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Abdalla T, Preen DB, Pole JD, Walwyn T, Bulsara M, Ives A, Choong CS, Ohan JL. Psychiatric disorders in childhood cancer survivors: A retrospective matched cohort study of inpatient hospitalisations and community-based mental health services utilisation in Western Australia. Aust N Z J Psychiatry 2024:48674241233871. [PMID: 38404162 DOI: 10.1177/00048674241233871] [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] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We examined the impact of long-term mental health outcomes on healthcare services utilisation among childhood cancer survivors in Western Australia using linked hospitalisations and community-based mental healthcare records from 1987 to 2019. METHOD The study cohort included 2977 childhood cancer survivors diagnosed with cancer at age < 18 years in Western Australia from 1982 to 2014 and a matched non-cancer control group of 24,994 individuals. Adjusted hazard ratios of recurrent events were estimated using the Andersen-Gill model. The cumulative burden of events over time was assessed using the method of mean cumulative count. The annual percentage change in events was estimated using the negative binomial regression model. RESULTS The results showed higher community-based service contacts (rate/100 person-years: 30.2, 95% confidence interval = [29.7-30.7] vs 22.8, 95% confidence interval = [22.6-22.9]) and hospitalisations (rate/1000 person-years: 14.8, 95% confidence interval = [13.6-16.0] vs 12.7, 95% confidence interval = [12.3-13.1]) in childhood cancer survivors compared to the control group. Childhood cancer survivors had a significantly higher risk of any event (adjusted hazard ratio = 1.5, 95% confidence interval = [1.1-2.0]). The cumulative burden of events increased with time since diagnosis and across age groups. The annual percentage change for hospitalisations and service contacts significantly increased over time (p < 0.05). Substance abuse was the leading cause of hospitalisations, while mood/affective and anxiety disorders were common causes of service contacts. Risk factors associated with increased service events included cancer diagnosis at age < 5 years, leukaemia diagnosis, high socioeconomic deprivation, and an attained age of < 18 years. CONCLUSIONS The elevated utilisation of healthcare services observed among childhood cancer survivors emphasises the need for periodic assessment of psychiatric disorders, particularly in high-risk survivors, to facilitate early management and optimise healthcare resources.
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Affiliation(s)
- Tasnim Abdalla
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Jason D Pole
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Thomas Walwyn
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Max Bulsara
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Angela Ives
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Catherine S Choong
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
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Tan HEI, Lakshmanan R, Warne R, Walwyn T, Roebuck D. Neuroimaging manifestations of paediatric histiocytoses. J Med Imaging Radiat Oncol 2023. [PMID: 37964685 DOI: 10.1111/1754-9485.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Histiocytoses are rare multi-system disorders marked by abnormal histiocyte cell proliferation, affecting children with diverse clinical presentations. Classified into five groups in 2016, including Langerhans-related (L), cutaneous (C), malignant (M), Rosai-Dorfman disease (R) and haemophagocytic lymphohistiocytosis (H), newer entities such as ALK-positive histiocytosis have also emerged, heralding the era of molecular (sub)classification. Common entities include Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), Rosai-Dorfman disease (RDD) and haemophagocytic lymphohistiocytosis (HLH). This pictorial essay aids radiologists in recognising and differentiating paediatric histiocytoses based on unique neuroimaging features.
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Affiliation(s)
- Hsern Ern Ivan Tan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rahul Lakshmanan
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Thomas Walwyn
- University of Western Australia, Perth, Western Australia, Australia
- Department of Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Derek Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
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3
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Fardell JE, Wakefield CE, De Abreu Lourenco R, Signorelli C, McCarthy M, McLoone J, Osborn M, Gabriel M, Anazodo A, Alvaro F, Lockwood L, Walwyn T, Skeen J, Tillemans R, Cohn RJ. Long-term health-related quality of life in young childhood cancer survivors and their parents. Pediatr Blood Cancer 2021; 68:e29398. [PMID: 34606168 DOI: 10.1002/pbc.29398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Few studies have investigated the health-related quality of life (HRQoL) of young childhood cancer survivors and their parents. This study describes parent and child cancer survivor HRQoL compared to population norms and identifies factors influencing child and parent HRQoL. METHODS We recruited parents of survivors who were currently <16 years, and >5 years postdiagnosis. Parents reported on their child's HRQoL (Kidscreen-10), and their own HRQoL (EQ-5D-5L). Parents rated their resilience and fear of cancer recurrence and listed their child's cancer-related late effects. RESULTS One hundred eighty-two parents of survivors (mean age = 12.4 years old and 9.7 years postdiagnosis) participated. Parent-reported child HRQoL was significantly lower than population norms (48.4 vs. 50.7, p < .009). Parents most commonly reported that their child experienced sadness and loneliness (18.1%). Experiencing more late effects and receiving treatments other than surgery were associated with worse child HRQoL. Parents' average HRQoL was high (0.90) and no different to population norms. However 38.5% of parents reported HRQoL that was clinically meaningfully different from perfect health, and parents experienced more problems with anxiety/depression (43.4%) than population norms (24.7%, p < .0001). Worse child HRQoL, lower parent resilience, and higher fear of recurrence was associated with worse parent HRQoL. CONCLUSIONS Parents report that young survivors experience small but significant ongoing reductions in HRQoL. While overall mean levels of HRQoL were no different to population norms, a subset of parents reported HRQoL that was clinically meaningfully different from perfect health. Managing young survivors' late effects and improving parents' resilience through survivorship may improve HRQoL in long-term survivorship.
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Affiliation(s)
- Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
| | - Jordana McLoone
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Michael Osborn
- Paediatric Haematology/Oncology, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Liane Lockwood
- Oncology Service Group, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Thomas Walwyn
- Perth Children's Hospital, School of Paediatrics & Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Ramon Tillemans
- School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Kensington, New South Wales, Australia
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- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Crothers A, Haeusler GM, Slavin MA, Babl FE, Mechinaud F, Phillips R, Tapp H, Padhye B, Zeigler D, Clark J, Walwyn T, Super L, Alvaro F, Thursky K, De Abreu Lourenco R. Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents. EClinicalMedicine 2021; 40:101095. [PMID: 34746716 PMCID: PMC8548915 DOI: 10.1016/j.eclinm.2021.101095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The impact febrile neutropenia (FN) has on the health-related quality of life (HRQoL) of children with cancer and their families is poorly understood. We sought to characterize the course of child and parent HRQoL during and following FN episodes. METHOD Data on HRQoL were collected in the multisite Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study. Participants were enrolled between November 2016 to January 2018. The Child Health Utility (CHU9D) was used to assess HRQoL in children (N = 167 FN events) and the Assessment of Quality of Life (AQoL-8D) was used to assess HRQoL parents (N = 218 FN events) at three time points: 0-3 days, 7-days and 30-days following the onset of FN. Group-based trajectory modeling (GBTM) was used to characterize the course of HRQoL. FINDINGS For children, three distinct groups were identified: persistently low HRQoL over the 30-day course of follow-up (chronic: N = 78/167; 47%), increasing HRQoL after the onset of FN to 30 days follow-up (recovering: N = 36/167; 22%), and persistently high HRQoL at all three timepoints (resilient: N = 53/167; 32%). Applying these definitions, parents were classified into two distinct groups: chronic (N = 107/218, 49%) and resilient (N = 111/218, 51%). The child being male, having solid cancer, the presence of financial stress, and relationship difficulties between the parent and child were significant predictors of chronic group membership for both parents and children. Children classified as high-risk FN were significantly more likely to belong to the recovery group. Being female, having blood cancers and the absence of financial or relationship difficulties were predictive of both parents and children being in the resilient group. INTERPRETATION Approximately half the children and parents had chronically low HRQoL scores, which did not improve following resolution of the FN episode. The child's sex, cancer type, and presence of financial and relationship stress were predictive of chronic group membership for both parents and children. These families may benefit from increased financial and psychosocial support during anti-cancer treatment. FUNDING National Health and Medical Research Council Grant (APP1104527).
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Affiliation(s)
- Anna Crothers
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Australia
- Corresponding author.
| | - Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- The Paediatric Integrated Cancer Service, Parkville, Australia
- Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Australia
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Emergency Medicine, Royal Children's Hospital, Parkville, Australia
| | - Francoise Mechinaud
- Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, France
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK
| | - Heather Tapp
- Department of Oncology, Women's and Children's Hospital, Adelaide, Australia
| | - Bhavna Padhye
- Cancer Centre for Children, Westmead Children's Hospital, Sydney, Australia
| | - David Zeigler
- Kid's Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Julia Clark
- Infection Management Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Thomas Walwyn
- Department of Oncology, Perth Children's Hospital, Perth, Australia
| | - Leanne Super
- Children's Cancer Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Frank Alvaro
- Children's Cancer Department, John Hunter Children's Hospital, University of Newcastle, Newcastle, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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McLoone J, Wakefield CE, Sansom-Daly UM, Thornton-Benko E, Govender D, Gabriel M, Walwyn T, Signorelli C, Johnston K, Cohn RJ. The lived experience of children and adolescents with cancer. Aust J Gen Pract 2021; 50:545-549. [PMID: 34333569 DOI: 10.31128/ajgp-04-21-5945] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The lived experience of children and adolescents diagnosed with cancer differs greatly from that of the adult cancer patient. A diagnosis of cancer disrupts almost every developmental life stage and continues to affect the child, and potentially their whole family, throughout adulthood. OBJECTIVE While it is important to recognise the potential for post-traumatic growth, a considerable proportion of children and adolescents will experience poorer psychological, social, educational and quality-of-life outcomes. Parents, particularly mothers, have been shown to experience levels of post-traumatic distress even greater than that of survivors. As such, there exists a critical need to provide family-centred support from diagnosis through to long-term survivorship or bereavement. DISCUSSION Ongoing surveillance, proactive management of chronic health conditions, and health behaviour education are critical to survivors' lifelong wellbeing and can be facilitated locally by general practitioners with support from tertiary healthcare teams in a shared-care arrangement.
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Affiliation(s)
- Jordana McLoone
- PhD, Lecturer, School of Women@s and Children@s Health, University of New South Wales, Sydney, NSW; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Claire E Wakefield
- PhD, Professor, School of Women@s and Children@s Health, University of New South Wales, Sydney, NSW; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Ursula M Sansom-Daly
- BPsych (Hons), MPsychol (Clin), PhD, Senior Research Fellow, School of Women@s and Children@s Health, UNSW Medicine, University of New South Wales, Randwick, NSW; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children@s Hospital, Sydney, NSW; Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW
| | - Elysia Thornton-Benko
- BSc, MBBS (Hons), PhD, FRACGP, Specialist General Practitioner, Sydney, NSW; Research Fellow, Behavioural Sciences Unit, Faculty of Medicine, University of New South Wales, Sydney, NSW; Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Dinisha Govender
- MBChB, FRACP, Staff Specialist, Children@s Hospital at Westmead, Westmead, NSW
| | - Melissa Gabriel
- MBBS, FRACP, Head, Oncology Survivorship Clinic, Caner Centre for Children, Children@s Hospital at Westmead, Westmead, NSW
| | - Thomas Walwyn
- MBBS, DRCOG, MRCPCH, FRACP, Paediatric @ Adolescent Oncologist, Perth Children@s Hospital, Nedlands, WA
| | - Christina Signorelli
- PhD, Post-doctoral Fellow,, School of Women@s and Children@s Health, University of New South Wales, Sydney, NSW; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Karen Johnston
- RN, Clinical Nurse Consultant, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW
| | - Richard J Cohn
- MBBCh, DCH, FRACP, Paediatric Haematologist Oncologist, Director of Survivorship Program, Kids Cancer Centre, Sydney Children@s Hospital, Randwick, NSW; Professor, School of Women@s and Children@s Health, University of New South Wales, Sydney, NSW
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7
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Ng CH, Walwyn T, Gibson C, Gottardo N. Rare case of spontaneous simultaneous extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum and pneumorrhachis. Arch Dis Child 2021; 106:547. [PMID: 32518137 DOI: 10.1136/archdischild-2020-319189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Chia Huan Ng
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Thomas Walwyn
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Craig Gibson
- Department of Radiology and Diagnostic Imaging, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Nicholas Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Brain Tumour Research Programme, Telethon Kids Institute, Nedlands, Western Australia, Australia
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8
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Lapirow D, La Gerche A, Toro C, Masango E, Costello B, Porello E, Ludlow L, Marshall G, Trahair T, Mateos M, Lewin J, Byrne J, Boutros R, Manudhane R, Heath J, Ayer J, Gabriel M, Walwyn T, Saundankar J, Forsey J, Le H, Mason K, Celermajer D, Downie P, Walker R, Holland L, Martin M, McLeman L, Diamond Y, Marcocci M, Donath S, Cheung M, Elliott DA, Conyers R. The Australia and New Zealand Cardio-Oncology Registry: evaluation of chemotherapy-related cardiotoxicity in a national cohort of paediatric cancer patients. Intern Med J 2021; 51:229-234. [PMID: 31841257 DOI: 10.1111/imj.14719] [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: 09/25/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Cancer therapy related cardiac dysfunction (CTRCD) is an area of increasing focus, particularly during the survivorship period, for paediatric, adolescent and adult cancer survivors. With the advent of immunotherapy and targeted therapy, there is a new set of mechanisms from which paediatric and young adult patients with cancer may suffer cardiovascular injury. Furthermore, cardiovascular disease is the leading cause of morbidity and mortality in the survivorship period. The recently established Australian Cardio-Oncology Registry is the largest and only population-based cardiotoxicity database of paediatric and adolescent and young adult oncology patients in the world, and the first paediatric registry that will document cardiotoxicity caused by chemotherapy and novel targeted therapies using a prospective approach. The database is designed for comprehensive data collection and evaluation of the Australian practice in terms of diagnosis and management of CTRCD. Using the Australian Cardio-Oncology Registry critical clinical information will be collected regarding predisposing factors for the development of CTRCD, the rate of subclinical left ventricular dysfunction and transition to overt heart failure, further research into protectant molecules against cardiac dysfunction and aid in the discovery of which genetic variants predispose to CTRCD. A health economic arm of the study will assess the cost/benefit of both the registry and cardio-oncology clinical implementation. Finally, an imaging arm will establish if exercise cardiac magnetic resonance imaging and VO2 max testing is a more sensitive predictor of cardiac reserve in paediatric and adolescent and young adult oncology patients exposed to cardiac toxic therapies.
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Affiliation(s)
- Daniel Lapirow
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Cardiac Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Claudia Toro
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emma Masango
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ben Costello
- Cardiac Imaging Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Enzo Porello
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Physiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Ludlow
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Glenn Marshall
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia
| | - Toby Trahair
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia
| | - Marion Mateos
- Department of Pathology, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jeremy Lewin
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jennifer Byrne
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rose Boutros
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rebecca Manudhane
- The Michael Rice Centre, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - John Heath
- Paediatric Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Julian Ayer
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Thomas Walwyn
- Oncology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jelena Saundankar
- Oncology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jonathon Forsey
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ha Le
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Kylie Mason
- OnTrac@Petermac, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Clinical Haematology and Bone Marrow Transplant Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Celermajer
- Cardiology Department, The Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Downie
- Children's Cancer Centre, Monash Health, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Roderick Walker
- Oncology Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lucy Holland
- Oncology Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Michelle Martin
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lorna McLeman
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yonatan Diamond
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Marcocci
- Chair, My Room Children's Cancer Charity, Melbourne, Victoria, Australia
| | - Susan Donath
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David A Elliott
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Conyers
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
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9
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Haeusler GM, De Abreu Lourenco R, Clark H, Thursky KA, Slavin MA, Babl FE, Mechinaud F, Alvaro F, Clark J, Padhye B, Phillips M, Super L, Tapp H, Walwyn T, Ziegler D, Phillips R, Worth LJ. Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia. J Pediatric Infect Dis Soc 2021; 10:125-130. [PMID: 32267508 DOI: 10.1093/jpids/piaa029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/26/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. METHODS Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. RESULTS A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. CONCLUSIONS In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Paediatric Integrated Cancer Service, Victoria State Government, Melbourne, Australia.,Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Hannah Clark
- Paediatric Integrated Cancer Service, Victoria State Government, Melbourne, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,NHMRC, National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Victorian Infectious Diseases Service, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Victorian Infectious Diseases Service, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Francoise Mechinaud
- Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France
| | - Frank Alvaro
- Children's Cancer Department, John Hunter Children's Hospital, University of Newcastle, Newcastle, Australia
| | - Julia Clark
- Infection Management Service, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Bhavna Padhye
- Kid's Cancer Centre, Westmead Children's Hospital, Sydney, Australia
| | | | - Leanne Super
- Children's Cancer Centre, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Heather Tapp
- Department of Oncology, Women's and Children's Hospital, Adelaide, Australia
| | - Thomas Walwyn
- Department of Oncology, Perth Children's Hospital, Perth, Australia
| | - David Ziegler
- Kid's Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Leon J Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Health and Medical Research Council, National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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10
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Burns MA, Fardell JE, Wakefield CE, Cohn RJ, Marshall GM, Lum A, Ellis SJ, Donnan B, Walwyn T, Carter A, Barton B, Lah S. School and educational support programmes for paediatric oncology patients and survivors: A systematic review of evidence and recommendations for future research and practice. Psychooncology 2021; 30:431-443. [PMID: 33403751 DOI: 10.1002/pon.5606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/05/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The Psychosocial Standards of Care (PSSC) in paediatric oncology prescribe the minimum standards for education support. It is unknown, however, if published education support programmes for children with cancer meet the PSSC standards for education support. Successful implementation of standards for education support is challenging but may be achieved with guidance. We aimed to (1) review education support programmes for childhood cancer patients and survivors against the PSSC standards and (2) provide practical recommendations for future research and implementation of education support programmes. METHODS We searched PsycINFO, PubMed, CINAHL, EMBASE, and Educational Resources Information and Center databases. We reviewed the education support programmes using five evaluation criteria derived from the PSSC and summarised the structure of identified programmes. We examined the features and limitations of programmes that met all evaluation criteria. RESULTS We identified 20 education support programmes in paediatric oncology, including peer programmes (n = 3), teacher programmes (n = 5), and school re-entry programmes (SRPs n = 12). We found that three SRPs met all evaluation criteria and that SRP components were timed according to the child's position on the cancer trajectory (e.g., diagnosis and treatment, school re-entry, and follow up throughout schooling). The supporting evidence of the programmes, however, is unclear due to the lack of adequately designed studies. CONCLUSIONS SRPs provide a promising structure for future education support programmes. We recommend strategies for developing and evaluating education support that adheres to the PSSC and adapts to international and local contexts.
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Affiliation(s)
- Mary A Burns
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Glenn M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alistair Lum
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sarah J Ellis
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Barb Donnan
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Thomas Walwyn
- Paediatric and Adolescent Clinical Haematology and Oncology, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Amanda Carter
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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11
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Vetsch J, Wakefield CE, Tucker KM, McCarthy M, Signorelli C, Walwyn T, Alvaro F, Cohn RJ. Genetics-related service and information needs of childhood cancer survivors and parents: a mixed-methods study. Eur J Hum Genet 2020; 28:6-16. [PMID: 31363185 PMCID: PMC6906423 DOI: 10.1038/s41431-019-0481-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/11/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 01/12/2023] Open
Abstract
Genetics in paediatric oncology is becoming increasingly important in diagnostics, treatment and follow-up care. Genetic testing may offer a possibility to stratify survivors follow-up care. However, survivors' and parents' preferences and needs for genetics-related services are largely unknown. This mixed-methods study assessed genetics-related information and service needs of survivors and parents. Six hundred and twenty-two participants (404 survivors: mean age: 26.27 years; 218 parents of survivors: mean age of child: 13.05 years) completed questionnaires. Eighty-seven participants (52 survivors; 35 parents) also completed in-depth telephone interviews. We analysed data using multivariable logistic regression and qualitative thematic analyses. Thirty-six of 50 families who were offered cancer-related genetic testing chose to undergo testing. Of those not offered testing, 11% of survivors and 7.6% of parents indicated that they believed it was 'likely/very likely' that the survivor had inherited a gene fault. Twenty-nine percent of survivors and 36% of parents endorsed access to a genetics specialist as important in their care. Survivors (40.9%) and parents (43.7%) indicated an unmet need for information about genetics and childhood cancer. Parents indicated a higher unmet need for information related to the survivors' future offspring than survivors (p < 0.001). Many survivors and parents have unmet needs for genetics-related services and information. Greater access to services and information might allow survivors at high risk for late effects to detect and prevent side effects early and improve medical outcomes. Addressing families' needs and preferences during survivorship may increase satisfaction with survivorship care.
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Affiliation(s)
- Janine Vetsch
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia.
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
- Prince of Wales Clinical School, UNSW Sydney, Melbourne, Australia
| | - Maria McCarthy
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Christina Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Thomas Walwyn
- Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Paediatrics & Child Health, University of Western Australia, Melbourne, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Melbourne, Australia
- University of Newcastle, Melbourne, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
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12
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Ellis SJ, Fardell JE, Wakefield CE, Schilstra CE, Burns MA, Donnan B, Walwyn T, Lum A, Marshall G, Carter A, Barton B, Cohn RJ. Are we meeting the training needs of healthcare and education professionals supporting children with cancer in their return to school? Pediatr Blood Cancer 2019; 66:e27575. [PMID: 30537149 DOI: 10.1002/pbc.27575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Sarah J Ellis
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Clarissa E Schilstra
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Mary A Burns
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Barb Donnan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Thomas Walwyn
- Paediatric and Adolescent Clinical Haematology and Oncology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Alistair Lum
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Glenn Marshall
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Amanda Carter
- Children's Health Queensland Hospital and Health Service, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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13
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Clemens E, van den Heuvel-Eibrink MM, Mulder RL, Kremer LCM, Hudson MM, Skinner R, Constine LS, Bass JK, Kuehni CE, Langer T, van Dalen EC, Bardi E, Bonne NX, Brock PR, Brooks B, Carleton B, Caron E, Chang KW, Johnston K, Knight K, Nathan PC, Orgel E, Prasad PK, Rottenberg J, Scheinemann K, de Vries ACH, Walwyn T, Weiss A, Am Zehnhoff-Dinnesen A, Cohn RJ, Landier W. Recommendations for ototoxicity surveillance for childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCare Consortium. Lancet Oncol 2019; 20:e29-e41. [PMID: 30614474 PMCID: PMC7549756 DOI: 10.1016/s1470-2045(18)30858-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 01/26/2023]
Abstract
Childhood, adolescent, and young adult (CAYA) cancer survivors treated with platinum-based drugs, head or brain radiotherapy, or both have an increased risk of ototoxicity (hearing loss, tinnitus, or both). To ensure optimal care and reduce consequent problems-such as speech and language, social-emotional development, and learning difficulties-for these CAYA cancer survivors, clinical practice guidelines for monitoring ototoxicity are essential. The implementation of surveillance across clinical settings is hindered by differences in definitions of hearing loss, recommendations for surveillance modalities, and remediation. To address these deficiencies, the International Guideline Harmonization Group organised an international multidisciplinary panel, including 32 experts from ten countries, to evaluate the quality of evidence for ototoxicity following platinum-based chemotherapy and head or brain radiotherapy, and formulate and harmonise ototoxicity surveillance recommendations for CAYA cancer survivors.
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Affiliation(s)
- Eva Clemens
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Pediatric and Adolescent Hematology/Oncology and Children's Hematopoietic Stem Cell Transplant Unit, Great North Children's Hospital and Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, New York, NY, USA
| | - Johnnie K Bass
- Rehabilitation Services, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Pediatrics, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Thorsten Langer
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, Lübeck, Germany
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Edith Bardi
- Department of Pediatrics and Adolescent Medicine, Kepler Universitätsklinikum, Linz, Austria
| | | | - Penelope R Brock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Beth Brooks
- Rehabilitation Services, St Jude Children's Research Hospital, Memphis, TN, USA; Audiology and Speech Pathology Department, British Columbia's Children's Hospital, Vancouver, BC, Canada; School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bruce Carleton
- Pharmaceutical Outcomes Programme, British Columbia's Children's Hospital, Vancouver, BC, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Caron
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kay W Chang
- Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Karen Johnston
- Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, Australia
| | - Kristin Knight
- Department of Pediatric Audiology, Child Development and Rehabilitation Center, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
| | - Paul C Nathan
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Etan Orgel
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pinki K Prasad
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Division of Pediatric Hematology/Oncology, Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Jan Rottenberg
- Department of Otolaryngology and Head and Neck Surgery, St Ann's University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Katrin Scheinemann
- Division of Pediatric Hematology/Oncology, Hospital for Children and Adolescents, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Pediatric Hematology/Oncology, University for Children's Hospital Basel, Basel, Switzerland; Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Thomas Walwyn
- Department of Pediatric and Adolescent Oncology, Perth Children's Hospital, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Annette Weiss
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Antoinette Am Zehnhoff-Dinnesen
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, Westphalian Wilhelm University of Münster, Münster, Germany
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW, Australia
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, AL, USA.
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14
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Zhukova N, Rajagopal R, Lam A, Coleman L, Shipman P, Walwyn T, Williams M, Sullivan M, Campbell M, Bhatia K, Gottardo NG, Hansford JR. Use of bevacizumab as a single agent or in adjunct with traditional chemotherapy regimens in children with unresectable or progressive low-grade glioma. Cancer Med 2018; 8:40-50. [PMID: 30569607 PMCID: PMC6346232 DOI: 10.1002/cam4.1799] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 01/01/2023] Open
Abstract
In pediatric low‐grade gliomas not amenable to complete resection, various chemotherapy regimens are the mainstream of treatment. An excellent overall survival of these patients makes justification of the intensification of chemotherapy difficult and calls for the development of new strategies. Bevacizumab, a humanized monoclonal antibody directed against Vascular endothelial growth factor (VEGF), has been successfully used in combination with irinotecan in a number of adult and pediatric studies and reports. Fifteen patients at median age of 7 years old (range 3 months to 15 years) were treated with bevacizumab in combination with conventional low‐toxicity chemotherapy. The majority had chiasmatic/hypothalamic and midline tumors, seven had confirmed BRAF pathway alterations including neurofibromatosis type 1 (2). Fourteen patients had more than one progression and three had radiotherapy. No deaths were documented, PFS at 11 and 15 months was 71.5% ± 13.9% and 44.7% ± 17.6% respectively. At the end of follow‐up 40% of patients has radiologically stable disease, three patients progressed shortly after completion of bevacizumab and two showed mixed response with progression of cystic component. Rapid visual improvement was seen in 6/8 patients, resolution of endocrine symptoms in 2/4 and motor function improvement in 4/6. No relation between histology or BRAF status and treatment response was observed. Treatment‐limiting toxicities included grade 4 proteinuria (2) and hypertension (2) managed with cessation (1) and pausing of therapy plus antihypertensives (1). In conclusion, bevacizumab is well tolerated and appears most effective for rapid tumor control to preserve vision and improve morbidity.
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Affiliation(s)
- Nataliya Zhukova
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Revathi Rajagopal
- Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Perth, West Australia, Australia.,Department of Pediatrics, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Adrienne Lam
- Department of Radiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lee Coleman
- Department of Radiology, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter Shipman
- Department of Radiology, Perth Children's Hospital, Perth, West Australia, Australia
| | - Thomas Walwyn
- Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Perth, West Australia, Australia
| | - Molly Williams
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Sullivan
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Martin Campbell
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kanika Bhatia
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas G Gottardo
- Department of Pediatric and Adolescent Clinical Hematology and Oncology, Perth Children's Hospital, Perth, West Australia, Australia
| | - Jordan R Hansford
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Dholaria HG, Davies A, Kotecha RS, Gottardo NG, Walwyn T. Comment on: Comparison of hypersensitivity rates to intravenous and intramuscular PEG-asparaginase in children with acute lymphoblastic leukemia: A meta-analysis and systematic review. Pediatr Blood Cancer 2018; 65:e27065. [PMID: 29630778 DOI: 10.1002/pbc.27065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Hetal G Dholaria
- Department of Paediatric Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Amy Davies
- Department of Paediatric Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Australia
| | - Rishi S Kotecha
- Department of Paediatric Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Nicholas G Gottardo
- Department of Paediatric Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Thomas Walwyn
- Department of Paediatric Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
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Wakefield CE, Quinn VF, Fardell JE, Signorelli C, Tucker KM, Patenaude AF, Malkin D, Walwyn T, Alvaro F, Cohn RJ. Family history-taking practices and genetic confidence in primary and tertiary care providers for childhood cancer survivors. Pediatr Blood Cancer 2018; 65. [PMID: 29286558 DOI: 10.1002/pbc.26923] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is growing impetus for increased genetic screening in childhood cancer survivors. Family history-taking is a critical first step in determining survivors' suitability. However, the family history-taking practices of providers of pediatric oncology survivorship care and the confidence of these providers to discuss cancer risks to relatives are unknown. PROCEDURE Fifty-four providers completed semistructured interviews in total, which included eight tertiary providers representing nine hospitals across two countries (63% male, 63% oncologists, 37% nurses) and 46 primary care providers (PCPs) nominated by a survivor (59% male, 35% regional practice). We used content analysis and descriptive statistics/regression to analyze the data. RESULTS Few tertiary (38%) or primary (35%) providers regularly collected survivors' family histories, often relying on survivors/parents to initiate discussions. Providers mostly took two-generation pedigrees (63% tertiary and 81% primary). Primary providers focused on adult cancers. Lack of time, alternative priorities, and perceived lack of relevance were common barriers. Half of all tertiary providers felt moderately comfortable discussing genetic cancer risk to children of survivors (88% felt similarly discussing risks to other relatives). Most primary providers lacked confidence: 41% felt confident regarding risks to survivors' children and 48% regarding risks to other relatives. CONCLUSIONS While family history-taking will not identify all survivors suitable for genetics assessment, recommendations for regular history-taking are not being implemented in tertiary or primary care. Additional PCP-targeted genetic education is warranted given that they are well placed to review family histories of pediatric cancer survivors.
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Affiliation(s)
- Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Veronica F Quinn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christina Signorelli
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Malkin
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Departments of Pediatrics and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Walwyn
- Department of Paediatric and Adolescent Oncology, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
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Vetsch J, Fardell JE, Wakefield CE, Signorelli C, Michel G, McLoone JK, Walwyn T, Tapp H, Truscott J, Cohn RJ. "Forewarned and forearmed": Long-term childhood cancer survivors' and parents' information needs and implications for survivorship models of care. Patient Educ Couns 2017; 100:355-363. [PMID: 27693083 DOI: 10.1016/j.pec.2016.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/02/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This mixed-method study assessed 1) survivors' and parents' information needs; and 2) associations between unmet information needs and clinical and socio-demographic characteristics. METHODS Stage 1: CCS and parents of CCS, >5years post-diagnosis completed a questionnaire on information needs, overall health and perceived risk. Predictors for unmet information needs were assessed by multivariable regression. Stage 2: participants were interviewed in-depth on these topics. RESULTS Questionnaires were completed by 485 participants comprising 322 survivors (mean age: 26.7years, SD=7.9; time since diagnosis: 19.7years, SD=8.8) and 163 parents (child age: 12.9years, SD=2.4; time since diagnosis: 9.7years, SD=2.3), and complemented by 70 interviews. Survivors reported unmet information needs about late effects (57.5%) and parents for fertility issues (62.5%). Survivors had more unmet needs for medical information whereas parents had significantly more regarding sexual issues and lifestyle. Being a parent (p=0.001), dissatisfaction with follow-up care (p=0.003), lower overall health (p=0.014), higher perceived risk of late effects (p<0.001), and greater anxiety/depression (p<0.001) were significantly associated with more unmet needs. CONCLUSION Unmet information needs were common for survivors and parents of CCS. PRACTICE IMPLICATIONS Future efforts towards tailoring information on potential late effects, healthy lifestyles and follow-up care may help to address unmet information needs.
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Affiliation(s)
- Janine Vetsch
- University of Lucerne, Department of Health Sciences and Health Policy, Lucerne, Switzerland; Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Joanna E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Gisela Michel
- University of Lucerne, Department of Health Sciences and Health Policy, Lucerne, Switzerland
| | - Jordana K McLoone
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
| | - Thomas Walwyn
- Department of Oncology and Haematology, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Heather Tapp
- Department of Clinical Haematology/Oncology, Women's and Children's Hospital, Adelaide, Australia
| | - Jo Truscott
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, NSW, 2031, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia
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Nettelbeck T, Robson L, Walwyn T, Downing A, Jones N. Inspection time as mental speed in mildly mentally retarded adults: analysis of eye gaze, eye movement, and orientation. Am J Ment Defic 1986; 91:78-91. [PMID: 3740119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The effect of eye movements away from a target on accuracy of visual discrimination was examined. In Experiment I inspection time was measured for 10 mildly mentally retarded and 10 nonretarded adults under two conditions, with each trial initiated by the subject or under experimental control. Retarded subjects did not gain any advantage from controlling trial onset. Video records of eye movements revealed that retarded subjects glanced off-target more than did nonretarded controls, but this was not sufficient to explain appreciably slower inspection time of the retarded group. Experiment 2 supported this conclusion; the same subjects completed a letter-discrimination task with direction of gaze monitored automatically. Although retarded subjects' eye gaze was more scattered early during a trial, gaze was appropriately directed by the time that the target appeared. Results from both experiments supported the hypothesis that speed of central, perceptual processing is slower among retarded persons, over and above the influence of distractibility. Results from three experiments in Part II were consistent with this interpretation. Experiment 3 was designed to eradicate trials among retarded subjects in which gaze was not properly directed, but results showed that too few such events occurred to influence accuracy. Experiment 4 demonstrated that the preparatory procedure in the previous studies resulted in efficient eye gaze among retarded subjects. Experiment 5 confirmed that lower discriminative accuracy among 10 retarded adults (compared with 10 nonretarded controls) was not due to less-efficient orientation prior to discrimination.
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