychology, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
| | - Vanessa Miranda
- Pediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON M5G 1V2, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - L. Lee Dupuis
- Department of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada
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12
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Mark C, Gibson P, Lafay-Cousin L, Martin G, Oberoi S, Pecheux L, Rassekh SR, Zorzi A, Alexander S, Gupta S. Outcomes of Coronavirus Disease 2019 Infection in Children and Adolescents With Cancer in Canada: Population-based Study and Systematic Review. J Pediatr Hematol Oncol 2023; 45:e689-e694. [PMID: 36897636 DOI: 10.1097/mph.0000000000002644] [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: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023]
Abstract
Published outcomes for children with cancer with coronavirus disease 2019 (COVID-19) have varied. Outcome data for pediatric oncology patients in Canada, outside of Quebec, have not been reported. This retrospective study captured patient, disease, and COVID-19-related infectious episode characteristics and outcome data for children, 0 to 18 years, diagnosed with a first COVID-19 infection between January 2020 to December 2021 at 12 Canadian pediatric oncology centers. A systematic review of pediatric oncology COVID-19 cases in high-income countries was also undertaken. Eighty-six children were eligible for study inclusion. Thirty-six (41.9%) were hospitalized within 4 weeks of COVID-19; only 10 (11.6%) had hospitalization attributed to the virus, with 8 being for febrile neutropenia. Two patients required intensive care unit admission within 30 days of COVID-19 infection, neither for COVID-19 management. There were no deaths attributed to the virus. Of those scheduled to receive cancer-directed therapy, within 2 weeks of COVID-19, 20 (29.4%) experienced treatment delays. Sixteen studies were included in the systematic review with highly variable outcomes identified. Our findings compared favorably with other high-income country's pediatric oncology studies. No serious outcomes, intensive care unit admissions, or deaths, in our cohort, were directly attributable to COVID-19. These findings support the minimization of chemotherapy interruption after COVID-19 infection.
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Affiliation(s)
- Catherine Mark
- Department of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto
| | - Paul Gibson
- Haematology/Oncology Unit, McMaster Children's Hospital, Hamilton
| | - Lucie Lafay-Cousin
- Departmentof Paediatric Hematology/Oncology, Alberta Children's Hospital, Calgary
| | - Georgina Martin
- Department of Hematology/Oncology, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg
| | - Lucie Pecheux
- University of Alberta, Edmonton, AB
- Pediatric Oncology, Stollery Children Hospital, Edmonton
| | - Shahrad R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Colombia, Vancouver, Canada
| | - Alexandra Zorzi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Western University, London, ON
| | - Sarah Alexander
- Department of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto
| | - Sumit Gupta
- Department of Hematology/Oncology, Toronto Hospital for Sick Children, Toronto
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13
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Oberoi S, Qumseya A, Xue W, Harrison DJ, Rudzinski ER, Wolden SL, Dasgupta R, Venkatramani R, Gupta AA. Feasibility of combining temsirolimus to vincristine, dactinomycin, cyclophosphamide, and vincristine and irinotecan chemotherapy for children with intermediate-risk rhabdomyosarcoma: A report from Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30436. [PMID: 37243336 PMCID: PMC10676447 DOI: 10.1002/pbc.30436] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Temsirolimus has shown in vivo activity against rhabdomyosarcoma (RMS). We aimed to determine the feasibility of incorporating temsirolimus within the standard Children's Oncology Group (COG) chemotherapy backbone of vincristine, actinomycin-D, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (VI) in children with intermediate-risk (IR) RMS. METHODS The feasibility phase of the COG IR-RMS trial, ARST1431 (NCT02567435), assigned 10 patients to receive 15 mg/m2 /dose (dose level 1) of temsirolimus on days 1, 8, and 15 of each of three weekly VAC and VI cycles for the first 12 weeks of induction chemotherapy. The primary endpoint of the feasibility phase was to establish the safe dose and safety of combining temsirolimus with VAC/VI. The combination regimen was deemed feasible if less than 40% of patients developed a priori defined nonhematological dose-limiting toxicities (DLTs). RESULTS Ten patients (seven males and three females; median age = 4.5 years [range: 0.2-14.4 years]) with IR-RMS were enrolled and received dose level 1 of temsirolimus. Eight patients had FOXO1-negative disease, while two had FOXO1-positive disease. Two patients had metastatic disease. Of 10 patients, two developed DLTs: grade 3 oral mucositis and pneumonitis. Four patients (40%) had grade 4 neutropenia. No treatment-related mortality occurred. The median duration of the completion of the feasibility phase was 12.1 weeks (range: 11.7-15 weeks). CONCLUSIONS Weekly temsirolimus at 15 mg/m2 /dose during VAC/VI chemotherapy was feasible and well tolerated. The efficacy of this regimen is currently being tested in a phase III randomized trial against VAC/VI chemotherapy alone in the ARST1431 trial.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Amria Qumseya
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Douglas J Harrison
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, USA
| | - Erin R. Rudzinski
- Department of Laboratories, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abha A. Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Yan AP, Venkatramani R, Bradley JA, Lautz TB, Urla CI, Merks JHM, Oberoi S. Clinical Characteristics, Treatment Considerations, and Outcomes of Infants with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15082296. [PMID: 37190224 DOI: 10.3390/cancers15082296] [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: 03/29/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
RMS most commonly presents in children and adolescents, however a subset of tumors are diagnosed in infants under one year of age. Due to the rarity of infant RMS, utilization of different treatment approaches and goals, and small sample sizes, the published studies of infants with RMS have yielded heterogeneous results. In this review, we discuss the outcomes of infants with RMS treated in various clinical trials and the strategies that various international cooperative groups have employed to reduce the morbidity and mortality related to treatment without compromising the overall survival of this population. This review discusses the unique scenarios of diagnosing and managing congenitals or neonatal RMS, spindle cell RMS and relapsed RMS. This review concludes by exploring novel approaches to diagnosis and management of infants with RMS that are currently being studied by various international cooperative groups.
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Affiliation(s)
- Adam P Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1R1, Canada
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, FL 33024, USA
| | - Timothy B Lautz
- Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL 60208, USA
| | - Cristian I Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Johannes H M Merks
- Princess Ma'xima Center for Paediatric Oncology, 3584 CS Utrecht, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB R3T 0A1, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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15
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Grover SA, Abbott L, Berman JN, Bourque G, Chan JA, Denburg AE, Deyell RJ, Fernandez CV, Hawkins C, Henning JW, Irwin MS, Jabado N, Jones SJ, Lange PF, Moorehead P, Moran MF, Morgenstern DA, Oberoi S, Palmer A, Rassekh SR, Senger DL, Shlien A, Sinnett D, Strahlendorf C, Sullivan PJ, Taylor MD, Vercauteren S, Villani A, Villeneuve S, Whitlock JA, Malkin D. Abstract 4509: A pan-Canadian precision oncology program for children, adolescents and young adults with hard-to-cure cancer: The PRecision Oncology For Young peopLE (PROFYLE) Program. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Over 4,300 children, adolescents, and young adults (CAYA) are diagnosed with cancer each year in Canada, 1/3 of whom have refractory/metastatic disease or will relapse. The PRecision Oncology For Young peopLE (PROFYLE) national, collaborative program, was created to provide equitable access to molecular profiling to identify novel targeted treatment options in a clinically relevant timeframe for all CAYA with hard-to-cure cancers in Canada.
Design: Building upon 3 pre-existing regional precision oncology programs, PROFYLE now includes >20 institutions and has united an interdisciplinary team of experts, leaders, research teams, end-users and advocates from across Canada. The program has 14 domain specific nodes that are unified by a shared governance structure, and has harmonized biobanking, genomics, bioinformatics and reporting procedures. PROFYLE includes genomic and transcriptomic sequencing of paired germline and cancer fresh/frozen samples, proteomic analysis, and cancer modelling. Inclusion criteria: ≤29y; treatment at a Canadian center; diagnosis of a hard-to-cure cancer. Profiling results are reviewed by multidisciplinary Molecular Tumor Boards. A report including a results/recommendations summary of actionable findings (therapeutic, diagnostic, prognostic, cancer predisposition), potential targeted therapy options including available clinical trials, clarification of diagnosis, and genetic counseling recommendations is provided to the treating oncologist.
Results: >1,000 CAYA are included from all of the provinces. Cancer diagnoses: 34% sarcoma, 16% leukemia/lymphoma, 16% CNS tumor, 11% neuroblastoma, 23% other. 17% of participants had a cancer-predisposing pathogenic/likely pathogenic germline variant, 45% had ≥1 potentially actionable somatic alteration, 22.6% had a therapeutically targetable somatic alteration. The most frequent classes of therapeutic alterations were RAS/MAPK (15%), cell cycle (14%), epigenetic (13%), RTK (12%), PI3K/AKT/mTOR (11%), DNA repair (9%), immune checkpoint (8%). Of clinicians who reported the utility of results, 55% indicated the findings were useful for clinical management.
Future Directions: Collaborations with other national and international initiatives and data from this interdisciplinary, multi-institutional research program will inform the development of a framework to innovatively link research, clinical and system considerations with Canadian values relevant to multi-omic profiling and drug access for CAYA. In addition, we believe that with a comprehensive molecular view of cancer, PROFYLE will transform our understanding of underlying disease mechanisms, facilitate and improve diagnostic and prognostic indicators, and identify new therapeutic strategies and targets for CAYA patients with cancer.
Citation Format: Stephanie A. Grover, Lesleigh Abbott, Jason N. Berman, Guillaume Bourque, Jennifer A. Chan, Avram E. Denburg, Rebecca J. Deyell, Conrad V. Fernandez, Cynthia Hawkins, Jan-Willem Henning, Meredith S. Irwin, Nada Jabado, Steven J. Jones, Philipp F. Lange, Paul Moorehead, Michael F. Moran, Daniel A. Morgenstern, Sapna Oberoi, Antonia Palmer, Shahrad R. Rassekh, Donna L. Senger, Adam Shlien, Daniel Sinnett, Caron Strahlendorf, Patrick J. Sullivan, Michael D. Taylor, Suzanne Vercauteren, Anita Villani, Stephanie Villeneuve, James A. Whitlock, David Malkin, on behalf of the PROFYLE Consortium. A pan-Canadian precision oncology program for children, adolescents and young adults with hard-to-cure cancer: The PRecision Oncology For Young peopLE (PROFYLE) Program. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4509.
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Affiliation(s)
| | - Lesleigh Abbott
- 2Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jason N. Berman
- 2Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Nada Jabado
- 8McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Paul Moorehead
- 10Janeway Health and Rehabilitation Centre, St. John’s, Newfoundland and Labrador, Canada
| | | | | | - Sapna Oberoi
- 11CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Antonia Palmer
- 12Advocacy for Canadian Childhood Oncology Research Network (Ac2orn), Toronto, Ontario, Canada
| | | | - Donna L. Senger
- 13Lady Davis Institute of Medical Research and McGill University, Montreal, Quebec, Canada
| | - Adam Shlien
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Sinnett
- 14Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | | | | | | | | | - Anita Villani
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - David Malkin
- 1The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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Yan A, Howden K, Mahar AL, Scott I, Glidden C, Deleemans J, Chalifour K, Eaton G, Gupta A, Bolton JM, Garland SN, Oberoi S. Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic. J Cancer Surviv 2023; 17:370-383. [PMID: 35098486 PMCID: PMC8801282 DOI: 10.1007/s11764-021-01158-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors. METHODS We conducted a cross-sectional survey of AYAs aged 18-49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia. RESULTS The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11-4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18-3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18-4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08-3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03-3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08-8.29) or unemployed (AOR 3.97, 95% CI 1.46-10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43-13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05-4.70) and being single (AOR 2.52, 95% CI 1.08-5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively. CONCLUSIONS The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.
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Affiliation(s)
- Adam Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Dana-Farber/Boston Children's Blood and Cancer Disorder Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Julie Deleemans
- Department of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Abha Gupta
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Princess Margaret Cancer Care Research Institute, Toronto, ON, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada.
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada.
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, R3E0V9, Canada.
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17
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Oberoi S, Choy E, Chen YL, Scharschmidt T, Weiss AR. Trimodality Treatment of Extremity Soft Tissue Sarcoma: Where Do We Go Now? Curr Treat Options Oncol 2023; 24:300-326. [PMID: 36877374 DOI: 10.1007/s11864-023-01059-2] [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] [Accepted: 01/23/2023] [Indexed: 03/07/2023]
Abstract
OPINION STATEMENT Extremity soft tissue sarcoma (ESTS) constitutes the majority of patients with soft tissue sarcoma (STS). Patients with localized high-grade ESTS > 5 cm in size carry a substantial risk of developing distant metastasis on follow-up. A neoadjuvant chemoradiotherapy approach can enhance local control by facilitating resection of the large and deep locally advanced tumors while trying to address distant spread by treating the micrometastasis for these high-risk ESTS. Preoperative chemoradiotherapy and adjuvant chemotherapy are often used for children with intermediate- or high-risk non-rhabdomyosarcoma soft tissue tumors in North America and Europe. In adults, the cumulative evidence supporting preoperative chemoradiotherapy or adjuvant chemotherapy remains controversial. However, some studies support a possible benefit of 10% in overall survival (OS) for high-risk localized ESTS, especially for those with a probability of 10-year OS < 60% using validated nomograms. Opponents of neoadjuvant chemotherapy argue that it delays curative surgery, compromises local control, and increases the rate of wound complications and treatment-related mortality; however, the published trials do not support these arguments. Most treatment-related side effects can be managed with adequate supportive care. A coordinated multidisciplinary approach involving sarcoma expertise in surgery, radiation, and chemotherapy is required to achieve better outcomes for ESTS. The next generation of clinical trials will shed light on how comprehensive molecular characterization, targeted agents and/or immunotherapy can be integrated into the upfront trimodality treatment to improve outcomes. To that end, every effort should be made to enroll these patients on clinical trials, when available.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatric Hematology Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Edwin Choy
- Division of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Yen-Lin Chen
- Department of Orthopedics, Division of Musculoskeletal Oncology, The Ohio State University, Columbus, OH, USA
| | - Thomas Scharschmidt
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron R Weiss
- Department of Pediatric Hematology Oncology, Maine Medical Center, 100 Campus Drive, Suite 107 Scarborough, Portland, ME, USA.
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18
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Louis D, Oberoi S, Ricci FM, Pylypjuk C, Alvaro R, Seshia M, de Cabo C, Moddemann D, Sirski M, Lix LM, Garland A, Ruth CA. Grade 3 school performance among children born preterm: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2022; 108:286-293. [PMID: 36456174 DOI: 10.1136/archdischild-2022-324746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To study the association between prematurity and grade 3 school performance in a contemporary cohort of children. METHODS Population-based retrospective cohort study in Manitoba, Canada. Children born between 1999 and 2011 who had their grade 3 school performance data available were eligible. Preterm birth (<37 weeks) was the exposure of interest assessed using multivariable logistic regression models. Our primary outcomes were 'needs ongoing help' or 'outside the range' in at least two of each of the (1) four numeracy and (2) three reading competencies. RESULTS Of the 186 956 eligible children, 101 436 children (7187 preterm (gestational age, median (IQR) 35 weeks (34, 36)) and 94 249 term (40 weeks (39,40)) were included. Overall, 19% of preterm and 14% of term children had the numeracy outcome (adjusted OR (aOR) 1.38; 95% CI 1.29 to 1.47, p<0.001), while 19% and 13% had the reading outcome (aOR 1.38; 1.29 to 1.48, p<0.001). These differences showed a gestational age gradient. Gestational age (for numeracy, <28 weeks aOR 4.93 (3.45 to 7.03), 28-33 weeks 1.72 (1.50 to 1.98), 34-36 weeks 1.24 (1.15 to 1.34); for reading, <28 weeks 3.51 (2.40 to 5.14), 28-33 weeks 1.72 (1.49 to 1.98), 34-36 weeks 1.24 (1.17-1.37)), male sex, small for gestational age and maternal medical and sociodemographic factors were associated with the numeracy and reading outcomes in this cohort. CONCLUSIONS AND RELEVANCE Children born preterm had poorer performance in grade 3 numeracy and reading proficiencies than children born full term. All children born preterm, not just those born extremely preterm, should be screened for reading and numeracy performance in school and strategies implemented to address any deficits.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Child Health, University of Manitoba, Winipeg, Manitoba, Canada
| | - Florencia M Ricci
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christy Pylypjuk
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Alvaro
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Seshia
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia de Cabo
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Moddemann
- Neonatal Follow up program, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Monica Sirski
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Anastasia Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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19
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Louis D, Akil H, Bolton JM, Bacchini F, Netzel K, Oberoi S, Pylypjuk C, Flaten L, Cheung K, Lix LM, Ruth C, Garland A. Mental Disorders Among Mothers of Children Born Preterm: A Population-Based Cohort Study in Canada. Can J Psychiatry 2022; 68:338-346. [PMID: 36412096 DOI: 10.1177/07067437221138237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our aim was to examine the association between preterm delivery and incident maternal mental disorders using a population-based cohort of mothers in Canada. METHODS Retrospective matched cohort study using Manitoba Centre for Health Policy (MCHP) administrative data in Manitoba. Mothers who delivered preterm babies (<37 weeks gestational age) between 1998 and 2013 were matched 1:5 to mothers of term babies using socio-demographic variables. Primary outcome was any incident mental disorder within 5 years of delivery defined as any of (a) mood and anxiety disorders, (b) psychotic disorders, (c) substance use disorders, and (d) suicide or suicide attempts. Multivariable Poisson regression model was used to estimate the 5-year adjusted incidence rate ratios (IRRs). RESULTS Mothers of preterm children (N = 5,361) had similar incidence rates of any mental disorder (17.4% vs. 16.6%, IRR = 0.99, 95% CI, 0.91 to 1.07) compared to mothers of term children (N = 24,932). Mothers of term children had a higher rate of any mental disorder in the first year while mothers of preterm children had higher rates from 2 to 5 years. Being the mother of a child born <28 week (IRR = 1.5, 95% CI, 1.14 to 2.04), but not 28-33 weeks (IRR = 1.03, 95% CI, 0.86 to 1.19) or 34-36 weeks (IRR = 0.96, 95% CI, 0.88 to 1.05), was associated with any mental disorder. INTERPRETATION Mothers of preterm and term children had similar rates of incident mental disorders within 5-years post-delivery. Extreme prematurity was a risk factor for any mental disorder. Targeted screening and support of this latter group may be beneficial.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Hammam Akil
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - James M Bolton
- Department of Psychiatry, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | | | - Karen Netzel
- Neonatal Intensive Care Unit, Women's Hospital, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology Oncology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Christy Pylypjuk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa Flaten
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Kristene Cheung
- Department of Clinical Health Psychology, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Lisa M Lix
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
| | - Chelsea Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Canada.,Department of Medicine, Rady Faculty of Medicine, 8664University of Manitoba, Winnipeg, Canada
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20
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Louis D, Oberoi S, Ricci MF, Pylypjuk C, Alvaro R, Seshia M, de Cabo C, Moddemann D, Lix LM, Garland A, Ruth CA. School Readiness Among Children Born Preterm in Manitoba, Canada. JAMA Pediatr 2022; 176:1010-1019. [PMID: 35939291 PMCID: PMC9361185 DOI: 10.1001/jamapediatrics.2022.2758] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/17/2022] [Indexed: 11/14/2022]
Abstract
Importance Children born preterm may experience learning challenges at school. However, there is a paucity of data on the school readiness of these children as they prepare to begin grade 1. Objective To examine the association between prematurity and school readiness in a population-based cohort of children. Design, Setting, and Participants This cohort study was conducted in the province of Manitoba, Canada, and involved 2 cohorts of children in kindergarten at the time of data collection. The population-based cohort included children born between January 1, 2000, and December 31, 2011, whose school readiness was assessed in kindergarten using the Early Development Instrument (EDI) data. The sibling cohort comprised children born preterm and their closest-in-age siblings born full term. Data were analyzed between March 12 and September 28, 2021. Exposures Preterm birth, defined as gestational age (GA) less than 37 weeks. Main Outcomes and Measures The primary outcome was vulnerability in the EDI, defined as a score below the tenth percentile of the Canadian population norms for any 1 or more of the 5 EDI domains (physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge). Logistic regression models were used to identify the factors associated with vulnerability in the EDI. P values were adjusted for multiplicity using the Simes false discovery method. Results Of 86 829 eligible children, 63 277 were included, of whom 4352 were preterm (mean [SD] GA, 34 [2] weeks; 2315 boys [53%]) and 58 925 were full term (mean [SD] GA, 39 (1) weeks; 29 885 boys [51%]). Overall, 35% of children (1536 of 4352) born preterm were vulnerable in the EDI compared with 28% of children (16 449 of 58 925) born full term (adjusted odds ratio [AOR], 1.32; 95% CI, 1.23-1.41; P < .001]). Compared with children born full term, those born preterm had a higher percentage of vulnerability in each of the 5 EDI domains. In the population-based cohort, prematurity (34-36 weeks' GA: AOR, 1.23 [95% CI, 1.14-1.33]; <34 weeks' GA: AOR, 1.72 [95% CI, 1.48-1.99]), male sex (AOR, 2.24; 95% CI, 2.16-2.33), small for gestational age (AOR, 1.31; 95% CI, 1.23-1.40), and various maternal medical and sociodemographic factors were associated with EDI vulnerability. In the sibling cohort, EDI outcomes were similar for both children born preterm and their siblings born full term except for the communication skills and general knowledge domain (AOR, 1.39; 95% CI, 1.07-1.80) and Multiple Challenge Index (AOR, 1.43; 95% CI, 1.06-1.92), whereas male sex (AOR, 2.19; 95% CI, 1.62-2.96) and maternal age at delivery (AOR, 1.53; 95% CI, 1.38-1.70) were associated with EDI vulnerability. Conclusions and Relevance Results of this study suggest that, in a population-based cohort, children born preterm had a lower school-readiness rate than children born full term, but this difference was not observed in the sibling cohort. Child and maternal factors were associated with lack of school readiness among this population-based cohort.
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Affiliation(s)
- Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Florencia Ricci
- Neonatal Follow up Program, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christy Pylypjuk
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruben Alvaro
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Seshia
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia de Cabo
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Diane Moddemann
- Neonatal Follow up Program, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea A. Ruth
- Section of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Oberoi S, Protudjer JLP, Rapoport A, Rassekh SR, Crooks B, Siden H, Decker K, Ananth P, Chapman S, Balneaves LG, Vanan MI, Kelly LE. Perspectives of pediatric oncologists and palliative care physicians on the therapeutic use of cannabis in children with cancer. Cancer Rep (Hoboken) 2022; 5:e1551. [PMID: 34672127 PMCID: PMC9458513 DOI: 10.1002/cnr2.1551] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Children with cancer are increasingly using cannabis therapeutically. AIM The purpose of this study was to determine the perspectives and practices of pediatric oncologists and palliative care physicians regarding the use of cannabis for medical purposes among children with cancer. METHODS A self-administered, voluntary, cross-sectional, deidentified online survey was sent to all pediatric oncologists and palliative care physicians in Canada between June and August 2020. Survey domains included education, knowledge, and concerns about cannabis, views on its effectiveness, and the importance of cannabis-related research. Data were analyzed using descriptive statistics. RESULTS In total, 122/259 (47.1%) physicians completed the survey. Although 62.2% of the physicians completed some form of training about medical cannabis, nearly all (95.8%) desired to know more about the dosing, side effects, and safety of cannabis. Physicians identified a potential role of cannabis in the management of nausea and vomiting (85.7%), chronic pain (72.3%), cachexia/poor appetite (67.2%), and anxiety or depression (42.9%). Only four (0.3%) physicians recognized cannabis to be potentially useful as an anticancer agent. Nearly all physicians reported that cannabis-related research for symptom relief is essential (91.5%) in pediatric oncology, whereas 51.7% expressed that future studies are necessary to determine the anticancer effects of cannabis. CONCLUSIONS Our findings indicate that most pediatric oncologists and palliative care physicians recognize a potential role for cannabis in symptom control in children with cancer. Well-conducted studies are required to create evidence for cannabis use and promote shared decision making with pediatric oncology patients and their caregivers.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Jennifer L. P. Protudjer
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
- George and Fay Yee Centre for Healthcare InnovationWinnipegCanada
- Department Foods and Human Nutritional SciencesUniversity of ManitobaWinnipegCanada
| | - Adam Rapoport
- Paediatric Advanced Care TeamHospital for Sick ChildrenTorontoOntarioCanada
- Emily's House Children's HospiceTorontoOntarioCanada
- Department of PaediatricsFaculty of Medicine, University of TorontoTorontoOntarioCanada
- Department of Family & Community MedicineFaculty of Medicine, University of TorontoTorontoOntarioCanada
| | - Shahrad R. Rassekh
- Division of Oncology/Hematology/BMT, Department of PediatricsUniversity of British ColumbiaVancouverCanada
| | - Bruce Crooks
- Pediatric Hematology/Oncology & Medical EducationIWK Health CentreHalifaxCanada
| | - Harold Siden
- Department of Pediatrics, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Kathleen Decker
- Department of Community Health SciencesUniversity of ManitobaWinnipegCanada
| | - Prasanna Ananth
- Section of Pediatric Hematology/Oncology, Department of PediatricsYale School of Medicine
| | - Stacy Chapman
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
| | | | - Magimairajan Issai Vanan
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Department of Pediatric Hematology‐OncologyCancerCare ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Lauren E. Kelly
- Department of Pediatrics and Child HealthUniversity of ManitobaWinnipegCanada
- Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
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22
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Tulk J, Garland SN, Howden K, Glidden C, Scott I, Chalifour K, Eaton G, Mahar A, Oberoi S. Prevalence and factors associated with insomnia symptoms in adolescents and young adults with cancer during the COVID-19 pandemic. Sleep Health 2022; 8:410-416. [PMID: 35729003 PMCID: PMC9212947 DOI: 10.1016/j.sleh.2022.04.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has been particularly distressing for adolescents and young adults (AYAs) diagnosed with cancer. High levels of distress are associated with sleep disturbances. This study examined the prevalence of insomnia symptoms in AYAs during the COVID-19 pandemic and identified factors related to greater insomnia severity. DESIGN, SETTING, AND PARTICIPANTS An online survey was administered to Canadian AYAs (N = 805) diagnosed with cancer between 15 and 39 years from January to February 2021. MEASUREMENTS The primary measure was the Insomnia Severity Index (ISI). Univariable and multivariable binomial logistic regression examined demographic, clinical, and psychological factors associated with significant insomnia symptoms (ISI score ≥12). RESULTS Three hundred twelve (38.8%) participants reported insomnia symptoms. In the multivariable model, severe psychological distress (ie, depression and anxiety; adjusted odds ratio (AOR) = 28.75, p ≤.001), having a pre-existing mental health condition (AOR = 1.92, p = .03), worsened mental health during the pandemic (AOR = 1.73, p = .02), finished cancer treatment ≥1 year ago (AOR = 1.72, p = .03), and experiencing no changes to schooling during the COVID-19 pandemic (AOR = 2.18, p = .004) were associated with significant insomnia symptoms. Standardized coefficients also indicated that worrying about possible disruptions to cancer care and being a homemaker/caretaker contributed to insomnia symptoms. CONCLUSIONS Nearly 40% of AYAs with cancer reported insomnia symptoms during the COVID-19 pandemic. Insomnia was associated with potentially modifiable factors such as psychological distress, highlighting possible targets for intervention.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Canada; Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Canada.
| | - Kaitlyn Howden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, NL, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Section of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
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Kearns C, Taylor G, Oberoi S, Mertz E. Dominant Power and the Concept of Caste: Implications for Dentistry and Oral Health Inequality. Community Dent Health 2022; 39:137-142. [PMID: 35543466 PMCID: PMC9156562 DOI: 10.1922/cdh_iadr22kearns06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper explores the issues of caste and casteism in the U.S. as described by Pulitzer Prize winning journalist Isabel Wilkerson in her 2020 book "Caste: The Origin of Our Discontents". Wilkerson argues that a caste system not only exists in the U.S. but operates as a hidden force affecting social inequality. The paper draws on Wilkerson's work to explore caste as an analytical concept. It begins by defining caste and casteism in contrast with racism, the eight pillars of a caste system, the consequences of casteism, and the psychological drivers of casteism. The paper then applies to concept of caste to understanding power, dentistry, and oral health inequality. The paper concludes by emphasizing that the concept of caste and its relationship to oral health inequality must be understood it if we want to create real social change.
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Affiliation(s)
- C Kearns
- University of California, San Francisco
| | - G Taylor
- University of California, San Francisco
| | - S Oberoi
- University of California, San Francisco
| | - E Mertz
- University of California, San Francisco
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24
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Glidden C, Howden K, Romanescu RG, Hatala A, Scott I, Deleemans JM, Chalifour K, Eaton G, Gupta AA, Bolton JM, Garland SN, Mahar AL, Oberoi S. Psychological distress and experiences of Adolescents and Young Adults with cancer during the COVID-19 pandemic: A cross-sectional survey. Psychooncology 2022; 31:631-640. [PMID: 34989053 DOI: 10.1002/pon.5849] [Citation(s) in RCA: 3] [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: 07/17/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study investigated prevalence of psychological distress, factors associated with distress, and experiences of Adolescents and Young Adults (AYAs) with cancer during the COVID-19 pandemic. It also compared distress in this group to previously surveyed Canadian AYAs with cancer in 2018 by the Young Adults with Cancer in their Prime (YACPRIME) study. METHODS A cross-sectional, online, self-administered survey of AYAs diagnosed with cancer between 15 and 39 years of age was conducted. Psychological distress was measured by the Kessler Psychological Distress Scale (K10). Associations between variables and high psychological distress (K10 ≥ 25), and comparison of prevalence of psychological distress with the YACPRIME study were done using multivariable logistic regression. Summative qualitative content analysis analyzed participant experiences during this pandemic. RESULTS We included 805 participants. High psychological distress was present in over two-thirds of the group (68.0%; 95% CI, 64.7%-71.2%). Employment impact during pandemic (AOR (adjusted odds ratio), 2.16; 95% CI, 1.41-3.31) and hematologic malignancy (AOR, 1.76; 95% CI 1.08-2.97) were associated with higher psychological distress, while older age [AOR, 0.95; 95% CI, 0.92-0.99] and personal income < $40,000 (AOR, 0.38; 95% CI, 0.24-0.58) were associated with lower distress. Adjusted odds of experiencing psychological distress among AYAs with cancer during pandemic compared to pre-pandemic years was 1.85 (95% CI: 1.36-2.53). Overarching themes of pandemic experiences included: inferior quality of life, impairment of cancer care, COVID-19 related concerns and extreme social isolation. CONCLUSION AYAs diagnosed with cancer are experiencing high psychological distress during this pandemic. Distress screening and evidence-based interventions to alleviate distress are essential.
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Affiliation(s)
- Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Razvan G Romanescu
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Hatala
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Julie M Deleemans
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St.John's, Newfoundland, Canada
| | - Abha A Gupta
- Princess Margaret Cancer Care Research Institute, Toronto, Ontario, Canada.,Department of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St.John's, Newfoundland, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology-Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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25
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Oberoi S, Lambert P, Gupta AA, Deyell RJ, Sung L, Cuvelier GDE. Diagnostic and treatment intervals are not associated with survival in rhabdomyosarcoma: A Cancer in Young People in Canada study. Pediatr Blood Cancer 2022; 69:e29306. [PMID: 34455698 DOI: 10.1002/pbc.29306] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Delay in diagnosis and treatment initiation can be associated with adverse outcomes in children with cancer. Diagnostic interval (DI) is defined as the time between the date of first health care contact for symptoms related to cancer to the date of cancer diagnosis, and treatment interval (TI) is defined as interval between the definitive cancer diagnosis and cancer treatment initiation. We aimed to determine the predictors of DI and TI in children with rhabdomyosarcoma (RMS) and their association with event-free survival (EFS) and overall survival (OS). METHODS Using the Cancer in Young People in Canada (CYP-C) national population-based database, we conducted a retrospective cohort study of children (0-14.99 years) newly diagnosed with RMS between 2001 and 2015 in Canada. Quantile regression was used to assess the predictors of DI and TI, and Cox regression was used to determine if these intervals were associated with EFS and OS. RESULTS Median DI and TI were 16.5 days (interquartile range [IQR] 6.0-38.0) and 5 days (IQR 0-12), respectively. DI and TI were not significantly associated with age at diagnosis, sex, race, tumor site, stage or histology, treatment region, distance from treatment center, income quintile or diagnosis year (all p > .05). DI and TI were not associated with EFS (DI: hazard ratio [HR] 1.00, 95% CI 0.96-1.05, p = .871; TI: HR 1.03, 95% CI 1.00-1.05, p = .053) or OS (DI: HR 0.99, 95% CI 0.94-1.05, p = .797; TI: HR 1.02, 95% CI 0.99-1.05, p = .155). CONCLUSIONS In the publicly funded Canadian health care system, DI and TI did not affect the survival of children with RMS.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca J Deyell
- Division of Hematology/Oncology/BMT, British Columbia Children's Hospital and Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey D E Cuvelier
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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26
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Gunning M, Rotenberg AD, Kelly LE, Crooks B, Oberoi S, Rapoport AL, Rassekh SR, Illes J. Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study. CMAJ Open 2022; 10:E196-E202. [PMID: 35292477 PMCID: PMC8929429 DOI: 10.9778/cmajo.20210239] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization. METHODS We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods. RESULTS We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards. INTERPRETATION Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.
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Affiliation(s)
- Margot Gunning
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Ari D Rotenberg
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Lauren E Kelly
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Bruce Crooks
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Sapna Oberoi
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Adam L Rapoport
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - S Rod Rassekh
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
| | - Judy Illes
- Neuroethics Canada (Gunning, Rotenberg, Illes), Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC; Department of Pediatrics and Child Health (Kelly), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Kelly), Winnipeg, Man.; Division of Hematology-Oncology (Crooks), Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS; Department of Pediatric Hematology-Oncology-BMT (Oberoi), CancerCare Manitoba, Winnipeg, Man.; Departments of Paediatrics and of Family and Community Medicine (Rapoport), Faculty of Medicine, University of Toronto; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; Division of Pediatric Hematology/Oncology/BMT (Rassekh), Department of Pediatrics, University of British Columbia, Vancouver, BC
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Yan AP, Howden K, Glidden C, Romanescu RG, Scott I, Deleemans JM, Chalifour K, Eaton G, Gupta AA, Bolton JM, Garland SN, Mahar AL, Oberoi S. COVID-19-Related Information Sources, Behavioral Changes, and Adherence to Social Distancing Among Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 11:352-359. [PMID: 34597190 DOI: 10.1089/jayao.2021.0126] [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: 12/23/2022] Open
Abstract
Purpose: This study aimed to assess the sources of COVID-19 information used, behavioral changes in response to the pandemic, and factors associated with adherence to social distancing guidelines among adolescents and young adults (AYAs) with cancer during the COVID-19 pandemic. Methods: We conducted a self-administered online survey of AYAs with cancer (aged 18-39 years) diagnosed between ages 15 and 39 and living in Canada during January and February 2021. Data were summarized using descriptive statistics. Multiple logistic regression was used to identify the factors associated with adherence to the social distancing guidelines. Results: In total, 805 AYAs were included. Participants were most likely to obtain COVID-19-related information from social media (60.5%), news reports (51.6%), and medical professionals (46.5%). The preferred modes of receiving information were websites of cancer organizations (47.9%), social media (44.8%), and medical professionals (40.2%). The common behavioral changes in response to the COVID-19 pandemic included wearing a protective mask (60.2%), avoiding crowded and public places (56.9%), and abiding by social distancing rules (49.4%). On multivariable analysis, participants were more likely to adhere to social distancing rules if they were women, unemployed or collecting disability/unemployment benefits, or had a personal income of <$40,000 in year 2020 (p < 0.05). Conclusion: Social media and websites of cancer organizations are the preferred modes of COVID-19 information. Since many AYAs are nonadherent to preventative health measures, cancer organizations should help develop and disseminate digital resources that provide tailored information to AYAs with cancer during this pandemic.
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Affiliation(s)
- Adam P Yan
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Razvan G Romanescu
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Julie M Deleemans
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, St. John's, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, St. John's, Canada
| | - Abha A Gupta
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Adolescent and Young Adult Program, Princess Margaret Cancer Care Research Institute, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada
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Chapman S, Protudjer J, Bourne C, Kelly LE, Oberoi S, Vanan MI. Medical cannabis in pediatric oncology: a survey of patients and caregivers. Support Care Cancer 2021; 29:6589-6594. [PMID: 33932156 DOI: 10.1007/s00520-021-06202-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are minimal data regarding the safety and efficacy of cannabis used as an anti-cancer agent or for symptom management in pediatric oncology. We aimed to characterize the prevalence and factors associated with the use of cannabis for the treatment of cancer and management of cancer-related symptoms in children during or after cancer treatment. METHODS An anonymous 40 question paper survey was offered to patients/caregivers of children with cancer attending a pediatric oncology clinic in a provincially mandated cancer agency between October 2019 and March 2020. RESULTS There were 64 respondents included in the analysis. Fourteen participants (N=14/64; 22%) reported use of cannabis, of which half used cannabis for either cancer treatment or symptom management, or both. Leukemia (n=9/14; 64%) was the most frequent diagnosis in children whose caregivers reported using cannabis and the majority of them were still receiving active cancer treatment (N= 5/9; 56%). All of the respondents using cannabis (14/14, 100%) experienced symptom improvement. Most of the caregivers procured cannabis from their friends (N=5/14; 36%), and oil was the most commonly used formulation (N=12/14; 86%). Cannabis-related information was received from another parent (N=4/14; 29%) or from a doctor (N=4/14; 29%). The reported monthly expenditure on cannabis varied widely from less than $50 CAD (N=4/14; 29%) to more than $500 CAD (N=3/14; 21%). CONCLUSIONS Our survey shows that cannabis, mostly oil products, was used by one-fifth of children with cancer during or after the completion of cancer treatment. These findings require validation in a larger nationwide survey.
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Affiliation(s)
- Stacy Chapman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Pediatric Hematology-Oncology, CancerCare Manitoba, ON-2038, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Jennifer Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Cathy Bourne
- Section of Pediatric Hematology-Oncology, CancerCare Manitoba, ON-2038, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Lauren E Kelly
- Section of Pediatric Hematology-Oncology, CancerCare Manitoba, ON-2038, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada.,The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Pediatric Hematology-Oncology, CancerCare Manitoba, ON-2038, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada
| | - Magimairajan Issai Vanan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada. .,Section of Pediatric Hematology-Oncology, CancerCare Manitoba, ON-2038, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada.
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29
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Oberoi S, Yang J, Woodgate RL, Niraula S, Banerji S, Israels SJ, Altman G, Beattie S, Rabbani R, Askin N, Gupta A, Sung L, Abou-Setta AM, Zarychanski R. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2012598. [PMID: 32766801 PMCID: PMC7414391 DOI: 10.1001/jamanetworkopen.2020.12598] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Mindfulness-based interventions (MBIs), grounded in mindfulness, focus on purposely paying attention to experiences occurring at the present moment without judgment. MBIs are increasingly used by patients with cancer for the reduction of anxiety, but it remains unclear if MBIs reduce anxiety in patients with cancer. OBJECTIVE To evaluate the association of MBIs with reductions in the severity of anxiety in patients with cancer. DATA SOURCES Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from database inception to May 2019 to identify relevant citations. STUDY SELECTION Randomized clinical trials (RCTs) that compared MBI with usual care, waitlist controls, or no intervention for the management of anxiety in cancer patients were included. Two reviewers conducted a blinded screening. Of 101 initially identified studies, 28 met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of RCTs, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Summary effect measures were reported as standardized mean differences (SMDs) and calculated using a random-effects model. MAIN OUTCOMES AND MEASURES Our primary outcome was the measure of severity of short-term anxiety (up to 1-month postintervention); secondary outcomes were the severity of medium-term (1 to ≤6 months postintervention) and long-term (>6 to 12 months postintervention) anxiety, depression, and health-related quality of life of patients and caregivers. RESULTS This meta-analysis included 28 RCTs enrolling 3053 adults with cancer. None of the trials were conducted in children. Mindfulness was associated with significant reductions in the severity of short-term anxiety (23 trials; 2339 participants; SMD, -0.51; 95% CI, -0.70 to -0.33; I2 = 76%). The association of mindfulness with short-term anxiety did not vary by evaluated patient, intervention, or study characteristics. Mindfulness was also associated with the reduction of medium-term anxiety (9 trials; 965 participants; SMD, -0.43; 95% CI, -0.68 to -0.18; I2 = 66%). No reduction in long-term anxiety was observed (2 trials; 403 participants; SMD, -0.02; 95% CI, -0.38 to 0.34; I2 = 68%). MBIs were associated with a reduction in the severity of depression in the short term (19 trials; 1874 participants; SMD, -0.73; 95% CI; -1.00 to -0.46; I2 = 86%) and the medium term (8 trials; 891 participants; SMD, -0.85; 95% CI, -1.35 to -0.35; I2 = 91%) and improved health-related quality of life in patients in the short term (9 trials; 1108 participants; SMD, 0.51; 95% CI, 0.20 to 0.82; I2 = 82%) and the medium term (5 trials; 771 participants; SMD, 0.29; 95% CI, 0.06 to 0.52; I2 = 57%). CONCLUSIONS AND RELEVANCE In this study, MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. Future trials should explore the long-term association of mindfulness with anxiety and depression in adults with cancer and determine its efficacy in more diverse cancer populations using active controls.
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Affiliation(s)
- Sapna Oberoi
- Departments of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jiayu Yang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Saroj Niraula
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Shantanu Banerji
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sara J. Israels
- Departments of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gary Altman
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sara Beattie
- Alberta Blood and Marrow Transplant Program, Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Rasheda Rabbani
- George and Fay Yee Center for Healthcare Innovation, Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abha Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ahmed M. Abou-Setta
- George and Fay Yee Center for Healthcare Innovation, Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Oberoi S, Leitao D, Stefanovici C, Del-bigio M, Higgins R, Bunge M, Serleitis D, Vanan MI. MNGI-15. RARE PRESENTATION OF EXTRACRANIAL PARAVERTEBRAL MENINGIOMA IN A CHILD WITH NEUROFIBROMATOSIS TYPE 2: A CASE REPORT. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.631] [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: 11/14/2022] Open
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Jheon AH, Oberoi S, Solem RC, Kapila S. Moving towards precision orthodontics: An evolving paradigm shift in the planning and delivery of customized orthodontic therapy. Orthod Craniofac Res 2018. [PMID: 28643930 DOI: 10.1111/ocr.12171] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Advances in precision medicine portend similar progress in orthodontics and will be increasingly harnessed to achieve customized treatment approaches and enhance treatment efficiencies. Our goal is to provide a background on emerging advances in computer technologies and biomedicine and highlight their current and likely future applications to precision orthodontics. A review of orthodontically relevant technologies and advances in pertinent biological research was undertaken. Innovations in computer hardware and software, and 3D imaging technologies offer the ability for customized treatment and biomechanical planning that will be more fully realized within the next few decades. These technologies combined with 3D printing are already being applied to customized appliance fabrication such as aligners and retainers. The future prospects for custom fabrication of orthodontic brackets of appropriate material properties and smart devices are highly desirable and compelling goals. Within biomedicine, the fundamental understanding of cartilage growth and bone biology is currently being tested in animal models to modify mandibular growth and modulate tooth movement, respectively. Some of these discoveries will ultimately have clinical applications in orthodontics including for growth modification, accelerating orthodontic tooth movement, and enhancing anchorage or retention of teeth. Additional genomic and proteomic information will add to further customization of orthodontic diagnosis and treatments. Over the coming decades, precision orthodontics will continue to benefit from advances in many fields and will require the integration of advances in technology, and biomedical and clinical research to deliver optimal, efficient, safe, and reproducible personalized orthodontic treatment.
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Affiliation(s)
- A H Jheon
- Division of Craniofacial Anomalies and Program in Craniofacial Biology, Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - S Oberoi
- Division of Craniofacial Anomalies and Program in Craniofacial Biology, Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - R C Solem
- Division of Orthodontics, Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - S Kapila
- Division of Orthodontics, Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
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Abstract
OBJECTIVES The RASopathies are a group of syndromes that have in common germline mutations in genes that encode components of the Ras/mitogen-activated protein kinase (MAPK) pathway and have been a focus of study to understand the role of this pathway in development and disease. These syndromes include Noonan syndrome (NS), Noonan syndrome with multiple lentigines (NSML or LEOPARD syndrome), neurofibromatosis type 1 (NF1), Costello syndrome (CS), cardio-facio-cutaneous (CFC) syndrome, neurofibromatosis type 1-like syndrome (NFLS or Legius syndrome) and capillary malformation-arteriovenous malformation syndrome (CM-AVM). These disorders affect multiple systems, including the craniofacial complex. Although the craniofacial features have been well described and can aid in clinical diagnosis, the dental phenotypes have not been analysed in detail for each of the RASopathies. In this review, we summarize the clinical features of the RASopathies, highlighting the reported craniofacial and dental findings. METHODS Review of the literature. RESULTS Each of the RASopathies reviewed, caused by mutations in genes that encode different proteins in the Ras pathway, have unique and overlapping craniofacial and dental characteristics. CONCLUSIONS Careful description of craniofacial and dental features of the RASopathies can provide information for dental clinicians treating these individuals and can also give insight into the role of Ras signalling in craniofacial development.
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Affiliation(s)
- H Cao
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases and Branch of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
| | - N Alrejaye
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
| | - O D Klein
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA.,Department of Pediatrics and Institute for Medical Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - A F Goodwin
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
| | - S Oberoi
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
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Tomlinson D, Robinson P, Oberoi S, Cataudella D, Culos-Reed N, Davis H, Duong N, Gibson F, Götte M, Hinds P, Nijhof S, van der Torre P, Cabral S, Dupuis L, Sung L. Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis. Curr Oncol 2018; 25:e152-e167. [PMID: 29719440 PMCID: PMC5927795 DOI: 10.3747/co.25.3883] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct). Methods For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. Results In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): -0.52; 95% confidence interval (ci): -0.89 to -0.14] and with methylphenidate (smd: -0.36; 95% ci: -0.56 to -0.15); modafinil (or armodafinil) and corticosteroids were not effective. Conclusions Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
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Affiliation(s)
- D. Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | | | - S. Oberoi
- Pediatric Oncology Group of Ontario, Toronto, ON
| | - D. Cataudella
- Department of Pediatric Psychology, Children’s Hospital, London Health Sciences Centre, London, ON
| | - N. Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB
| | - H. Davis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - N. Duong
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - F. Gibson
- Centre for Outcomes and Experiences Research in Children’s Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, and School of Health Sciences, University of Surrey, Guildford, U.K
| | - M. Götte
- University Hospital Essen, Center for Child and Adolescent Medicine, Department of Pediatric Hematology/Oncology, Essen, Germany
| | - P. Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children’s National Health System; and Department of Pediatrics, George Washington University, Washington, DC, U.S.A
| | - S.L. Nijhof
- Division of Pediatrics, Wilhelmina Children’s Hospital (part of UMC Utrecht), Utrecht, Netherlands
| | - P. van der Torre
- Division of Pediatrics, Wilhelmina Children’s Hospital (part of UMC Utrecht), Utrecht, Netherlands
| | - S. Cabral
- Pediatric Oncology Group of Ontario, Toronto, ON
| | - L.L. Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Department of Pharmacy, The Hospital for Sick Children; and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON
| | - L. Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON
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Oberoi S, Robinson PD, Cataudella D, Culos-Reed SN, Davis H, Duong N, Gibson F, Götte M, Hinds P, Nijhof SL, Tomlinson D, van der Torre P, Cabral S, Dupuis LL, Sung L. Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 2018; 122:52-59. [DOI: 10.1016/j.critrevonc.2017.12.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/02/2017] [Accepted: 12/14/2017] [Indexed: 11/25/2022] Open
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Duong N, Davis H, Robinson PD, Oberoi S, Cataudella D, Culos-Reed SN, Gibson F, Götte M, Hinds P, Nijhof SL, Tomlinson D, van der Torre P, Ladas E, Cabral S, Dupuis LL, Sung L. Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 120:210-216. [DOI: 10.1016/j.critrevonc.2017.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 01/17/2023] Open
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Oberoi S, Das A, Trehan A, Ray P, Bansal D. Can complications in febrile neutropenia be predicted? Report from a developing country. Support Care Cancer 2017; 25:3523-3528. [DOI: 10.1007/s00520-017-3776-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
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Das A, Trehan A, Oberoi S, Bansal D. Validation of risk stratification for children with febrile neutropenia in a pediatric oncology unit in India. Pediatr Blood Cancer 2017; 64. [PMID: 27860223 DOI: 10.1002/pbc.26333] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/12/2016] [Accepted: 10/07/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE The study aims to validate a score predicting risk of complications in pediatric patients with chemotherapy-related febrile neutropenia (FN) and evaluate the performance of previously published models for risk stratification. PATIENTS AND METHODS Children diagnosed with cancer and presenting with FN were evaluated in a prospective single-center study. A score predicting the risk of complications, previously derived in the unit, was validated on a prospective cohort. Performance of six predictive models published from geographically distinct settings was assessed on the same cohort. RESULTS Complications were observed in 109 (26.3%) of 414 episodes of FN over 15 months. A risk score based on undernutrition (two points), time from last chemotherapy (<7 days = two points), presence of a nonupper respiratory focus of infection (two points), C-reactive protein (>60 mg/l = five points), and absolute neutrophil count (<100 per μl = two points) was used to stratify patients into "low risk" (score <7, n = 208) and assessed using the following parameters: overall performance (Nagelkerke R2 = 34.4%), calibration (calibration slope = 0.39; P = 0.25 in Hosmer-Lemeshow test), discrimination (c-statistic = 0.81), overall sensitivity (86%), negative predictive value (93%), and clinical net benefit (0.43). Six previously published rules demonstrated inferior performance in this cohort. CONCLUSION An indigenous decision rule using five simple predefined variables was successful in identifying children at risk for complications. Prediction models derived in developed nations may not be appropriate for low-middle-income settings and need to be validated before use.
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Affiliation(s)
- Anirban Das
- Pediatric Hematology-Oncology Unit, Tata Medical Center, Kolkata, West Bengal, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sapna Oberoi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Abstract
Long-term damage to the residual kidney is of concern in the survivors of Wilms tumor. Our objective was to evaluate the long-term glomerular function and size of the residual kidney in these patients. Twenty-nine survivors of Wilms tumor diagnosed between July 1999 and June 2004 were enrolled. The glomerular function was assessed by creatinine clearance, 99mTc DTPA radionuclide scintigraphy and 24-hour urinary protein. Renal size was evaluated by ultrasonography. Median age at diagnosis and at enrollment were 2.87 ± 1.8 (range: 0.5-7.5) and 7.9 ± 3.8 years (range: 2.5-18). Median duration of follow-up was 4.78 ± 2.6 years (range: 1-8.8). Evidence of renal dysfunction in the form of either function or size was identified in eight (27.6%) children. Six children had subnormal glomerular filtration rate and one had proteinuria. Subnormal size of the residual kidney was observed in one child. Age at diagnosis, stage, and duration elapsed after nephrectomy had no association with renal dysfunction (P >.05). Long-term follow up is crucial to identify clinical nephrotoxicity among survivors of Wilms tumor.
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Affiliation(s)
- Sai Sunil Kishore
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Advanced Pediatric Centre , Chandigarh , India
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Oberoi S, Trehan A, Marwaha RK. Medication errors on oral chemotherapy in children with acute lymphoblastic leukemia in a developing country. Pediatr Blood Cancer 2014; 61:2218-22. [PMID: 25175850 DOI: 10.1002/pbc.25203] [Citation(s) in RCA: 5] [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] [Received: 04/20/2014] [Accepted: 07/07/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication errors occur universally. Inappropriate administration of chemotherapy drugs can have adverse effects in cancer patients. Our objective was to assess the rate and type of medication errors in children with acute lymphoblastic leukemia (ALL) receiving oral chemotherapy in outpatient setting. PROCEDURE Prescription and administration of oral chemotherapy drugs in children with ALL were evaluated prospectively to determine rate and type of medication errors. Errors were defined as prescription (physician) level or administration (patient) level errors. RESULTS Two hundred eighty-nine drugs were prescribed to 121 patients. Medication errors occurred in 36 (12.5%) prescriptions; 21(7.3%) were administration errors, 13 (4.5%) were prescribing errors, and two errors occurred at both levels. Mercaptopurine (6-MP) was significantly associated with higher rates of errors (Odds ratio [OR] = 2.1, 95% CI [confidence interval] 1-4.1) whereas lapses were less with dexamethasone (OR = 0.25, 95% CI 0.09-0.67). As a result of medication errors 28 (23.1%) patients received inappropriate doses. Twenty five (21%) patients received sub-optimal doses whereas three got higher doses of chemotherapy. On univariate analysis, socioeconomic status, education status of the caregiver, 6-MP and methotrexate were significantly associated with errors (P ≤ 0.05). On multivariate analysis, ≤ primary school education of the caregiver and prescription of methotrexate were independent predictors of errors. CONCLUSIONS Medication errors affected nearly one fourth of the children receiving oral chemotherapy. Future studies are needed to look at effective interventions to avoid chemotherapy associated errors especially amongst the lower strata of society.
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Affiliation(s)
- Sapna Oberoi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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Oberoi S, Zamperlini–Netto G, Beyene J, Treister NS, Sung L. Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis. PLoS One 2014; 9:e107418. [PMID: 25198431 PMCID: PMC4157876 DOI: 10.1371/journal.pone.0107418] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [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: 06/25/2014] [Accepted: 08/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Objective was to determine whether prophylactic low level laser therapy (LLLT) reduces the risk of severe mucositis as compared to placebo or no therapy. METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched until February 2014 for randomized controlled trials (RCTs) comparing prophylactic LLLT with placebo or no therapy in patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT). All analyses used random effects models. RESULTS Eighteen RCTs (1144 patients) were included. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). LLLT also reduced the following outcomes when compared to placebo/no therapy: severe mucositis at the time of anticipated maximal mucositis (RR 0.34, 95% CI 0.20 to 0.59), overall mean grade of mucositis (standardized mean difference -1.49, 95% CI -2.02 to -0.95), duration of severe mucositis (weighted mean difference -5.32, 95% CI -9.45 to -1.19) and incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37). CONCLUSION Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting.
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Affiliation(s)
- Sapna Oberoi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Joseph Beyene
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Nathaniel S. Treister
- Division of Oral Medicine & Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
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Louis D, More K, Oberoi S, Shah PS. Intravenous immunoglobulin in isoimmune haemolytic disease of newborn: an updated systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2014; 99:F325-31. [PMID: 24514437 DOI: 10.1136/archdischild-2013-304878] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIg) is used in neonates with isoimmune haemolytic disease to prevent exchange transfusion (ET). However, studies supporting IVIg had methodological issues. OBJECTIVE To update the systematic review of efficacy and safety of IVIg in neonates with isoimmune haemolytic disease. METHODS MEDLINE, Embase databases and Cochrane Central Register of Controlled Trials (Cochrane Library) were searched (from inception to May 2013) for randomised or quasi-randomised controlled trials comparing IVIg with placebo/controls in neonates with isoimmune haemolytic disease without any language restriction. Three investigators assessed methodological quality of included trials. Meta-analyses were performed using random effect model and risk ratio (RR)/risk difference (RD) and mean difference with 95% CI calculated. MAIN RESULTS Twelve studies were included, ten trials (n=463) of Rh isoimmunisation and five trials (n=350) of ABO isoimmunisation (three studies had both population). Significant variations in risk of bias precluded an overall meta-analysis of Rh isoimmunisation. Studies with high risk of bias showed that IVIg reduced the rate of ET in Rh isoimmunisation (RR 0.23, 95% CI 0.13 to 0.40), whereas studies with low risk of bias that also used prophylactic phototherapy did not show statistically significant difference (RR 0.82, 95% CI 0.53 to 1.26). For ABO isoimmunisation, only studies with high risk of bias were available and meta-analysis revealed efficacy of IVIg in reducing ET (RR 0.31, 95% CI 0.18 to 0.55). CONCLUSIONS Efficacy of IVIg is not conclusive in Rh haemolytic disease of newborn with studies with low risk of bias indicating no benefit and studies with high risk of bias suggesting benefit. Role of IVIg in ABO disease is not clear as studies that showed a benefit had high risk of bias.
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Oberoi S, Lehrnbecher T, Phillips B, Hitzler J, Ethier MC, Beyene J, Sung L. Leukapheresis and low-dose chemotherapy do not reduce early mortality in acute myeloid leukemia hyperleukocytosis: a systematic review and meta-analysis. Leuk Res 2014; 38:460-8. [PMID: 24472688 DOI: 10.1016/j.leukres.2014.01.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/02/2014] [Accepted: 01/04/2014] [Indexed: 11/25/2022]
Abstract
The role of leukapheresis and low-dose chemotherapy is unclear in decreasing early mortality in acute myeloid leukemia (AML) patients with hyperleukocytosis. This systematic review was conducted to describe early mortality (deaths during first induction) in patients with AML with an initial white blood count≥100×10(9)L(-1) stratified by the approach to leukapheresis and hydroxyurea/low-dose chemotherapy. Twenty-one studies were included. Weighted mean early deaths rate (20 studies, 1354 patients) was 20.1% (95% confidence interval 15.0-25.1). Neither leukapheresis strategy (p=0.67) nor hydroxyurea/low-dose chemotherapy (p=0.23) influenced the early death rate. Early mortality related to hyperleukocytosis in AML is not influenced by universal or selected use of leukapheresis or hydroxyurea/low-dose chemotherapy.
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Affiliation(s)
- Sapna Oberoi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Bob Phillips
- Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds, UK; Centre for Reviews and Dissemination, University of York, York, UK
| | - Johann Hitzler
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Marie-Chantal Ethier
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Joseph Beyene
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, 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.
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Abstract
A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. A systematic approach with relevant clinical history and examination along with appropriate laboratory investigations aid in reaching the diagnosis promptly. Indication and administration of blood products including fresh frozen plasma, cryoprecipitate, random donor and single donor apheresis platelets is elaborated. Management of hemophilia, Von Willebrand disease, disseminated intravascular coagulation and bleeding in cyanotic congenital heart disease, among other causes is outlined. Role of antifibrinolytic therapy, desmopressin and recombinant factor VIIa is briefly described. The review outlines the approach to a bleeding child in the emergency room. Practical points in history, examination, investigations and management are discussed. Management in resource constraint setting of developing countries is addressed.
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Affiliation(s)
- Deepak Bansal
- Hematology -Oncology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Feberwee H, Feenstra I, Oberoi S, Sama I, Ockeloen C, Clum F, Slavotinek A, Kuijpers M, Dooijes D, Kuijpers-Jagtman A, Kleefstra T, Carels C. NovelBCORmutations in patients with oculofaciocardiodental (OFCD) syndrome. Clin Genet 2013; 85:194-7. [DOI: 10.1111/cge.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/08/2013] [Accepted: 02/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - I. Feenstra
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen The Netherlands
| | | | | | - C.W. Ockeloen
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen The Netherlands
| | - F. Clum
- Department of Pediatrics; University of California; San Francisco CA USA
| | | | | | - D. Dooijes
- Department of Medical Genetics; University Medical Centre Utrecht; Utrecht The Netherlands
| | | | - T. Kleefstra
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen The Netherlands
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Abstract
Febrile neutropenia is a common emergency encountered in children receiving chemotherapy for a malignancy. Left untreated, it can lead to serious morbidity and mortality. Febrile neutropenia is suspected in any patient on chemotherapy who presents with fever. Prompt evaluation and management by the primary contact pediatrician is essential for a successful outcome. A detailed history and physical examination is warranted to identify source of infection, although two thirds of them may not have localizing symptoms or signs. Risk stratification is valuable in categorizing the severity and guiding therapy. Initial stabilization, prompt initiation of appropriate antibiotics and adequate supportive care are the cornerstone of treatment. Knowledge of the locally prevailing bacteriological profile and antimicrobial susceptibility data is crucial for each hospital/unit to frame and periodically modify guidelines for the choice of antimicrobials. Delay in initiating antimicrobials significantly worsens the outcome. Education of the family as well as the members of the treating unit is important in this regard. Pro-active steps must be taken to reduce incidence of hospital acquired sepsis. Diagnosis and management in relevance to the emergency room is reviewed and institutional practice is shared.
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Affiliation(s)
- Sapna Oberoi
- Hematology-Oncology unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Goodwin AF, Oberoi S, Landan M, Charles C, Groth J, Martinez A, Fairley C, Weiss LA, Tidyman WE, Klein OD, Rauen KA. Craniofacial and dental development in cardio-facio-cutaneous syndrome: the importance of Ras signaling homeostasis. Clin Genet 2012; 83:539-44. [PMID: 22946697 DOI: 10.1111/cge.12005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/27/2012] [Accepted: 08/27/2012] [Indexed: 01/05/2023]
Abstract
Cardio-facio-cutaneous syndrome (CFC) is a RASopathy that is characterized by craniofacial, dermatologic, gastrointestinal, ocular, cardiac, and neurologic anomalies. CFC is caused by activating mutations in the Ras/mitogen-activated protein kinase (MAPK) signaling pathway that is downstream of receptor tyrosine kinase (RTK) signaling. RTK signaling is known to play a central role in craniofacial and dental development, but to date, no studies have systematically examined individuals with CFC to define key craniofacial and dental features. To fill this critical gap in our knowledge, we evaluated the craniofacial and dental phenotype of a large cohort (n = 32) of CFC individuals who attended the 2009 and 2011 CFC International Family Conferences. We quantified common craniofacial features in CFC which include macrocephaly, bitemporal narrowing, convex facial profile, and hypoplastic supraorbital ridges. In addition, there is a characteristic dental phenotype in CFC syndrome that includes malocclusion with open bite, posterior crossbite, and a high-arched palate. This thorough evaluation of the craniofacial and dental phenotype in CFC individuals provides a step forward in our understanding of the role of RTK/MAPK signaling in human craniofacial development and will aid clinicians who treat patients with CFC.
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Affiliation(s)
- A F Goodwin
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
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Affiliation(s)
- S. Oberoi
- a Institute of Macromolecular and Textile Chemistry, Dresden University of Technology, D-01069 Dresden, Germany
| | - E. Jähne
- b Institute of Macromolecular and Textile Chemistry, Dresden University of Technology, D-01069 Dresden, Germany
| | - H.-J. Adler
- c Institute of Macromolecular and Textile Chemistry, Dresden University of Technology, D-01069 Dresden, Germany
| | - I. K. Varma
- d Indian Institute of Technology, New Delhi, 110016, India
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Affiliation(s)
- S. Oberoi
- a Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
| | - Y. Lu
- b Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
| | - G. Busch
- c Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
| | - E. Jaehne
- d Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
| | - A. Pich
- e Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
| | - H.-J. P. Adler
- f Institute of Macromolecular Chemistry and Textile Chemistry, Dresden University of Technology, D-01062 Dresden, Germany
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Oberoi S, Das R, Panigrahi I, Kaur J, Marwaha RK. Xmn1-G γ polymorphism and clinical predictors of severity of disease in β-thalassemia intermedia. Pediatr Blood Cancer 2011; 57:1025-8. [PMID: 21755589 DOI: 10.1002/pbc.23175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Accepted: 03/30/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the prevalence of Xmn1-(G)γ polymorphism in North Indian children and adolescents with β thalassemia intermedia (TI) and to correlate it with disease severity. METHODS All patients of thalassemia intermedia presenting to the pediatric hematology clinic of a tertiary care hospital in North India were enrolled. Clinical severity of their disease was assessed by a phenotypic score proposed by Phadke and Agarwal. They were classified according to status of their Xmn1-(G)γ polymorphism as Xmn1-(G)γ +/+, Xmn1-(G)γ +/-, and Xmn1-(G)γ -/- by molecular analysis. RESULTS A total of 104 patients were enrolled. Severe TI was seen in 56.7% (59) patients, while 43.3% (45) had non-severe TI. Jaundice was more frequent in severe TI than in non-severe TI. Xmn1-(G)γ +/+ was present in 25.9% (25) patients. The frequency of the Xmn1-(G)γ +/- and Xmn1-(G)γ -/- was 22% and 37.3% in severe TI children. The corresponding frequencies were 31.1% and 42.2% in non-severe TI group respectively. No significant correlation was observed between the Xmn1-(G)γ polymorphism and severity of thalassemia, age at onset of symptoms, age at diagnosis, age at first transfusion, transfusion frequency or average hemoglobin levels. HbF level was significantly higher in Xmn1-(G)γ +/+ and Xmn1-(G)γ +/- patients. CONCLUSIONS This study showed that although the prevalence of Xmn1-(G)γ polymorphism is high in β thalassemia intermedia patients, it alone could not predict clinical severity in TI patients. Further refinement and validation of clinical scoring system is necessary for guiding appropriate management.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, UT, India
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Oberoi S, Bansal D, Sharma RR, Gautam V, Marwaha N, Marwaha RK. Antithymocyte globulin-induced acute lung injury during transplantation for aplastic anemia. J Pediatr Hematol Oncol 2011; 33:150-2. [PMID: 21285902 DOI: 10.1097/mph.0b013e3182003095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 10-year-old boy with acquired, very severe aplastic anemia developed acute lung injury after the administration of equine antithymocyte globulin, during conditioning for allogenic bone marrow transplantation. Limited cases of antithymocyte globulin-induced acute lung injury have been described in adults. The respiratory worsening was sudden and required mechanical ventilation. The clinical course was complicated by sepsis with Escherichia coli, vancomycin-resistant enterococci, and Stenotrophomonas maltophilia. Implications for treatment are discussed and earlier literature is reviewed.
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Affiliation(s)
- Sapna Oberoi
- Hematology/Oncology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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