Hematology Oncology Research Articles

The Effect of Iron Deficiency Anemia on Emergency Department Admission in Asthmatic Children.

Iron deficiency (ID) is the most common nutritional deficiency and cause of anemia in childhood. Iron deficiency anemia (IDA) is a common public health problem in Turkey as in the rest of the World. Asthma is a chronic inflammatory disease of the respiratory tract, affecting approximately 10% of the population in developing countries. There are very few reports available in the medical literature regarding the association of childhood asthma and anemia, as well as the effects of anemia on asthma. This study was designed to investigate the possible relationship between serum iron levels of asthmatic patients and their frequency of emergency admission for asthma exacerbation treatment. The patients who were followed up with a diagnosis of asthma for at least 12 months at the Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, whose current age is below 21, and whose serum iron, total iron binding capacity, and ferritin levels were checked between 2017 and 2019, were included in the study. In the assessment of 612 patients diagnosed with asthma, 105 individuals, constituting 18.4% of those under asthma follow-up, were identified as having anemia. Additionally, ID not progressing to anemia was observed in 120 patients, accounting for 21.1% of the total. Individuals with IDA and/or ID alone experienced a significantly higher frequency of emergency admissions for asthma exacerbations. Moreover, ID and/or IDA were established as independent risk factors linked to emergency admissions for asthma exacerbations. odds ratio = 1.56, confidence interval = 1.06-2.30 p = 0.022. In conclusion, it may be recommended to follow up the hemoglobin and iron parameters of asthmatic patients and to take nutritional and/or supportive preparations to keep them at a high level.

A Pilot Study in a Recently Established Childhood Cancer Center for Evaluating the Priority of National Pediatric Cancer Registry

Background: Pediatric cancers account for nearly 2% of all cancers worldwide. In 2018, there were approximately 200,000 newly diagnosed cases of childhood cancer. Objectives: The aim of this study was to assess the need for a national pediatric cancer registry based on case incidence. Methods: This pilot study was conducted on 100 children with cancer who were treated in a recently established pediatric hematology oncology department of Golestan Hospital. Demographic and epidemiological data were collected and analyzed using SPSS software version 25. Results: Sixty-four percent of children with cancer were girls, and the average age of the patients was 7.6 ± 0.42 years. The most common types of cancer diagnosed were leukemia, brain tumor, lymphoma, and retinoblastoma respectively. Metastasis was confirmed in 11 cases. The most prevalent clinical manifestations of cancer included fever, weakness, loss of appetite, paleness, and weight loss. Conclusions: The results of this study align with global rates and data. Based on the findings, the authors emphasize the necessity and priority of establishing a pediatric cancer registry in Iran's health ministry. Therefore, all healthcare workers and specialists in pediatric hematology and oncology should make concerted efforts to establish this registry.

Knowledge, attitude, and practice toward family-based treatment among parents of children with leukemia.

To investigate the KAP toward family-based treatment among parents of children with leukemia. This cross-sectional study was conducted between December, 2022 and July, 2023 in the Pediatric hematologic oncology department of West China Second University Hospital, Sichuan University. The study population consisted of parents of children diagnosed with leukemia. Their demographic characteristics and KAP toward family-based treatment for leukemia were collected by self-administered questionnaires. A total of 482 parents participated, including 379 (78.63%) females, with an average age of 35.83 ± 6.40 years. The mean scores for KAP were 7.28 ± 1.13 (possible range: 0-10), 37.82 ± 4.38 (possible range: 9-45), and 40.09 ± 4.17 (possible range: 9-45), respectively. Multivariate logistic regression analysis indicated that the knowledge score (OR = 1.48, 95% CI: [1.08-2.05], P = 0.016), attitude score (OR = 1.31, 95% CI: [1.18-1.46], P < 0.001), education of junior college and above (OR = 11.28, 95% CI: [1.94-65.65], P = 0.007), and monthly income of 5,000-10,000 Yuan (OR = 10.88, 95% CI: [1.15-102.98], P = 0.037) were independently associated with a proactive practice. Structural equation modeling (SEM) results highlighted the significant direct impact of knowledge on attitude (β = 0.72, P = 0.002), attitude on practice (β = 0.57, P < 0.001), and knowledge on practice (β = 0.81, P < 0.001). Parents of children with leukemia demonstrated inadequate knowledge, but positive attitudes and proactive practices toward family-based treatment for leukemia. Future interventions should not only prioritize augmenting parental knowledge through educational initiatives but also focus on fostering positive attitudes and providing support for both knowledge and practical parenting skills to facilitate proactive involvement.

The Experience of Hematologic Oncology in Armenia

The Experience of Hematologic Oncology in Armenia

Integrative Hematology Oncology Fellowship: A Descriptive Analysis of the First Accredited Program in the United States

Integrative Hematology Oncology Fellowship: A Descriptive Analysis of the First Accredited Program in the United States

OP039 Topic: AS06–Extracorporeal Organ Support: ECMO/Ventricular Assist Devices (Temporary &amp; Durable)/MARS/Total Plasma Exchange/Plasmapheresis/Other: CRITICAL HEMATOLOGY ONCOLOGY REFERRAL PATHWAY FOR EXTRACORPOREAL MEMBRANE OXYGENATION (CHORPE): IMPROVING ACCESS AND OUTCOMES

OP039 Topic: AS06–Extracorporeal Organ Support: ECMO/Ventricular Assist Devices (Temporary &amp; Durable)/MARS/Total Plasma Exchange/Plasmapheresis/Other: CRITICAL HEMATOLOGY ONCOLOGY REFERRAL PATHWAY FOR EXTRACORPOREAL MEMBRANE OXYGENATION (CHORPE): IMPROVING ACCESS AND OUTCOMES

Sudden Hearing Loss as the Initial Manifestation of Chronic Myeloid Leukemia

Sudden hearing loss rarely presents as an initial manifestation of a hematologic disorder, although it can result from various factors. A 48-year-old male had sudden hearing loss in both ears. The pure tone audiometry and audiometry brainstem response revealed profound hearing loss in both ears. Further examination indicated an elevated leukocyte count, and a temporal bone magnetic resonance image suggested potential bleeding in the cochlear and labyrinth of both ears. Upon consultation with hematologic oncology, chronic myeloid leukemia was diagnosed. Hearing loss in leukemia patients is attributed to leukemic infiltration, hemorrhage, infection, and hyperviscosity. Following treatment using tyrosine kinase inhibitor for chronic myeloid leukemia, the leukocyte count was normalized. However, on the 90th day of treatment, both profound hearing loss persisted. We suspect that the cause of sudden hearing loss may be related to hemorrhage in both cochlear and labyrinth. Accurate diagnosis and treatment are essential for preventing complications.

Clinical analysis of bleeding and thrombotic events in haematological-oncology patients with severe thrombocytopenia and a high risk of thrombosis

Background: Haematological patients with severe thrombocytopenia and high thrombotic risk face challenges related to balancing bleeding and thrombosis risks. This study investigated factors associated with bleeding and thrombosis in high-risk haematological oncology patients with severe thrombocytopenia not receiving anticoagulant therapy and characterized their clinical features when both events occurred. Methods: A total of 446 haematological oncology patients with Caprini scores ≥ 5 were included from July 2022 to June 2023 at Mianyang City Central Hospital. Those not receiving prophylactic anticoagulants due to an admission platelet count < 50 × 109/L were studied. Patients were categorized into bleeding/nonbleeding and thrombotic/nonthrombotic groups on the basis of hospital course. Relevant clinical data were collected, and univariate/multivariate logistic regression was used to analyse the influencing factors. The platelet count at admission was assessed via ROC curves for thrombosis prediction. Results: In the bleeding group, higher proportions of patients with leukaemia, myeloid tumours, lung infections, and a central venous catheter (CVC) with two lumens were observed, along with shorter catheter durations, lower initial and minimum platelet counts during hospitalization, and prolonged plasminogen times (all P < 0.05). The thrombotic group had a greater thrombosis history, initial platelet count, use of two venous catheter lumens, parenteral nutrition, sedation, and autologous haematopoietic stem cell transplantation (Auto-HSCT), with a lower leukaemia proportion (P < 0.05). Logistic regression identified lymphoma type and minimum platelet count as bleeding protective factors and the Charlson Comorbidity Index (CCI) score as an independent risk factor. Thrombosis history, two venous catheter lumens, and sedation were risk factors for thrombosis. The median platelet count was lower at bleeding and thrombosis than at admission (P = 0.007). The platelet count at admission had predictive value for thrombosis, especially severe thrombocytopenia, with an AUC of 0.735 (95% CI 0.613–0.858, P = 0.003) and a cut-off value of 42.5 × 109/L. Conclusions: For haematological neoplasm patients with a high risk of venous thromboembolism (VTE), severe thrombocytopenia and high CCI scores, risk prevention and control of bleeding take precedence over thrombosis prophylaxis. Prophylactic anticoagulation is still recommended for patients with lymphoma assessed at high risk for VTE and with platelet counts of at least 42.5 × 109/L.

Use of the Android-Based Application "LEUMYLO TRACKER" to Monitor Treatment Adherence in Chronic Myelocytic Leukaemia Patients

Leukaemia is a life-threatening cancer globally, characterized by the replacement of normal bone marrow elements with abnormal blood cells. Among various types, Chronic Myeloid Leukaemia (CML) poses significant health concerns, particularly in Asia. Managing CML requires strict adherence to targeted therapies like tyrosine kinase inhibitors, which is often challenging due to complex treatment schedules and side effects. Information and communication technologies, such as Android-based applications, can offer innovative solutions to improve medication adherence. This study aims to design, develop, and evaluate the effectiveness of an Android-based application, "LEUMYLO TRACKER," in monitoring treatment adherence among CML patients. The research uses a quasi-experimental design with a developmental research approach. The study involved 51 CML patients undergoing therapy at the Haematology Oncology Medical Internal Medicine Polyclinic, Cipto Mangunkusumo Hospital, selected through systematic random sampling. The primary factors studied were medication adherence using the Probabilistic Medication Adherence Scale and clinical response. The application development involved needs analysis, user interface design, and implementation of features such as medication reminders, adherence tracking, side effect notes, educational information, and communication capabilities with medical personnel. The application was developed using the Android platform and tested with a small group of patients to gather feedback and assess usability. Results from the univariate analysis indicated that 52.9% of respondents had good clinical responses, while 74.5% adhered to their medication regimen. Bivariate analysis showed a significant relationship between medication adherence and clinical response (p = 0.029), with non-adherent patients having a sixfold higher risk of poor clinical response. The LEUMYLO TRACKER application proved beneficial in improving adherence by providing automatic medication reminders and allowing real-time data collection for clinical evaluation. In conclusion, the LEUMYLO TRACKER application effectively enhanced medication adherence and clinical outcomes in CML patients. Its features, such as medication reminders and educational information, supported patients in managing their treatment schedules more consistently. The application also facilitated better communication between patients and medical personnel, allowing timely interventions. Ensuring ease of use and data security is crucial for maximizing the application's benefits. This study highlights the potential of mobile health applications in improving chronic disease management and patient outcomes.

Challenges faced by international medical graduate (IMG) residents interested in hematology-oncology.

29 Background: International Medical Graduates (IMGs) comprise over one-third of internal medicine (IM) trainees and practicing oncologists in the United States. We aimed to examine challenges faced by IM IMG residents in pursuing hematology-oncology (HO) fellowship positions. Methods: We conducted a pilot survey using SurveyPluto to assess demographics and evaluate visa related challenges amongst ACGME residents interested in HO. The survey was disseminated through the ASCO IMG Community of Practice (CoP), the Heme-Onc Fellows Mentorship Empowerment (H.O.M.E) group and the IMG Oncologists social media homepage (@IMG_Oncologists). Results: A total of 59 IMG residents completed the survey (20% PGY-1, 36% PGY-2 and 44% PGY-3). The majority of trainees (88%) were from community or university-affiliated community programs. J-1 visa was the most common visa type (67.8%). The visa process was rated as difficult or very difficult by 36% of trainees. Annual visa renewal was required by 51% trainees and 55.9% reported visa related impact on plans for research grant applications (Table). The greatest challenges associated with visa status were disruption of travel plans and inability to unite with family (35.6%); obtaining documentation from home country (33.9%); visa renewal (28.8%) and lack of clarity in visa instructions (27.1%). Among resources that respondents wanted better access to, IMG networking groups (81.4%), legal/financial aids (47.5%), institutional visa seminars (45.8%) and flexibility from their program to visit family overseas (45.8%) were identified as priorities. Conclusions: Visa related barriers pose significant challenges to IMGs interested in HO. Policy changes, advocacy work and additional resources could be beneficial for future IMG oncologists. Challenges associated with visa status for hematology/oncology aspirants. Greatest visa related barriers during training % of respondents (n=59) Documentation from home country 33.9% Disruption in travel plans/ inability to unite with family 35.6% Lack of clarity in renewal instructions/ renewal process post document procurement 55.9% Ability to secure grant affected by visa 22% Non-monetary grant aspects affected by visa 13.6% Did not pursue grants due to visa 20.3% Desired resources during residency Institutional visa seminars 45.8% IMG network groups 81.4% Program flexibility to visit family overseas/ legal and financial aids 45.8%/47.5%

Development and implementation of an equitable and efficient navigation program to address supportive care needs in patients with cancer.

58 Background: Despite evidence backing the use of navigation along the cancer care trajectory, existing programs struggle to deliver services efficiently and equitably. To bridge this gap, we developed and implemented a patient-centric, data-driven navigation program that leverages a risk-stratification approach to prioritize and address unmet needs. Methods: Our program was developed with key principles to address inefficiencies in existing navigation systems. First, we embedded the program within our institution’s Epic environment, using data-driven risk calculators, dashboards, flowsheets, and templates to support the navigation curriculum. Second, the program structure aligned with the patient’s journey from initial consult through treatment, focusing on early identification of unmet needs, centralized resourcing, and remote symptom monitoring for high-risk patients. Third, we unified the workflows of navigators, intake personnel, triage nurses, and providers, fostering system-wide collaboration. Results: The program has been successfully implemented in patients with new consults in gastrointestinal, breast, and hematologic oncology. To date, 2,080 patients have had an initial assessment leading to a Navigation Assessment Score (NAS) that predicts longitudinal burden of unmet needs and directs subsequent resourcing. 226 referrals have been generated to: cancer rehabilitation (76), nutrition (60), psychosocial oncology (48), tobacco cessation (39), and palliative care (3). Remote symptom monitoring was piloted in 34 gastrointestinal oncology patients meeting the calculated highest decile risk for unplanned acute care event use. Proportions of patients with a NAS score (N=2,080): 69.3% White, 17.7% Black, 3% Latinx, 1.8% Asian, 0.9% American Indian; referrals (N=226): 61.2% White, 23.0% Black, 4.9% Latinx, 1.1% Asian, 0.5% American Indian; remote symptom monitoring (N=34): 79.4% White, 11.8% Black, 5.9% American Indian. Except for Latinx patients, these distributions align with the patient population in gastrointestinal, breast, and hematologic oncology (N=4,267; 68.0% White, 22.5% Black, 6.4% Latinx, 1.9% Asian, 0.9% American Indian). Conclusions: Development and implementation of our program is feasible, and the approach has potential to mitigate disparities in cancer service delivery and outcomes. Ongoing efforts include exploring accessibility among Latinx patients and developing the business case for sustainability and scaling.

Developing & Validating a Clinical Decision Support Tool for ER-Targeted PET Imaging With 16α-18F-Fluoro-17β-Fluoroestradiol

BackgroundEstrogen receptor (ER) status in breast cancer (BC) is routinely determined by immunohistochemistry (IHC); however, this technique is not without limitations, including false results. Imaging of CeriannaTM (fluoroestradiol F18) injection provides high diagnostic accuracy of ER expression, supplementing information from biopsy. A Clinical Decision Support (CDS) tool was developed to better assess its clinical usefulness in metastatic and recurrent breast cancer management. This study evaluated a conceptual tool that reflects clinical practice variables. MethodsIndividual patient characteristics - candidacy for therapeutic treatment and rate of recurrence - determined initial eligibility. The CDS tool uses rules (IF-THEN statements) to produce an output on the diagnostic accuracy of ER status based on tumor burden, anatomical location(s) of metastasis, heterogeneity, and confidence in sample collection & pathology accuracy (CSC & PA). An Excel-based probability decision tree calculates the accuracy of ER expression. Results360 oncologists in the United States participated in the survey study. 223 respondents identified as medical oncologists (62%), 77 as clinical oncologists (21%), and 60 as hematologic oncologists (17%). 93% of respondents found the CDS tool intuitive and easy to follow with medical and clinical oncologists favoring the tool more than hematologic oncologists. Individual CDS attributes - clinical criteria, diagnostic comparator, true positive and true negative, patient inclusion and exclusion, and clinical patient level inputs - were tested with overall positive feedback. ConclusionsBased on respondent feedback, further development of CDS tools are warranted for potential use in patients’ diagnostic workup.

Palliative Care Services for Children with Cancer, Current Situation, and Areas of Improvement

Abstract Background Pediatric palliative care is a holistic approach that aims to enhance the quality of life of seriously ill children and their families. Despite the documented benefits, many barriers challenge early integration of such care. Objective The primary aim of the study is to evaluate the current situation of palliative care services for pediatric oncology patients from patient’s, parents’ and physician’s perspective and the secondary aim is to highlight the areas of improvement of palliative care services to provide better quality of life for pediatric oncology patients. Methodology A Cross-sectional questionnaire-based study was conducted on 80 parents/caregivers and young patients, in addition to all health care providers in the pediatric hematology/oncology unit at the Pediatric Hematology/Oncology Unit, Children's Hospital, Ain Shams University over six months. A validated Arabic version for PedsQL4 questionnaire was distributed to patients and/or their parents if feasible. The PedsQL is a 23-item instrument and consists of four domains: physical (eight items), emotional (five items), Social (five items), and School (five items) functioning. A 25 questions questionnaire was offered to physicians in the pediatric hematology oncology unit and other specialties treating hematology oncology patients. The questionnaire was based on review of literature, it was validated and offered to 3 physicians to check the applicability of the questionnaire. The physician perception section of the questionnaire covered confidence in and need for PPC, perceived appropriate referral timing of and barriers to PPC. Results The current study included the response of 19 parents of 2-4 years old children, 22 parents of 5-7 years old, 23 parents of 8-12 years old and 17 parents of 13-18 years old. Starting age of 5-12 yrs old children also reported their input. The mean score of physical domain was (69.1±21.1, 58.1±23.91, 66.47±26.48, 54.75±27.85, 60.87±27.05, 47.85±22.95, 52.2±24.40) respectively. The mean score of emotional domain (33.76±21.3, 33.86±26.0, 43.18±34.55, 48.92±29.30, 54.62±31.53, 35.3±24.58, 36.76±21.71) respectively. The mean score of social domain (78.92±19.8, 69.54±18.05, 77.28±24.91, 71.74±19.74, 79.14±19.28, 65.88±25.32, 67.94±24.56) respectively. Most school aged patients were home schooled. The worst reported score was the emotional domain especially among (13-18 years) as fear, anger and sadness were mostly reported by both parents and children. Among physicians involved with pediatric oncology patients, the response rate was 62%. All reported the lack of well- structured PPC service and the lack of specialty training in palliative care. The most common reported barrier was the lack of institutions offering PPC as well as the lack of trained manpower. Other common reported barrier was physicians` and parents` perception towards palliative care either physicians giving up or caregivers insisting on continuation of standard treatment. Almost half of physicians see that initiation of palliative care and home based palliation is necessary, 70% did not recommend referring to adult PC centers with the main concern being the lack of experience and knowledge of such centers with pediatric age group. Conclusion PPC is an essential element of care in patients with malignancy. The lowest score for quality of life were mainly for emotional domain as patients reported fear and worry from the disease prognosis. PPC is not a well established service in our center with most physicians considering PPC as equivalent to end of life care only. The main barrier was lack of manpower and PPC specialized institutions. To improve or initiate this service, specialty training in PPC is a with designation of team of health care professionals (nurse, pediatric oncologist, pain specialist).

Evaluation of parenteral nutrition treatment in hematological oncology patients in terms of appropriateness with ESPEN Guideline and pharmacoeconomics

Evaluation of parenteral nutrition treatment in hematological oncology patients in terms of appropriateness with ESPEN Guideline and pharmacoeconomics

Clinico-Epidmological Study and Outcome of COVID 19 Infection in Children with Hemato-Oncological Disorders

Abstract Background Severe acute respiratory syndrome Coronavirus 2 (SARS-Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. Several studies reported the specific role of an immunocompromised status as a possible risk factor for CoV-related pneumonia. The detrimental impacts of COVID-19 pandemic on childhood cancer are multiple including a delay in diagnosis and starting treatment, the impact of infection, and the uncertainty about the decision for chemotherapy in polymerase chain reaction–positive asymptomatic patients. Aim of the Work The study aimed to Measure the frequency of COVID-19 infection among children with hemato-oncological disorder in a period from 27 February 2022 till 27 March 2023 and to develop a registry dataset which can be used as a template for national registry for children with hemato-oncological disorder with proven COVID19 infection. Patients and Methods This is a retrospective cohort non-interventional study in which we recruited 620 child and adolescents patients who attended the pediatric hematology oncology unit, Ain Shams University, Children’s hospital in a period from 27 February 2022 till 27 March 2023. Results This is a cohort study included 620 immunocompromised children including 319 patients with hematological malignancies, 30 patients with solid malignancy, 271 patients with benign hematology. Our findings showed that 620 patients, 87 of them were found to be COVID-19 positive. The median age of COVID-19 the patients was 5 years (range: 0.75–16 years). The median duration of COVID-19 positivity of the patients was 12 days (range: 3–38 days). There was significant increase in the percentage of patients with positive chest X-ray, abnormal echo, patients with organomegaly in abdominal US in COVID-19 group than non COVID-19 group. Conclusion The percentage of patients with COVID-19 were higher among patients with hematological malignancies and benign hematological diseases especially acute lymphoplastic leukemia and aplastic anemia respectively. COVID-19 was tolerable among immunocompromised patients. Mortality was associated with abnormal neurological examination in patients with COVID-19 disease.

Prognostic Impact of CD200 and CD56 Expression in Patients with Acute Myeloid Leukemia

Abstract Background Acute myeloid leukemia (AML) is a clonal malignant disease of hematopoietic tissue which results from a block of normal differentiation of hematopoietic progenitor cells along with uncontrolled proliferation of cells of myeloid origin with maturation arrest leading to infiltration of bone marrow and other tissues by myeloblasts. It escapes from immunosurveillance by induction of immunosuppression through expression of specific cell surface molecules with immune modulatory function. Novel immune-directed therapeutic approaches form a major focus of current and clinical research. Objective to assess the expression level of CD200 and CD56 in de-novo acute myeloid leukemia patients and evaluate the prognostic value of their positive expressions in patients with AML. Methods This Cohort study was conducted at Ain Shams University Hospitals, on 51 newly diagnosed adult AML patients attending the Hematology Oncology Unit of Ain Shams University Hospitals from February, 2022 until June, 2023. Results CD200+ expression was reported in 74.5% of patients while 9.8% of patients showed CD56+ expression. M1-M2 were found to be the most common FAB subtypes. CD200+ was higher among female patients (p = 0.045). On the other hand, CD56+ patients were younger in comparison to CD56- patients (p = 0.002). Total death was higher among CD200+ patients than CD200- patients (p = 0.037). Conclusion Our study reveals that CD200 expression is associated with higher incidence of mortality which suggests a negative impact of CD200 expression on survival rate while CD56 is not associated with a significant mortality.

Enhancing referral practices: A bariatric department's education initiative to reduce unnecessary referrals to hematology oncology.

82 Background: Bariatric surgery patients face an elevated risk of iron deficiency anemia. Referrals from the Bariatric department to Hematology Oncology for work up of these anemias strain clinic resources and delay timely care for cancer patients. We initiated a targeted education program to reduce unnecessary referrals from the Bariatric department to Hematology Oncology by raising awareness among staff about appropriate referral criteria. Methods: We developed a curriculum highlighting the differences between symptoms of bariatric surgery complications and hematologic malignancies. Interactive training sessions were held with Bariatric department staff, supplemented by informational materials. Case studies and real-world examples reinforced understanding and decision-making. Staff were also educated on managing iron deficiency anemia internally. Referral rates were tracked before and after the intervention. Results: Baseline data were collected from July 2023 to November 2023, showing an average of 17 referrals per month (85 total over 5 months). The educational initiative included three sessions in December 2023 on anemia management and referral criteria. These sessions highlighted the distinction between symptoms of bariatric complications and hematologic malignancies, as well as education to the bariatric surgery providers on management of hematologic diagnoses resulting from bariatric surgery. Post-intervention data from January 2024 to May 2024 showed a substantial reduction in referrals for bariatric-related iron deficiency anemias to an average of 4.4 referrals per month (22 total over 5 months), indicating a 74% reduction. Improved internal management of iron deficiency anemia contributed to this outcome. The percentage of cancer patients receiving a consult within 7 days of referral contemporaneously improved from 85.7% to 88.1%, indicating improved access to oncology care. Conclusions: The educational intervention significantly reduced unnecessary referrals from the Bariatric department to Hematology Oncology, improving access for cancer patients. Empowering staff with the knowledge to make informed referral decisions and manage common hematologic issues internally improved patient care and clinic efficiency, reducing healthcare costs and patient burden in both departments.

Improving childhood cancer care in South Africa using the Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool

Aim Using the St. Jude Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool, the South African Association of Paediatric Haematology Oncology (SAAPHO) collaborated with St Jude Children’s Research Hospital to evaluate the delivery of health services and provide evidence-based assessments to inform and prioritise action plans to improve childhood cancer care. Methods PrOFILE was used to assess paediatric oncology care in thirteen public-sector hospitals comprehensively. Following that, representatives from each of the thirteen public-sector hospitals and from SAAPHO, the National Department of Health, the World Health Organization, St. Jude Global, and Childhood Cancer Foundation South Africa participated in a national stakeholder prioritisation workshop. Participants were assigned one of the PrOFILE components (Context, Workforce, Diagnostics, Multidisciplinary Team, Therapy, or Patients and Outcomes), forming six working groups to assess, map, and evaluate childhood cancer topics. Using a modified implementation mapping approach and through participation in structured co-designed activities, each group designed multi-level health interventions: prioritising initiatives identified by the SAAPHO, setting goals for each priority, co-designing project-specific logic models, reviewing potential barriers to implementation, and developing a post-workshop agenda. Results Individual hospital reports and a national aggregate report were compiled to discuss opportunities and priorities. The goal of the workshop was to utilise evidence-based assessments to achieve, a) objective assessment data to inform prioritisation exercises conducted by stakeholders, and b) priorities and action plans to inform childhood cancer control activities and demonstrate national organisation, human resources capabilities, and technical support to improve childhood cancer care. Through structured discussion and voting, six priority areas were identified and assigned to working groups: redrafting the organisation’s constitution, standardising multidisciplinary reporting, developing protocols and treatment guidelines, establishing fever-management guidelines, strengthening chemotherapy safety practices, and enhancing hospital-based cancer registries. Conclusions An implementation map enabled stakeholders to develop actionable plans, the success of which is demonstrated by the active implementation of the identified priorities by the focused working groups. This could serve as a model for countries with identified priorities but need more means to implement them. Based on mapping and outputs from the PrOFILE workshop, the NDoH will facilitate the creation of a childhood cancer committee to sustain progress on the key themes and priorities identified through the PrOFILE mapping process.

Improving vaccination counseling rates in first time patients with cancer: A multi-disciplinary approach.

315 Background: ASCO guidelines 2024 recommend that “clinicians determine vaccination status and ensure that adults newly diagnosed with cancer about to initiate treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines.” Prior to the study, Baylor Scott and White Hematology Oncology Round Rock (BSWHRR) clinic lacked a formalized process for vaccine education. The primary aim of this study was to increase vaccination counseling for first-time cancer patients with solid tumors or hematologic malignancies. The secondary endpoint was to optimize vaccination status for this group of patients. Methods: Inclusion criteria were patients 18 years or older with initial diagnosis of solid tumor or hematologic malignancy, receiving chemotherapy and/or immunotherapy for the first time, and treated within BSWHRR. Exclusion criteria were patients with subsequent malignancy, malignancy requiring second line chemotherapy and/or immunotherapy, or deceased. Patients meeting these criteria n=57 were collected during the pre-intervention period October 15-December 15. Post-intervention data n=52 was collected 6 weeks following the initiation of the intervention from February 18 – April 18. The intervention included a 2-sided handout containing current recommendations for vaccination schedules in immunocompromised adults. These handouts were provided along with counseling at 2 separate encounters (during the initial consult and during chemotherapy education). The handout included instructions for scheduling vaccines with the Baylor Scott and White Pharmacy and/or their PCP. This multi-disciplinary approach included nurse navigators, triage nurses, pharmacists, and physicians. A standardized documentation process was initiated and utilized for both consult and chemotherapy education encounters. Results: Following the introduction of vaccine education handouts and standardized documentation, vaccine counseling rates during the consult visit improved from 0% to 49%. Vaccine counseling rates during chemotherapy education visits increased from 0% to 71%. Overall, the number of patients that attended and were counseled during at least one of these visits increased from 0% to 70%. The secondary endpoint of increasing vaccination rates showed that non-seasonal vaccination rates improved. Pneumococcal vaccination rates improved from 33% to 42%, a 27% increase. Shingles coverage improved from 16% to 25%, a 56% increase. Conclusions: This study showed that a multidisciplinary approach, utilization of patient/physician education handouts, and standardization of documentation was effective in achieving a substantial increase in vaccination counseling rates for patients with newly diagnosed malignancy. The intervention was also effective in achieving the secondary endpoint of increasing pneumococcal and shingles vaccinations.

Central Nervous System Fungal Diseases in Children with Malignancies: A 16-Year Study from the Infection Working Group of the Hellenic Society of Pediatric Hematology Oncology.

We analyzed data on pediatric invasive fungal diseases of the central nervous system (CNS-IFDs) reported by five of a total of eight Pediatric Hematology-Oncology Departments in Greece for 16 years (2007-2022). A total of twelve patients (11 boys, median age: 9.5 years, range: 2-16) were reported suffering from CNS-IFDs. The underlying malignancy was acute lymphoblastic leukemia in 9/12 and acute myeloid leukemia, Ewing sarcoma, and rhabdomyosarcoma in one each. Eleven patients presented with CNS-related symptoms (i.e., seizures, headache, cerebral palsy, ataxia, hallucination, seizures, blurred vision, amaurosis). All patients had pathological MRI findings. Multifocal fungal disease was observed in 6/12 patients. Nine proven and three probable CNS-IFD cases were diagnosed. Causative pathogens in proven cases were Aspergillus spp. and Candida albicans (n = 2 each), Mucor spp., Rhizopus arrhizus, Absidia spp., Fusarium oxysporum and Cryptococcus neoformans (n = 1 each). Causative pathogens in probable cases were Aspergillus spp. (n = 2) and Candida spp. (n = 1). All patients received appropriate antifungal therapy (median duration: 69.5 days, range 19-364). Two patients underwent additional surgical treatment. Six patients were admitted to the Intensive Care Unit due to complications. Three patients (25%) died, two due to IFD and one due to an underlying disease. Early recognition and prompt intervention of CNS-IFDs may rescue the patients and improve overall survival.