1
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Wright ML, Theroux CI, Olsavsky AL, DaJusta D, McCracken KA, Hansen-Moore J, Yeager ND, Whiteside S, Audino AN, Nahata L. The impact of hiring a full-time fertility navigator on fertility-related care and fertility preservation at a pediatric institution. Pediatr Blood Cancer 2022; 69:e29857. [PMID: 35732078 DOI: 10.1002/pbc.29857] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/07/2022]
Abstract
Fertility navigators (FNs) are important in communicating infertility risk and fertility preservation (FP) options to patients receiving gonadotoxic therapies. This retrospective study examined electronic medical records of patients with fertility consults at a large pediatric institution (2017-2019), before and after hiring a full-time FN. Of 738 patient encounters, 173 consults were performed pre-navigator and 565 post-navigator. Fertility consults for long-term follow-up cancer survivors increased most substantially: pre-navigator (n = 7) and post-navigator (n = 387). Across diagnoses, females had a larger increase in consults compared to males (χ2 [3, N = 738] = 8.17, p < .05). Findings highlight FNs' impact on counseling rates, particularly in survivorship.
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Affiliation(s)
- Mariah L Wright
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Charleen I Theroux
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Anna L Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Daniel DaJusta
- Department of Urology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kate A McCracken
- Division of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, USA
| | - Jennifer Hansen-Moore
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas D Yeager
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stacy Whiteside
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Anthony N Audino
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
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2
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Baliga S, Matsui J, Klamer B, Cetnar A, Ewing A, Cadieux C, Gupta A, Setty BA, Roberts RD, Olshefski RS, Cripe TP, Scharschmidt TJ, Aldrink J, Mardis E, Yeager ND, Palmer JD. Clinical outcomes and efficacy of stereotactic body radiation therapy in children, adolescents, and young adults with metastatic solid tumors. Br J Radiol 2022; 95:20211088. [PMID: 35073182 PMCID: PMC10993982 DOI: 10.1259/bjr.20211088] [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: 09/28/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study is to report disease outcomes and toxicity with the use of stereotactic body radiation therapy (SBRT) in the treatment of pediatric metastatic disease. METHODS All pediatric and adolescent young adult (AYA) patients' who received SBRT were included between the years 2000 and 2020. Study endpoints included local control (LC), progression-free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The end points with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk. RESULTS 16 patients with 36 lesions irradiated met inclusion criteria and formed the study cohort. The median OS and PFS for the entire cohort were 17 months and 15.7 months, respectively. The 1 year OS for the entire cohort was 75%. The 6- and 12 month local control was 85 and 78%, respectively. There were no local failures in irradiated lesions for patients who received a BED10≥100 Gy. Patients who were treated with SBRT who had ≤5 metastatic lesions at first recurrence had a superior 1 year OS of 100 vs 50% for those with >5 lesions. One patient (6.3%) experienced a Grade 3 central nervous system toxicity. CONCLUSION LC was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10≥100 Gy. High-grade toxicity was rare in our patient population. Patients with five or fewer metastatic sites have a significantly better OS compared to >5 sites. ADVANCES IN KNOWLEDGE This study demonstrates that SBRT is safe and efficacious in the treatment of pediatric oligometastatic disease.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Jennifer Matsui
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Brett Klamer
- Department of Biomedical Informatics, College of Medicine at
the Ohio State University, Columbus,
OH, USA
| | - Ashley Cetnar
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Ashlee Ewing
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Catherine Cadieux
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Ajay Gupta
- Division of Hematology/Oncology, Roswell Park Comprehensive
Cancer Center, Buffalo, NY,
USA
| | - Bhuvana A Setty
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Ryan D Roberts
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Randal S Olshefski
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Timothy P Cripe
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Thomas J Scharschmidt
- Division of Pediatric Orthopedic Oncology, Department of
Surgery, Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Department of Surgery,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Elaine Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Nicholas D Yeager
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Joshua David Palmer
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
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3
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Biederman LE, Lee K, Yeager ND, Sribnick EA, Shenoy A. CIC::NUTM1 Sarcoma Mimicking Primitive Myxoid Mesenchymal Tumor of Infancy: report of a case. Histopathology 2022; 81:131-133. [PMID: 35191536 DOI: 10.1111/his.14630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kristy Lee
- Nationwide Children's Hospital, The Institute for Genomic Medicine
| | - Nicholas D Yeager
- Nationwide Children's Hospital Department of Hematology and Oncology
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4
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Runco DV, Stanek JR, Yeager ND, Belsky JA. Malnutrition identification and management variability: An administrative database study of children with solid tumors. JPEN J Parenter Enteral Nutr 2022; 46:1559-1567. [PMID: 35040171 PMCID: PMC9544103 DOI: 10.1002/jpen.2329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
Background Malnutrition during cancer treatment increases treatment‐related morbidity and mortality. Our study better characterizes variability in malnutrition identification and treatment by examining nutrition‐related diagnoses and support for children with central nervous system (CNS) and non‐CNS solid tumors during therapy. We examined diagnosis of malnutrition, use of tube feeding or parenteral nutrition (PN), and appetite stimulants. Methods We retrospectively reviewed 0 to 21‐year‐old patients in the Pediatric Health Information System from 2015 to 2019. Patients were classified as having (1) billed malnutrition diagnosis, (2) malnutrition diagnosis or using PN and enteral nutrition (“functional malnutrition”), and (3) any previous criteria or prescribed appetite stimulants (“possible malnutrition”), as well as associated risk factors. Results Among 13,375 unique patients, CNS tumors were most common (24.4%). Overall, 26.5% of patients had malnutrition diagnoses, 45.4% met functional malnutrition criteria, and 56.0% had possible malnutrition. Patients with adrenal tumors had highest billed, functional, and possible malnutrition (36.6%, 64.1%, and 69.4%, respectively) followed by CNS tumors (29.1%, 52.4%, and 64.1%). Patients with adrenal tumors had highest rates of PN use (47.4%) and those with CNS tumors had the highest tube feeding use (26.8%). Hospital admissions with malnutrition had a longer hospital length of stay (LOS) (6 vs 3 days, P < 0.0001), more emergency department admissions (24.4% vs 21.8%, P < 0.0001), and more opioid use (58.6% vs 41.4%, P < 0.0001). Conclusions Variability in malnutrition diagnoses hinders clinical care and nutrition research in pediatric oncology. Improving disease‐specific recognition and treatment of malnutrition can target nutrition support, ensure appropriate reimbursement, and potentially improve outcomes for children with solid tumors.
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Affiliation(s)
- Daniel V Runco
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology
| | - Joseph R Stanek
- Division of Pediatric Hematology/Oncology/Bone and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH.,Biostatistics Resource at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D Yeager
- Division of Pediatric Hematology/Oncology/Bone and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Jennifer A Belsky
- Indiana University School of Medicine, Department of Pediatrics, Division of Pediatric Hematology/Oncology
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5
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Gupta A, Liu H, Schieffer KM, Koo SC, Cottrell CE, Mardis ER, Roberts RD, Yeager ND. Targeted Therapy in a Young Adult With a Novel Epithelioid Tumor Driven by a PRRC2B-ALK Fusion. J Natl Compr Canc Netw 2021; 19:1116-1121. [PMID: 34666310 DOI: 10.6004/jnccn.2021.7056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
This case report describes an 18-year-old woman with an unusual epithelioid tumor of the omentum with a novel PRRC2B-ALK fusion. Although the atypical pathologic features raised significant diagnostic challenges, expression of CD30 on tumor cells and detection of an ALK rearrangement provided critical information for selecting targeted therapy in a patient not suitable for surgical resection. Despite an initially promising therapeutic response, the patient died. The efficacy of treatment was confirmed by the lack of viable tumor cells at autopsy. This case highlights the role of timely targeted therapy in patients with rare tumors and novel actionable molecular targets.
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Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Institute, and.,Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Huifei Liu
- Department of Pathology and Laboratory Medicine, and
| | - Kathleen M Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Selene C Koo
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine E Cottrell
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Pediatrics, and.,Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Pediatrics, and.,Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio; and
| | - Ryan D Roberts
- Department of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Nicholas D Yeager
- Department of Hematology/Oncology/BMT, Division of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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6
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Nahata L, Olsavsky A, Dattilo TM, Lipak KG, Whiteside S, Yeager ND, Audino A, Rausch J, Klosky JL, O'Brien SH, Quinn GP, Gerhardt CA. Parent-Adolescent Concordance Regarding Fertility Perspectives and Sperm Banking Attempts in Adolescent Males With Cancer. J Pediatr Psychol 2021; 46:1149-1158. [PMID: 34333651 DOI: 10.1093/jpepsy/jsab069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Approximately half of male childhood cancer survivors experience impaired fertility, yet fertility preservation (FP) remains underutilized. Although parent recommendation influences adolescents' decision-making, parents may be uncertain and/or underrate their sons' parenthood goals. This study assessed parent-adolescent and family-level concordance regarding adolescent fertility perspectives (i.e., values, goals) and associations with FP attempts. METHODS A prospective pilot study examined the impact of a family-centered values clarification tool (FAST) on banking attempts among adolescent males newly diagnosed with cancer at risk for infertility. The FAST assessed adolescent and parent perceptions of adolescents' fertility values and goals (i.e., perceived threat of infertility, perceived benefits/barriers to banking). Parent-adolescent concordance and family-level concordance on fertility perspectives were examined, along with associations with banking attempts and salient demographic factors. RESULTS Ninety-eight participants (32 adolescents aged 12-20, 37 mothers, 29 fathers) from 32 families completed the FAST before treatment initiation. Parent-adolescent dyads were concordant on approximately one-half of responses. Banking attempts were associated with higher family-level concordance regarding perceived benefits, r(32) = .40, p = .02. Older adolescent age was associated with higher family-level concordance regarding perceived threat, r(31) = .37, p = .04, and benefits, r(32) = .40, p = .03. Fathers' education was associated with higher family-level concordance regarding barriers, r(21) = .53, p = .01. CONCLUSIONS When parents were concordant with their son's fertility values and goals, particularly perceived benefits, adolescents were more likely to attempt FP. Clinicians should facilitate sharing of fertility perspectives within families before cancer treatment, especially with younger adolescents. Psychosocial support for families facing FP decisions is recommended at diagnosis and across the care continuum.
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Affiliation(s)
- Leena Nahata
- The Abigail Wexner Research Institute.,Nationwide Children's Hospital.,The Ohio State University College of Medicine
| | | | | | | | | | - Nicholas D Yeager
- Nationwide Children's Hospital.,The Ohio State University College of Medicine
| | - Anthony Audino
- Nationwide Children's Hospital.,The Ohio State University College of Medicine
| | - Joseph Rausch
- The Abigail Wexner Research Institute.,The Ohio State University College of Medicine
| | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine & The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta
| | - Sarah H O'Brien
- The Abigail Wexner Research Institute.,Nationwide Children's Hospital.,The Ohio State University College of Medicine
| | | | - Cynthia A Gerhardt
- The Abigail Wexner Research Institute.,The Ohio State University College of Medicine
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7
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Theroux CI, Hill KN, Olsavsky AL, Klosky JL, Yeager ND, Audino A, O’Brien SH, Quinn GP, Gerhardt CA, Nahata L. Satisfaction with Fertility Preservation Decisions among Adolescent Males with Cancer: A Mixed Methods Study. Cancers (Basel) 2021; 13:cancers13143559. [PMID: 34298773 PMCID: PMC8304836 DOI: 10.3390/cancers13143559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Fertility impairment is common among male childhood cancer survivors and negatively impacts quality of life. Sperm banking, before starting cancer treatment, is an established fertility preservation option, yet it remains underutilized at many pediatric centers. Although survivors often report regret about missed banking opportunities, little is known about short-term decisional satisfaction. The aim of this mixed methods study was to examine decisional satisfaction one month after diagnosis by comparing satisfaction among families of adolescents who did or did not attempt to bank. Quantitatively, families reported satisfaction regardless of the banking decision, while qualitatively, families of adolescents who did not attempt to bank reported potential for future regret. Thus, decisional dissatisfaction may not present after one month but could emerge in the future. The findings underscore the importance of longitudinal research to examine satisfaction over time, and why quantitative and qualitative discrepancies exist, as well as psychosocial support across the care continuum as survivors approach their reproductive years. Abstract Half of male childhood cancer survivors experience treatment-related fertility impairment, which can lead to distress. Survivors often regret forgoing fertility preservation (FP), and decisional dissatisfaction is associated with a lower quality of life. This mixed methods study examined short-term FP decisional satisfaction among families of male adolescents newly diagnosed with cancer who received an initial fertility consult and completed an FP values clarification tool. One-two months after the FP decision, thirty-nine families completed the Brief Subjective Decision Quality measure. Decisional satisfaction was compared for participants (mothers, fathers, adolescents) who did and did not attempt to bank. Semi-structured interviews included the following question: How do you/your family feel about the banking decision now/in the future? Decisional quality scores were moderate-high (M = 5.74–6.33 out of 7), with no significant differences between non-attempter (n = 15) and attempter (n = 24) families (adolescents: p = 0.83, d = 0.08; mothers: p = 0.18, d = 0.45; fathers: p = 0.32, d = 0.44). Three qualitative themes emerged among non-attempter families: (1) satisfaction with decision (50% of participants), (2) acceptance of decision (60%), and (3) potential for future regret (40%). Satisfaction with decision was the only theme identified in attempter families (93%). Quantitively, short-term decisional satisfaction was high regardless of the banking attempt. However, the qualitative findings suggest that the experiences of families who did not bank may be more nuanced, as several participants discussed a potential for future regret, highlighting the importance of ongoing support.
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Affiliation(s)
- Charleen I. Theroux
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
| | - Kylie N. Hill
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
| | - Anna L. Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
| | - James L. Klosky
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA 30329, USA;
| | - Nicholas D. Yeager
- Division of Hematology/Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.D.Y.); (A.A.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Anthony Audino
- Division of Hematology/Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.D.Y.); (A.A.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Sarah H. O’Brien
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
- Division of Hematology/Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.D.Y.); (A.A.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (C.I.T.); (K.N.H.); (A.L.O.); (S.H.O.); (C.A.G.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Division of Endocrinology, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Correspondence: ; Tel.: +1-(614)-722-4502; Fax: +1-(614)-722-6980
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8
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Belsky JA, Holmes C, Stanek J, Yeager ND, Audino AN. Evaluating Perspectives of a Smartphone Medication Application in the Adolescent and Young Adult Oncology Population: A Qualitative Study. J Adolesc Young Adult Oncol 2020; 10:282-287. [PMID: 32960135 DOI: 10.1089/jayao.2020.0113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Medication adherence research involving adolescent and young adult (AYA) oncology patients has consisted of small, retrospective studies demonstrating poor adherence rates. Technology plays an active role in attempt to improve medication adherence. There is a growing body of literature investigating the role of smartphone applications (apps). We hypothesized a medication phone app, MedActionPlan Pro (MPP), leads to perceived improvement in medication adherence. Methods: Thirty AYA oncology patients actively receiving treatment (AYA defined as 15-30 years) at Nationwide Children's Hospital were enrolled. Participants downloaded the MPP app on their smartphone for 3 months, during which time participants were provided text messages and alerts to encourage medication adherence. Post-app use, participants completed semi-structured interviews. Interviews were audio-recorded, transcribed, and independently coded to determine consensus thematic content. Results: Thirty AYA oncology participants (16 male), median age 17.5 (range: 15-30 years), participated in the study, with 22 participants (55% male) with a median age of 18 years (range: 15-30 years) participated in the final qualitative survey interview. Participants reported positive views about app utilization and perceived improved medication adherence. Additional themes included perceived decreased forgetfulness, improved organization, and identified customization for medications within the app was most important to AYAs. Conclusion: AYA oncology patients reported improvement in perceived medication adherence utilizing MPP and identified several features they thought would lead to improved medication adherence. These findings, integrated with previous literature, support the further need to investigate the utility of medication adherence apps that fit the unique needs of AYA oncology patients.
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Affiliation(s)
- Jennifer A Belsky
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Caitlin Holmes
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nicholas D Yeager
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Anthony N Audino
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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9
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Bhunia N, Yeager ND, Colace SI, Buzzaco D, Bajwa RPS. Ocular hemorrhage secondary to thioguanine-associated veno-occlusive disease in a child with acute lymphoblastic leukemia in delayed intensification. Pediatr Transplant 2020; 24:e13638. [PMID: 31840375 DOI: 10.1111/petr.13638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/17/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
Hepatic VOD is a potentially fatal complication during stem cell transplantation and is rarely seen in the non-transplant setting. We report the case of a five-year-old boy who presented with visual complaints during delayed intensification phase of treatment for ALL. He was found to have bilateral retinal hemorrhages associated with profound thrombocytopenia due to chemotherapy. VOD was diagnosed based on EBMT criteria and was managed with supportive care. Despite resolution of VOD, his vision progressively deteriorated and resulted in blindness. This case highlights the significance of close monitoring of ALL patients in delayed intensification when they are at risk for developing VOD, the importance of refractory thrombocytopenia as a diagnostic feature and the potential for VOD to manifest with intraocular bleeding.
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Affiliation(s)
- Nabanita Bhunia
- Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nicholas D Yeager
- Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Susan I Colace
- Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dominic Buzzaco
- Department of Ophthalmology, Ohio State University, Columbus, OH, USA
| | - Rajinder P S Bajwa
- Pediatric Hematology, Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA
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10
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Belsky JA, Yeager ND, Fitch J, Stanek J, Nandi D, Vear S. Case of Severe Cardiotoxicity in a Pediatric Patient After Fluorouracil Administration. JCO Precis Oncol 2019; 3:1-4. [DOI: 10.1200/po.18.00333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Jill Fitch
- Nationwide Children’s Hospital, Columbus, OH
| | | | | | - Susan Vear
- Nationwide Children’s Hospital, Columbus, OH
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11
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Nahata L, Morgan TL, Lipak KG, Clark OE, Yeager ND, O’Brien SH, Whiteside S, Audino A, Quinn GP, Gerhardt CA. Perceptions of participating in family-centered fertility research among adolescent and young adult males newly diagnosed with cancer: A qualitative study. Pediatr Blood Cancer 2019; 66:e27966. [PMID: 31407498 PMCID: PMC6754273 DOI: 10.1002/pbc.27966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over half of male childhood cancer survivors experience infertility after treatment, which is known to cause distress and impact future quality of life. Sperm banking rates remain low, and little is known about how adolescent and young adult (AYA) males and their families make fertility preservation (FP) decisions. This study examined AYA and parent perceptions of participating in a research study focused on testing a new FP decision tool at the time of cancer diagnosis. METHODS Forty-four participants (19 mothers, 11 fathers, 14 male AYAs 12-25 years old) from 20 families completed brief assessments at diagnosis and approximately one month later, including a qualitative interview exploring the impact of study participation. Verbatim transcripts were coded through thematic content analysis using the constant comparison method. RESULTS Two major themes emerged: (1) a positive effect of participating in the study and (2) a neutral effect (no positive/negative effect of participation). Subthemes that emerged for participants who noted a positive effect included (a) participation prompted deeper thinking, (b) participation influenced family conversations, and (c) participation resulted in altruism/helping others. No participant reported a negative effect. CONCLUSIONS This study demonstrates that participation in family-centered research focused on FP among AYA males, before treatment begins, is perceived as beneficial or neutral at the time of a new cancer diagnosis. These findings provide support for future family-centered FP interventions for this population.
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Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital
- Divisions of Endocrinology, Nationwide Children’s Hospital
- The Ohio State University College of Medicine, Columbus, OH
| | - Taylor L. Morgan
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital
| | - Olivia E. Clark
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital
| | - Nicholas D. Yeager
- The Ohio State University College of Medicine, Columbus, OH
- Hematology/Oncology, Nationwide Children’s Hospital
| | - Sarah H. O’Brien
- The Ohio State University College of Medicine, Columbus, OH
- Hematology/Oncology, Nationwide Children’s Hospital
- Center for Innovation and Pediatric Practice, The Research Institute at Nationwide Children’s Hospital
| | | | - Anthony Audino
- The Ohio State University College of Medicine, Columbus, OH
- Hematology/Oncology, Nationwide Children’s Hospital
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital
- The Ohio State University College of Medicine, Columbus, OH
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12
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Audino AN, Nahata L, Dajusta D, Saraf A, Brown C, Whiteside SL, Yeager ND. Two Successful Sperm Aspirations in High-Risk Adolescent and Young Adult Lymphoma Patients Before Initiation of Emergent Therapy. J Adolesc Young Adult Oncol 2019; 9:295-298. [PMID: 31613701 DOI: 10.1089/jayao.2019.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As survival rates for adolescent and young adult (AYA) cancer patients improve, fertility preservation has gained increased attention. Many AYAs report significant concerns about fertility potential after therapy. Preservation at diagnosis may be the only opportunity for future genetic parenthood for many patients. Time constraints, concerns about treatment delays, and difficulty accessing resources are reported as reasons for providers not providing counseling. In addition, some pubertal males are unable/unwilling to produce a sample through self-stimulation. Testicular sperm aspiration/extraction with sperm cryopreservation can be successfully performed in "high-risk" pubertal males with significant barriers to traditional collection before initiation of emergent chemotherapy.
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Affiliation(s)
- Anthony N Audino
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Daniel Dajusta
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda Saraf
- Division of Hematology/Oncology, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher Brown
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Stacy L Whiteside
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D Yeager
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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13
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Nahata L, Morgan TL, Lipak KG, Clark OE, Yeager ND, O'Brien SH, Whiteside S, Audino AN, Gerhardt CA, Quinn GP. Conducting reproductive research during a new childhood cancer diagnosis: ethical considerations and impact on participants. J Assist Reprod Genet 2019; 36:1787-1791. [PMID: 31372871 PMCID: PMC6730731 DOI: 10.1007/s10815-019-01546-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Research among adults shows benefits and low perceived burden of engaging in behavioral research. However, questions remain regarding the ethics of conducting behavioral research in pediatric populations during sensitive situations, including during a new life-threatening diagnosis or at end-of-life. We examined reactions to participating in a behavioral reproductive research study among male adolescents newly diagnosed with cancer and their parents, as a step towards optimizing fertility preservation utilization in a population where future infertility is common. METHODS Pediatric literature regarding the ethics of behavioral research was reviewed. In our pilot, forty-four participants (19 mothers, 11 fathers, 14 male adolescents newly diagnosed with cancer) from 20 families completed demographic questionnaires and a fertility preservation decision tool developed by the study team. Qualitative interviews exploring the impact of study participation were subsequently conducted. Verbatim transcripts were coded for thematic content using the constant comparison method. RESULTS Literature review showed positive reactions to research participation among youth/caregivers. In our pilot study, 89% (n = 17) of mothers, 64% (n = 7) of fathers, and 71% (n = 10) of adolescents reported at least one benefit of participating. Eleven percent (n = 2) of mothers, 36% (n = 4) of fathers, and 29% (n = 4) of adolescents said they were not affected; none of the participants reported a negative effect. CONCLUSION Consistent with prior literature, our study suggests behavioral reproductive research prior to cancer treatment can offer direct benefits to participants and society, without increasing burden. These findings will inform future interventions to improve long-term psychosocial and reproductive outcomes for youth with cancer.
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Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA.
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Taylor L Morgan
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Keagan G Lipak
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Olivia E Clark
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Nicholas D Yeager
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah H O'Brien
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Innovation and Pediatric Practice, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Stacy Whiteside
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony N Audino
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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14
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Nahata L, Morgan TL, Ferrante AC, Caltabellotta NM, Yeager ND, Rausch JR, O'Brien SH, Quinn GP, Gerhardt CA. Congruence of Reproductive Goals and Fertility-Related Attitudes of Adolescent and Young Adult Males and Their Parents After Cancer Treatment. J Adolesc Young Adult Oncol 2019; 8:335-341. [DOI: 10.1089/jayao.2018.0134] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Taylor L. Morgan
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda C. Ferrante
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicole M. Caltabellotta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D. Yeager
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R. Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sarah H. O'Brien
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
- Center for Innovation and Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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15
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Morgan TL, Clark OE, Whiteside S, Audino A, Yeager ND, Klosky JL, O'Brien SH, Quinn GP, Gerhardt CA, Nahata L. Recruiting families and children newly diagnosed with cancer for behavioral research: Important considerations and successful strategies. Psychooncology 2019; 28:928-930. [DOI: 10.1002/pon.5012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Taylor L. Morgan
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Olivia E. Clark
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Stacy Whiteside
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
| | - Anthony Audino
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
| | - Nicholas D. Yeager
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
| | - James L. Klosky
- Department of Pediatrics, Emory University School of MedicineChildren's Healthcare of Atlanta Atlanta Georgia
| | - Sarah H. O'Brien
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Gwendolyn P. Quinn
- Department of Obstetrics and GynecologyNew York University School of Medicine New York New York
| | - Cynthia A. Gerhardt
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
| | - Leena Nahata
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
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16
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Pollock RE, Payne JE, Rogers AD, Smith SM, Iwenofu OH, Valerio IL, Zomerlei TA, Howard JH, Dornbos D, Galgano MA, Goulart C, Mendel E, Miller ED, Xu-Welliver M, Martin DD, Haglund KE, Bupathi M, Chen JL, Yeager ND. Multidisciplinary sarcoma care. Curr Probl Surg 2018; 55:517-580. [PMID: 30526918 DOI: 10.1067/j.cpsurg.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Raphael E Pollock
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.
| | - Jason E Payne
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan D Rogers
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephen M Smith
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - O Hans Iwenofu
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ian L Valerio
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - David Dornbos
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Ehud Mendel
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric D Miller
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Karl E Haglund
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - James L Chen
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicholas D Yeager
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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17
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Ferrante AC, Gerhardt CA, Yeager ND, Rausch JR, Lehmann V, O'Brien S, Quinn GP, Nahata L. Interest in Learning About Fertility Status Among Male Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2018; 8:61-66. [PMID: 30260730 DOI: 10.1089/jayao.2018.0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE As many as two-thirds of male childhood cancer survivors are at risk for fertility impairment as a consequence of treatment. Despite this, survivorship guidelines lack concrete recommendations as to when fertility status conversations should happen between patients and providers and what should be discussed. Thus, conversations may be inconsistent, or do not occur at all in survivorship. To inform recommendations for fertility-related conversations in survivorship, this pilot study aimed to better understand background (e.g., age, diagnosis and treatment intensity) and psychosocial factors (i.e., perceived barriers and perceived susceptibility) associated with survivor interest in learning about fertility status. METHODS Male survivors (N = 45) 15-25 years of age were recruited within 1-8 years of completing treatment. Survivors completed questionnaires based on the Health Belief Model (HBM) to assess perception of infertility risk and attitudes toward testing. RESULTS Most survivors (n = 31; 69%) reported they were informed of their risk for infertility by a healthcare provider before treatment, but only 31% (n = 14) of the sample banked sperm. Nearly two-thirds of survivors (n = 29; 64%) were interested in learning more about their fertility post-treatment. This interest was significantly correlated with greater perceived susceptibility to infertility by survivors, but it was not associated with other psychosocial or background factors. CONCLUSION Informing survivors of their personal infertility risk may increase interest in pursuing testing. Offering opportunities for fertility testing and family planning alternatives may mitigate potential psychological distress and unplanned pregnancy. While additional research is needed, future survivorship guidelines should encourage regular communication about fertility status and offer fertility testing for male survivors.
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Affiliation(s)
- Amanda C Ferrante
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Cynthia A Gerhardt
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Nicholas D Yeager
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph R Rausch
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Vicky Lehmann
- 4 Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sarah O'Brien
- 2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,3 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.,5 Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Gwendolyn P Quinn
- 6 Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Leena Nahata
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University, Columbus, Ohio.,7 Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio
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18
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Nahata L, Caltabellotta NM, Yeager ND, Lehmann V, Whiteside SL, O'Brien SH, Quinn GP, Gerhardt CA. Fertility perspectives and priorities among male adolescents and young adults in cancer survivorship. Pediatr Blood Cancer 2018. [PMID: 29537134 DOI: 10.1002/pbc.27019] [Citation(s) in RCA: 24] [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] [Indexed: 11/11/2022]
Abstract
Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility-related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their "top 3" life goals. Only 40% reported fertility-related discussions with their health care providers in survivorship. Given the importance of biological children among this cohort, future guidelines should encourage a more proactive approach to providing fertility counseling and offering testing, to mitigate distress and prevent unplanned pregnancies.
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Affiliation(s)
- Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Nicole M Caltabellotta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas D Yeager
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Vicky Lehmann
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stacy L Whiteside
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah H O'Brien
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Medical Center, New York City, New York
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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19
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Lehmann V, Nahata L, Ferrante AC, Hansen-Moore JA, Yeager ND, Klosky JL, Gerhardt CA. Fertility-Related Perceptions and Impact on Romantic Relationships Among Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2018; 7:409-414. [PMID: 29466084 DOI: 10.1089/jayao.2017.0121] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/28/2022] Open
Abstract
PURPOSE To present an overview of fertility-related perceptions and describe the perceived negative/positive impact of (potential) infertility on romantic relationships among childhood cancer survivors. METHODS Male and female long-term childhood cancer survivors (N = 92) aged 22-43 and 7-37 years postdiagnosis, completed an online survey about fertility-related perceptions (i.e., knowledge, beliefs, uncertainty, concern, and attitudes toward testing) and romantic relationships. Potential differences based on sociodemographic/cancer-specific factors were tested. RESULTS Most survivors (82.4%, n = 75) knew about infertility risk due to childhood cancer treatment. Seventy percent (n = 65) reported being told they were personally at risk, but less than one-third believed it (29.2%, n = 19/65). Half of survivors (48.9%, n = 45) never underwent fertility testing and were unaware of their fertility status. Fertility-related uncertainty and concerns were more common among survivors without children and those who desired (additional) children (d's > 0.5). Among survivors without biological children (n = 52), partnered survivors felt more uncertain about their fertility than singles (d = 0.8). Ten survivors (10.9%) reported a negative impact of infertility on romantic relationships, 6 (6.5%) reported a positive impact, and 7 (7.6%) reported both (e.g., pressure on relationship, fights, break-ups, being closer, and open partner communication). CONCLUSIONS Fertility-related perceptions varied among survivors, but the majority never underwent fertility testing. Uncertainty or concerns differed by current circumstances (e.g., wanting children and relationship status). Providers should routinely discuss potential infertility and offer testing throughout survivorship. A negative impact on romantic relationships may seem small, but should be considered for survivors who desire children and may discover they are infertile in the future.
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Affiliation(s)
- Vicky Lehmann
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,2 Department of Psychology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Leena Nahata
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Pediatrics, The Ohio State University , Columbus, Ohio
| | - Amanda C Ferrante
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio
| | - Jennifer A Hansen-Moore
- 3 Department of Pediatrics, The Ohio State University , Columbus, Ohio.,4 Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital , Columbus, Ohio
| | - Nicholas D Yeager
- 3 Department of Pediatrics, The Ohio State University , Columbus, Ohio.,5 Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital , Columbus, Ohio
| | - James L Klosky
- 2 Department of Psychology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Cynthia A Gerhardt
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Pediatrics, The Ohio State University , Columbus, Ohio
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20
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Audino AN, Yeager ND. "Learning, Education, Awareness, Prevention (L.E.A.P.) Young Adult Cancer": An Education and Outreach Program. J Adolesc Young Adult Oncol 2017; 7:130-133. [PMID: 28953420 DOI: 10.1089/jayao.2017.0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Delayed diagnosis due to lack of education may contribute to lack of improvement in adolescent and young adult (AYA) cancer survival. This program sought to educate trainees and AYAs in the community. The "Learning, Education, Awareness, Prevention (L.E.A.P) Young Adult Cancer" outreach program was developed to teach the most common AYA cancers, signs and symptoms associated with them, and prevention. A total of 150 trainees were educated and presented to 1000 high school students in Columbus. Pre- and post-testing demonstrated increases in AYA cancer knowledge of both groups. Empowering medical professionals with AYA knowledge early in their learning may impact the way they examine and educate patients throughout their medical career.
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Affiliation(s)
- Anthony N Audino
- 1 Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital , Columbus, Ohio.,2 Division of Pediatrics, The Ohio State University , Columbus, Ohio
| | - Nicholas D Yeager
- 1 Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital , Columbus, Ohio.,2 Division of Pediatrics, The Ohio State University , Columbus, Ohio
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21
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Haworth KB, Arnold MA, Pierson CR, Choi K, Yeager ND, Ratner N, Roberts RD, Finlay JL, Cripe TP. Immune profiling of NF1-associated tumors reveals histologic subtype distinctions and heterogeneity: implications for immunotherapy. Oncotarget 2017; 8:82037-82048. [PMID: 29137242 PMCID: PMC5669868 DOI: 10.18632/oncotarget.18301] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/16/2017] [Indexed: 01/01/2023] Open
Abstract
Successful treatment of neurofibromatosis type 1 (NF1)-associated tumors poses a significant clinical challenge. While the primary underlying genetic defect driving RAS signaling is well described, recent evidence suggests immune dysfunction contributes to tumor pathogenesis and malignant transformation. As immunologic characterizations, prognostic and predictive of immunotherapeutic clinical response in other cancers, are not fully described for benign and malignant NF1-related tumors, we sought to define their immunologic profiles. We determined the expression of human leukocyte antigen (HLA)-A/-B/-C, β-2-microglobulin (B2M), and T cell inhibitory ligands PD-L1 and CTLA-4 by microarray gene analysis and flow cytometry. We examined HLA-A/-B/-C, B2M, and PD-L1 expression on thirty-six NF1-associated tumor samples by immunohistochemistry, and correlated these with tumoral CD4+, CD8+, FOXP3+, CD56+, and CD45RO+ lymphocytic infiltrates. We evaluated several tumors from a single patient, observing trends of increasing immunogenicity over time, even with disease progression. We observed similarly immunogenic profiles for malignant peripheral nerve sheath tumors (MPNST) and nodular and plexiform neurofibromas, contrasting with diffuse neurofibromas. These studies suggest that while immunotherapies may offer some benefit for MPNST and nodular and plexiform neurofibromas, tumor heterogeneity might pose a significant clinical challenge to this novel therapeutic approach.
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Affiliation(s)
- Kellie B Haworth
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.,Center for Childhood Cancer and Blood Diseases, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael A Arnold
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christopher R Pierson
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Division of Anatomy, Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kwangmin Choi
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nicholas D Yeager
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy Ratner
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan D Roberts
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.,Center for Childhood Cancer and Blood Diseases, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Timothy P Cripe
- Division of Hematology, Oncology, Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.,Center for Childhood Cancer and Blood Diseases, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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22
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Haworth KB, Arnold MA, Pierson CR, Choi K, Yeager ND, Ratner N, Finlay JL, Cripe TP. IMST-19. IMMUNE PROFILING OF NF1-ASSOCIATED TUMORS REVEALS DISTINCT DIFFERENCES AMONG HISTOLOGIC SUBTYPES AND POTENTIAL FOR PATIENT-SPECIFIC SELECTION OF IMMUNOTHERAPY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Setty BA, Jin Y, Houghton PJ, Yeager ND, Gross TG, Nelin LD. Hypoxic Proliferation of Osteosarcoma Cells Depends on Arginase II. Cell Physiol Biochem 2016; 39:802-13. [PMID: 27475813 DOI: 10.1159/000447790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Despite significant advancements in the diagnosis and treatment of osteosarcoma, the overall survival has remained relatively unchanged for over two decades. Hypoxic conditions have been demonstrated in solid tumors and are associated with increased cell proliferation and angiogenesis. L-arginine metabolism by arginase produces L-ornithine, the precursor for polyamine and proline synthesis required for cellular proliferation. We hypothesized that hypoxia would increase cellular proliferation via arginase induction in human osteosarcoma cell lines. METHODS We utilized a variety of approaches to examine the role of arginase II in hypoxic (1% O2, 5% CO2) cellular proliferation. RESULTS Arginase II mRNA and protein levels were significantly increased in osteosarcoma cells exposed to hypoxia for 48 hours. There were twice as many viable cells following 48 hours of hypoxia than following 48 hours of normoxia (21% O2, 5% CO2). The addition of difluoromethylornithine (DFMO), a putative arginase inhibitor, prevented hypoxia-induced proliferation. Transfection of small interfering RNAs (siRNA) targeting arginase II resulted in knockdown of arginase II protein levels and prevented hypoxia-induced cellular proliferation. CONCLUSIONS These data support our hypothesis that hypoxia increases proliferation of osteosarcoma cells in an arginase II-dependent manner. We speculate that arginase II may represent a therapeutic target in osteosarcoma.
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Affiliation(s)
- Bhuvana A Setty
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, Columbus, USA
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24
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Varga E, Chao EC, Yeager ND. The importance of proper bioinformatics analysis and clinical interpretation of tumor genomic profiling: a case study of undifferentiated sarcoma and a constitutional pathogenic BRCA2 mutation and an MLH1 variant of uncertain significance. Fam Cancer 2016; 14:481-5. [PMID: 25712765 PMCID: PMC4559104 DOI: 10.1007/s10689-015-9790-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Next-generation sequencing (NGS) technology is increasingly utilized to identify therapeutic targets for patients with malignancy. This technology also has the capability to reveal the presence of constitutional genetic alterations, which may have significant implications for patients and their family members. Here we present the case of a 23 year old Caucasian patient with recurrent undifferentiated sarcoma who had NGS-based tumor analysis using an assay which simultaneously analyzed the entire coding sequence of 236 cancer-related genes (3769 exons) plus 47 introns from 19 genes often rearranged or altered in cancer. Pathogenic alterations were reported in tumor as the predicted protein alterations, BRCA2 “R645fs*15″ and MLH1 “E694*”. Because constitutional BRCA2 and MLH1 gene mutations are associated with Hereditary Breast Ovarian Cancer Syndrome (HBOCS) and Lynch syndrome respectively, sequence analysis of DNA isolated from peripheral blood was performed. The presence of the alterations, BRCA2 c.1929delG and MLH1 c.2080G>T, corresponding to the previously reported predicted protein alterations, were confirmed by Sanger sequencing in the constitutional DNA. An additional DNA finding was reported in this analysis, MLH1 c.2081A>C at the neighboring nucleotide. Further evaluation of the family revealed that all alterations were paternally inherited and the two MLH1 substitutions were in cis, more appropriately referred to as MLH1 c.2080_2081delGAinsTC, which is classified as a variant of uncertain significance. This case illustrates important considerations related to appropriate interpretation of NGS tumor results and follow-up of patients with potentially deleterious constitutional alterations.
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Affiliation(s)
- Elizabeth Varga
- Division of Hematology/Oncology/Bone Marrow Transplant, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, USA,
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25
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Audino AN, Yeager ND, Asti L, Miao Y, O'Brien SH. Length of stay and treatment-related complications are similar in pediatric and AYA patients with bone sarcoma in United States children's hospitals. Pediatr Blood Cancer 2013; 60:415-9. [PMID: 22706952 DOI: 10.1002/pbc.24231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 03/30/2012] [Accepted: 05/21/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer patients have been shown to have unique clinical characteristics and inferior outcomes compared to younger patients. More than 2,500 new bone sarcomas are diagnosed yearly in the US, many of whom are AYAs treated at pediatric hospitals. Pediatric providers must understand the impact of increasing age on complications, costs, and outcomes. The study set-out to determine if AYA patients with bone sarcomas have increased healthcare utilization and treatment-related complications as compared to younger patients. PROCEDURE Data were obtained from the Pediatric Health Information System for bone sarcoma admissions at 41 US children's hospitals from 2006 to 2010. Patient demographics and morbidities were compared in patients 0-14 and 15-28 years using two sample t-tests, Wilcoxon two sample tests, or chi-squared tests. RESULTS We identified 835 pediatric and 562 AYA patients with bone sarcomas. Mean length of stay (LOS) was comparable between age groups (4.6 and 4.8 days, P = 0.46), although AYA patients had greater mean pharmaceutical charges ($18,124 vs. $13,637, P < 0.0001). Common treatment-related complications were similar between groups, with the exceptions that febrile neutropenia admissions were more likely in younger patients, and thrombosis, renal failure, and pain were more common in AYA patients. CONCLUSIONS In US children's hospitals, AYA patients with sarcomas do not have prolonged LOS or an increased risk of the most common treatment-related complications as compared to younger patients. Chronic pain appears to be a greater burden in AYA patients, and may account for their higher inpatient pharmaceutical costs.
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Affiliation(s)
- Anthony N Audino
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, USA
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26
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Streby KA, Ruymann FB, Whiteside S, Yeager ND. Rhabdomyosarcoma in Adolescents and Young Adults: A 25-Year Review at Nationwide Children's Hospital. J Adolesc Young Adult Oncol 2011. [DOI: 10.1089/jayao.2011.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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27
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Setty BA, Yeager ND, Bajwa RP. Heterozygous M1V variant of ELA-2 gene mutation associated with G-CSF refractory severe congenital neutropenia. Pediatr Blood Cancer 2011; 57:514-5. [PMID: 21618407 DOI: 10.1002/pbc.23018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/02/2010] [Accepted: 12/10/2010] [Indexed: 11/10/2022]
Abstract
Severe congenital neutropenia is an autosomal recessive disorder characterized by maturation arrest at the promyelocyte/myelocyte phase in the bone marrow, absolute neutrophil count <0.5 × 10(9) /L and recurrent bacterial infections. Homozygous mutations of either HAX-1 or ELA-2 have been described. We report the case of a premature male infant with congenital neutropenia, associated with multiple infections, refractory to treatment with granulocyte colony stimulating factor who subsequently underwent matched sibling donor stem-cell transplant. He was found to be heterozygous for the M1V variant of the ELA-2 gene that we postulate to be causative for his severe neutropenia
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Affiliation(s)
- Bhuvana A Setty
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
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28
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Termuhlen AM, Klopfenstein K, Olshefski R, Rosselet R, Yeager ND, Soni S, Gross TG. Mobilization of PML-RARA negative blood stem cells and salvage with autologous peripheral blood stem cell transplantation in children with relapsed acute promyelocytic leukemia. Pediatr Blood Cancer 2008; 51:521-4. [PMID: 18493994 DOI: 10.1002/pbc.21614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
BACKGROUND Relapsed acute promyleocytic leukemia (APL) is treated with re-induction chemotherapy, commonly arsenic trioxide, and stem cell transplantation (SCT). The effect of arsenic trioxide on autologous peripheral blood stem cell collection is unknown. PROCEDURE Five pediatric patients with relapsed APL had PML-RARA negative peripheral blood stem cells mobilized (four after arsenic trioxide) and underwent autologous SCT after cyclophosphamide (60 mg/kg x 2) and total body irradiation (TBI-fractionated 1,200 cGy) conditioning. RESULTS All five patients remain in molecular remission a median of 20 months post-transplant. CONCLUSION Autologous SCT performed during molecular remission is a treatment option for pediatric patients with relapsed APL and may provide durable leukemia-free survival without the complications of allogeneic transplantation.
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Affiliation(s)
- Amanda M Termuhlen
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
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29
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Yeager ND, Hoshaw-Woodard S, Ruymann FB, Termuhlen A. Patterns of care among adolescents with malignancy in Ohio. J Pediatr Hematol Oncol 2006; 28:17-22. [PMID: 16394887] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Adolescents with malignancy represent a unique population in oncology that traditionally has received care at a variety of institutions. Recent data have shown that clinical trial involvement and patient outcomes in this age group may be influenced by the type of hospital at which they are treated. This article examines factors influencing the location of treatment of patients aged 15 to 19 years from selected areas in Ohio. Patients 15 to 19 years of age with malignancy from the selected 45 counties between 1996 and 1999 were identified from the Ohio Cancer Incidence and Surveillance System database. Factors analyzed included specific diagnosis, age, race, and treating institution. A total of 169 patients were identified, with 46.7% treated at pediatric institutions, 24.8% at adult academic centers, and 28.5% at community hospitals. Diagnosis influenced treatment location: leukemias, central nervous system tumors, and sarcomas were treated more often at pediatric hospitals, whereas melanoma was more often treated at adult academic centers. Patient age and distance from an academic center were also found to affect the location of treatment. Specific diagnosis, age, and geographic location influence the site of treatment of adolescent patients. Efforts to improve survival and increase enrollment in clinical trials must take these factors into account.
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Affiliation(s)
- Nicholas D Yeager
- Section of Hematology/Oncology, Children's Hospital/The Ohio State University, Columbus, 43205, USA.
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30
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Yeager ND, Dolan ME, Gastier JM, Gross TG, Delaney S, Frick J, Ruymann FB, Ewesuedo R. O6-methylguanine-DNA methyltransferase activity and promoter methylation status in pediatric rhabdomyosarcoma. J Pediatr Hematol Oncol 2003; 25:941-7. [PMID: 14663276 DOI: 10.1097/00043426-200312000-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the activity of the DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) and MGMT promoter methylation status of pediatric rhabdomyosarcoma (RMS) and examine MGMT in RMS tumors from different prognostic groups. METHODS Fifteen samples each of the alveolar (ARMS) and embryonal (ERMS) subtypes were obtained for analysis of MGMT activity and promoter methylation status. MGMT activity was assayed by measuring the removal of O6-[3H] methylguanine from [3H]-methylated substrate by a tumor extract containing the enzyme. Promoter methylation status was examined using methylation-specific polymerase chain reaction (PCR). RESULTS MGMT activity was successfully assayed from 25 samples, 10 ERMS and 15 ARMS. All ERMS and 11 of the 15 ARMS samples displayed high activity levels. There was significant intertumor variability among both subtypes but no significant difference in mean activity between the two histologic groups. There were trends toward increased activity in ERMS tumors and tumors from anatomically unfavorable locations. Only one tumor was hypermethylated at the MGMT promoter region. CONCLUSIONS This analysis suggests that a low percentage of RMS samples are hypermethylated at the MGMT promoter and that most have significant MGMT activity, implying that clinical trials with MGMT-modulating agents may have a role in the treatment of these tumors. This analysis does not support MGMT activity as an explanation of the differential response to chemotherapy demonstrated by ARMS and ERMS, but does suggest that MGMT may be involved in RMS treatment failure regardless of subtype and in the poorer response shown by tumors from unfavorable locations.
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Affiliation(s)
- Nicholas D Yeager
- Hematology/Oncology, Children's Hospital, Columbus, Ohio 43205, USA.
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