Pediatric Oncology Unit Research Articles

Positron emission tomography-magnetic resonance imaging applications in pediatric musculoskeletal tumors.

The hybrid imaging positron emission tomography/magnetic resonance (PET/MR) is an important tool in the management of pediatric oncology patients, particularly in malignant musculoskeletal pathologies, because it combines the functional and metabolic information of tumor provided by PET with the high soft-tissue contrast and the functional information offered by magnetic resonance imaging (MRI). We performed an observational retrospective study that included pediatric patients diagnosed with primary bone or soft-tissue sarcomas in the Pediatric Hematology and Oncology Unit at the HM Montepríncipe University Hospital, Boadilla del Monte, Madrid (Spain) who underwent whole-body 18F-fluorodeoxyglucose (18F-FDG) PET/MRI as a staging study and for follow-up evaluation for treatment response from September 2017 to January 2023. This study explores the protocols, the practical application of the PET/MRI technique and our clinical experience at our center in the diagnosis and follow-up of primary bone tumors and soft-tissue sarcomas in children. Seventy-one 18F-PET/MR studies were performed on 39 patients. Most of them (55%) were initial extension studies and (45%) were follow-up studies. Most of the patients studied were male (74.4%) with a median age of 15 years. Of the 39 cases, 51% were primary bone tumors while 18% were Langerhans cell histiocytosis and 21% soft tissue tumors. Of the 71 studies, five showed metastases at the initial diagnosis, three presented lymph node involvement, one with local infiltration, and one with pulmonary metastasis. PET/MR has represented a significant advancement in the evaluation of pediatric malignant neoplasms, with specific applications in musculoskeletal tumors showing clear benefits over PET/CT. The primary advantage is the reduction in ionizing radiation doses and the assessment of soft tissues, making it an excellent option for malignant musculoskeletal pathologies in pediatric patients who often require long-term follow-up. It is particularly useful for early tumor detection and functional therapy monitoring in oncology. The development of new protocols is making studies increasingly faster and better tolerated, even without the need for anesthesia. PET/MRI has shown to increase diagnostic accuracy in primary bone and soft tissue tumors, as it allows for the comprehensive evaluation of their morpho-metabolic characteristics, locoregional, and distant involvement in a single study. It is also useful in surgical planning and post-treatment follow-up.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (>300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

Implementation of a Nurse-Initiated Antibiotic Time-Out (NATO) in Childhood Cancer Patients in Central America

Abstract Background Children with cancer are at high risk for infection and frequently require antimicrobials. Antimicrobial stewardship (AMS) interventions can mitigate toxicity and development of antibiotic resistance yet the pharmacy and infectious diseases specialists who usually perform AMS are often absent in global settings. We report our experience testing a novel intervention to shift the antibiotic timeout to nurses in six pediatric oncology units in Central America. Methods The Nurse-initiated Antibiotic Timeout (NATO) is a scripted conversation between nurses and physicians to reevaluate antibiotic appropriateness after 48 to 72 hours of empiric use for febrile neutropenia. First, we performed a baseline assessment of AMS capacity using the WHO Practical Toolkit for AMS Programmes checklist. Based on these results, sites tailored a generic implementation plan emphasizing educational and documentation tools and iterative PDSA (Plan-Do, Study-Act) cycles to improve implementation and effectiveness outcomes. Results All sites collected antimicrobial use data for a minimum of two months. Four sites then piloted NATO, producing change ideas, including changes to documentation tools, antimicrobial decision categories, communication processes, and times. From August 2022 – October 2023, NATO was performed in 53.4% of febrile neutropenia episodes in the three sites reporting data. Sites had substantial NATO performance rate variation from month to month. Sites reported changes in antimicrobial therapy in 47% of episodes after a 6-month period (Figure 1). Conclusion The difference in performance rate of NATO underscores the importance of real-time reporting to adjust AMS implementation strategies. The change ideas developed by each site differed, however, core tools emerged, which will support AMS in other global settings. Next steps include comparing antimicrobial use pre- and post-intervention and determining a sustainability and scalability plan. Figure 1. Incidence of change in antibiotic therapy over time.

Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study.

Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant. A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD. A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse.

Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability.

Family-centered care (FCC) is an intervention approach based on a respectful relationship between family and health care providers (HCPs) to ensure the health and well-being of children and their families. Although HCPs have a better perception of FCC, the level of its implementation is low. Reasons for low implementation include limited understanding, lack of training, and lack of implementation guidelines and tools to support implementation. Thus, we developed the Parent Education and Counseling (PairEd-C) intervention to improve FCC in pediatric oncology settings and assess its acceptability. The objective of this study is to assess the prospective acceptability of the PairEd-C intervention using the theoretical framework of acceptability (TFA) in the pediatric oncology department in a tertiary hospital in Ethiopia. The study was conducted using an exploratory qualitative study design. We aimed to recruit 10 to 15 participants for the in-depth interview. The study participants were health service leaders working in child cancer, HCPs, social workers, and parents of children with cancer. The intervention was developed using the integration of the first phase of the Medical Research Council (MRC) framework for developing and testing complex interventions and the behavior change wheel (BCW) framework. The main PairEd-C intervention components align with the intervention functions of education, persuasion, training, environmental restructuring, modeling, and enablement, which were intended to improve FCC in the pediatric oncology unit by providing structured and comprehensive education and counseling of parents of children with cancer. The intervention was implemented by providing training for the health care team, facilitating discussion among HCPs and setting a shared plan, improving the commitment of the health care team, providing education for parents, improving parents' capacity to attend the intervention sessions, arranging discussion among parents of children with cancer, and provision of education and counseling on distress. The HCPs working in the unit received training on the designed intervention. The trained educators and the health care provider delivered the intervention. Data will be analyzed using deductive thematic coding with a framework analysis technique based on the 7 TFA constructs. Atlas ti. version 9 will be used for data analysis. Funding was acquired in 2017, and ethical clearance for conducting the study was obtained. We conducted the interviews with the study participants from December 2023 to January 2024. As of the acceptance of this protocol (June 2024), 12 study participants were interviewed. The data analysis process was started subsequently, and the manuscript will be completed and submitted for publication in early 2025. This acceptability study is expected to show that the designed intervention is acceptable to study participants, and the findings will be used to improve the intervention before progressing to the next step of our project. DERR1-10.2196/54914.

Cancer Predisposition Syndromes in Children: Who, How, and When Should Genetic Studies Be Considered?

Early detection of cancer predisposition syndromes (CPS) is crucial to determine optimal treatments and follow-up, and to provide appropriate genetic counseling. This study outlines an approach in a pediatric oncology unit, where 50 randomly selected patients underwent clinical assessment, leading to 44 eligible for genetic testing. We identified 2 pathogenic or likely pathogenic variants in genes associated with CPS and 6 variants of uncertain significance (VUS) potentially associated with cancer development. We emphasize the importance of a thorough and accurate collection of family history and physical examination data and the full coordination between pediatric oncologists and geneticists.

Implemented nutritional intervention algorithm in pediatric oncology compared to standard nutritional supportive care outcomes

AimTo implement a childhood cancer-specific nutritional algorithm adapted for the South African context for interventions at time-set intervals to evaluate differences in the nutritional status of newly diagnosed children with cancer. MethodChildren with newly diagnosed cancer were assessed for stunting, underweight, wasting, and moderate to severe malnutrition (MUAC < -2SD and < - 3 SD) between October 2018 and December 2020 in a longitudinal nutritional assessment study with monthly assessments. Two pediatric oncology units (POUs) served as the intervention group that implemented the nutritional algorithm-directed intervention and three other POUs formed the control group that implemented standard supportive nutritional care. ResultsA total of 320 patients were enrolled with a median age of 6.1 years (range three months to 15.3 years) and a male-to-female ratio of 1.1:1. The malnourished patients in the intervention group showed significant improvement at six months after diagnosis for stunting (P =0.028), underweight (P < 0.001), and wasting until month five (P = 0.014). The improvements in the control group were not significant. Moderate acute malnutrition (MAM) significantly improved over the first six months of cancer treatment in the intervention group (P <0.001), while MAM improvement was only significant in the control group for the children under five years of age (P = 0.004). The difference in mean z-scores over time for the nutritional parameters between the intervention and control groups was insignificant. ConclusionWe established that the nutritional algorithm adapted for South Africa as an intervention tool for childhood cancer assisted in optimizing nutritional interventions and improved nutritional outcomes over the first six months of cancer treatment.

Changes over the last two decades in Hemophilia A and B management in a Tertiary Care Pediatric Centre

ObjectiveThe treatment of Hemophilia A and B has significantly evolved. Study designwe conducted a retrospective, observational study among patients with HA and HB managed in a Pediatric Hematology and Oncology Unit for almost 22 years for a total of 34 patients. ResultsUntil 2009, more than 80 % of patients were treated only on demand, while in 2022,100 % of patients with moderate and severe disease were receiving continuous prophylaxis. The median age at the start of prophylaxis passed from 10,9 to 1,65 years. In 2022, only one patient was on Standard-half-life-rFVIII, 7 patients were on Extended Half-Life (EHL)-rFVIII/rFIX and 7 patients were on Emicizumab; 1 patient was on Concizumab. The mean ABR passed from 5,7 in the period 2001–2009 to 0,8 in the period 2019–2022. We performed 106 ultrasonographic exams in 19 patients to evaluate the HEAD-US score: a percentage of 45,3 % of these exams revealed a score of 0 and the HEAD-US score resulted inferior in patients who started prophylaxis at an age below the median age at the initiation of prophylaxis. The score showed a tendency to correlate with the number of previous hemarthrosis. In our cohort, the overall prevalence of inhibitors is 0,09 among all patients, and 0,14 in severe HA/HB. 4 patients needed a Central Venous Line (CVL), and 3 patients developed at least one severe complication. Before 2017, we observed 4 cases of life-threatening bleeding in children less than 2 years old not on prophylaxis. Resultsour real-life experience reflects the changes in hemophilia management in the last two decades. In the future, other drugs are expected.

Outcome of Retinoblastoma After Implementation of National Retinoblastoma Treatment Guidelines in South Africa.

Retinoblastoma, a curable childhood cancer, has been identified as a tracer cancer in the WHO Global Initiative for Childhood Cancer. To document the outcomes of children with retinoblastoma in South Africa, treated as per the first prospective standard national treatment guidelines for childhood cancer in South Africa. All children diagnosed with retinoblastoma between 2012 and 2016 in five South African pediatric oncology units were treated with a standard treatment on the basis of the International Society of Pediatric Oncology-Pediatric Oncology in Developing Countries guidelines for high-income settings. Treatment included focal therapy with/without chemotherapy, or enucleation with/without chemotherapy, and orbital radiotherapy, depending on enucleated eye histology. The end point was survival at 24 months, using Kaplan-Meier curves with log-rank (Mantel-Cox) and chi-square (χ2) tests with respective P values reported. A total of 178 children were included in the study; 68% presented with unilateral disease. The median age was 27 months (range 0-118 months) with a male:female ratio of 1:0.75. The overall survival was 79% at 24 months with significant association with stage at diagnosis (P < .001) and older age over 2 years as opposed to younger than 2 years (P < .001). Causes of death were disease progression/relapses in 90% (34 of 38) and unknown in 2% (1 of 38), whereas treatment abandonment was 1.7% (3 of 178). Efficacy with national treatment guidelines was confirmed, and feasibility of implementing standard national childhood cancer treatment guidelines was documented, involving multidisciplinary teams in South Africa. Outcome was significantly associated with stage at diagnosis and age.

Family-centered care for child cancer treatment in Ethiopia—A qualitative descriptive study

BackgroundFamilies are the primary source of support and strength in the care process of children with cancer. Family-centered care (FCC) is a healthcare delivery approach that considers parents as both partners and care recipients, characterized by providing care based on dignity and respect, information sharing, participation, and collaboration or partnership. AimThis study aimed to describe the delivery of care based on the family-centered care approach at the Tikur Anbessa Specialized Hospital pediatric cancer unit. MethodAn exploratory, descriptive qualitative study was conducted from March 2023 to August 2023. Eighteen participants (thirteen parents and five health care providers) were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and translated into English. The translated transcripts were used for inductive, data-driven thematic analysis. ATLAS.ti 9 software was used to assist the analysis process. ResultTwo themes have emerged during the analysis. These are (1) Information sharing, and (2) Enabling and partnership. Under the information sharing theme, we described parents' understanding of child cancer, parents' information-related expectations, the process of obtaining information, adequacy of information received, and factors inhibiting information sharing. Under the enabling and partnership theme, we presented family participation in childcare, discussion among parents, parents' communication with healthcare providers and psychosocial support. ConclusionSuboptimal implementation of family-centered care practice was identified at the pediatric oncology unit. Practice implicationsThe findings from this study indicate the need to strengthen the provision of child cancer-related information, improve communication, and strengthen family participation in childcare.

The Effect of Oral Care Protocols on Mucositis in Pediatric Cancer Patients: A Randomized Controlled Trial

Background/Aims: Standard oral care protocols can reduce the incidence of mucositis. This study aimed to evaluate the effect of the "Oral Care Protocol" containing sodium bicarbonate or saline on mucositis development, degree, and duration in pediatric cancer patients. Methods: This study is a blind, parallel trial design, randomized controlled study. Patients (n = 43) who received inpatient chemotherapy treatment for more than three days at the Pediatric Hematology and Oncology Unit were included. The oral care protocol with saline was given to the patients in the control group (n = 22), and the oral care protocol with sodium bicarbonate was given to the patients in the study group (n = 21). The primary outcome was the development of mucositis. The secondary outcomes were mucositis degree, patient data at the time of mucositis development, and the duration of mucositis. The characteristics of the patients in the study and control groups and the data of patients with and without mucositis were compared with Fisher's exact test, t-test, and chi-square analysis. Results: No statistically significant difference was found between the study and control groups in terms of mean age, gender, diagnosis, relapse status, treatment stage, risk group, and treatment protocols. Mucositis developed in 18.2% of the patients in the control group and 9.5% of the patients in the study group. No statistically significant difference was found in terms of mucositis development, degree, and duration. Conclusions: The oral care protocol with sodium bicarbonate can be used to prevent mucositis in pediatric cancer patients. ClinicalTrials.gov Identifier: NCTXXX.

CELF4 (rs1786814) gene polymorphism and speckle-tracking Echocardiography for cardiovascular complications in childhood cancer survivors.

Despite a well-known dose-dependent association between the risk of cardiac dysfunction and anthracycline, the risk of cardiac dysfunction for any given anthracycline dose varies between patients. So, we assessed CELF4 (rs1786814) gene polymorphism on anthracycline-related cardiotoxicity in childhood cancer survivors (CCS). This comparative cross-sectional study included 53 CCS who had regular follow-up visits at the Pediatric Oncology Unit, Menoufia University Hospital. CELF4 (rs1786814) gene polymorphism and conventional and speckle-tracking Echocardiography were done for all survivors. Regarding CELF4 (rs1786814) genotypes, significant differences existed between the studied groups with a predominance of GG homozygous mutation. For Echocardiographic findings, the ejection fraction and end-systolic diameter compared to the control group, were significantly lower in the survivors group. Speckle- tracking Echocardiography showed a significant difference regarding (GLPS-A4C) and (GLPS-LAX), with no significant difference regarding (GLPS-A2C), (GLPS-Avg) and left atrium between the studied groups. Multivariate logistic regression analysis illustrated a statistically significant relation between cumulative anthracycline dose >300 mg/m2 and CLEF4 (rs1786814) genotypes (GG and GA) and the risk of cardiotoxicity with more significance in GG mutation. Early detection of ventricular dysfunction in CCS with subclinical cardiotoxicity with regular follow-up is promising before the development of life-threatening complications. Early detection of anthracycline-related cardiotoxicity in childhood cancer survivors (CCS) after finishing chemotherapy. CLEF4 (rs1786814) GG variant is more significant in CCS exposed to high-dose anthracycline. GLPS holds promise as an early predictor of late left ventricular dysfunction and subclinical cardiotoxicity in CCS.

Childhood cancer presentation and initial outcomes in Ethiopia: Findings from a recently opened pediatric oncology unit.

There were no pediatric oncology centers in southwest Ethiopia prior to 2016. This study aims to describe presenting diagnoses and initial outcomes at Jimma University Medical Center (JUMC), the first pediatric oncology unit (POU) in southwest Ethiopia, provide initial insights into regional pediatric cancer epidemiology, illustrate the rapid growth of pediatric cancer services, and highlight ongoing challenges. We used a retrospective descriptive approach to assess the epidemiologic pattern and initial treatment outcomes of pediatric cancer at JUMC POU from August 2016 through December 2022. During the study period, 749 children were diagnosed with cancer at JUMC. The mean age was 7.2 years (20 days-18 years). Acute lymphoblastic leukemia was the most common diagnosis (16.4%), followed by non-Hodgkin lymphoma (12.4%), Wilms tumor (11.1%), soft tissue sarcoma (8.8%), Hodgkin lymphoma (8.4%), and retinoblastoma (8.3%). Brain tumors accounted for only 2.7% of the diagnoses. Of the 703 patients that were not referred elsewhere, 42% of the patients abandoned treatment, 29% died, 17% completed treatment, and 7% remained on treatment at the time of this assessment. The findings emphasize the growth in the diagnosis and treatment of children with cancer in the southwest region of Ethiopia. The data suggests a different epidemiologic profile of childhood cancer cases diagnosed at the JUMC POU compared to high-income countries and neighbouring countries in Africa. Treatment abandonment remains a barrier to care. Ongoing areas of focus include establishment of a hospital-based cancer registry, reduction of treatment abandonment, improvement of diagnostic capacity, and increased access to advanced supportive care.

Ewings sarcoma in pediatric population of North India: Demographics, outcome & prognostic factors

BackgroundEwings sarcoma is relatively rare and accounts for a 3–4% of childhood cancer. The data of Ewings sarcoma is scarce in North India and so the study was planned to find out the demographics, outcome and prognostic factors of Ewings sarcoma. MethodsThis is a retrospective study conducted in the Department of Pediatrics, Pediatric Oncology unit at a tertiary care centre (KGMC, Lucknow) in North India. All patients of age 1–16 years with biopsy and IHC proven Ewings sarcoma during 2015–2020 were included in the study. Parameters were noted and follow up was done till December 2021. Statistical analysis was done by Microsoft Excel and GraphPad Prism 10. Overall survival was assessed using Kaplan Meir Survival Analysis. P value < 0.05 was considered significant. Results75 patients i.e.4.1 % of the total were diagnosed with ES. Median age of patients was 10 years. 37.35 % had metastasis at presentation. 32 % were defaulters (abandoned and not taking treatment). Extremity ES constituted 46.7 % of the patient. 29.4 % patients relapsed. The overall survival of the whole cohort was 23.5 % and OS of localised disease was 42.3 %. OS of patients with respect to various sites failed to show any significance. Staging of disease have shown to be affecting outcome. ConclusionProportion of Ewings sarcoma was in accordance with the world's data but the survival outcome was low at our centre primarily due to delayed presentation translating to metastatic disease at diagnosis and abandonment issues along with defaults in treatment. Conducting focussed group discussions, awareness sessions, caregivers counselling and educating them about disease might help in curbing these factors.

Knowledge, Attitudes, and Practices regarding Pain Assessment among Nurses Working at Public-Sector Pediatric Oncology Units in Pakistan

Abstract Introduction Pain in pediatric oncology patients is often undertreated due to a lack of timely assessment and inefficient communication between health care workers. Improper pain assessment is a leading cause of poorly managed pain in children. In high-income countries, pediatric oncology nurses play a key role in developmentally appropriate pain assessment measures to identify potential management strategies. However, nurses in low- and middle-income countries (LMICs) face a deficit of knowledge about pain assessment tools and management. Owing to differences in availability of resources, a disparity exists between health-related quality of life of cancer patients treated at public- and private-sector hospitals in Pakistan. Methodology The Indus Hospital and Health Network partnered with nine public-sector hospitals nationwide to improve pediatric oncology practices. Supported by the My Child Matters grant, training sessions were conducted for nurses at each public-sector pediatric oncology unit (POU) from March to December 2021. Pain assessment tools were provided. To assess retention and implementation of practices, a knowledge, attitudes, and practices questionnaire was distributed online to nurses at each POU. All responses remained anonymous. Results Fifty-four responses were recorded, 85% were female and most were between 26 and 30 years of age. Most of the participants held a diploma in nursing and were designated charge nurses with more than 6 years of experience. Forty nurses reported routinely assessing pain; the most common reason for not doing so was increased workload. Correlations were observed between routinely performing pain assessment and the number of patients per nurse, availability of formal credentialing or certifications at the institution and routinely performing pain assessment, availability of trainings focused on pain assessment and routinely performing pain assessment, and qualification of nurses and knowledge of nonpharmacological pain assessment methods. Conclusion Strategies to improve pain assessment knowledge and practices among pediatric oncology nurses in LMICs must be developed to improve patient care and clinical outcomes.

The Impact of Music Therapy in a Pediatric Oncology Setting: An Italian Observational Network Study.

Music Therapy (MT) is a non-pharmacological, art-based intervention that employs music experiences within a therapeutic alliance to attend to clients' physical, emotional, cognitive, and social requirements. This is the first study aiming at investigating the impact of MT on the psychological facets of children suffering from cancer. The study, combining the AQR and m-YPAS assessment tools, evaluated behavioral, sound-musical, and interactive parameters in pediatric oncology patients undergoing MT sessions during hospitalization. Fifty patients admitted to the Paediatric Oncology and Haematology Unit at Policlinico S. Orsola Hospital in Bologna, Italy, were enrolled, irrespective of their treatment regimen. Data collection occurred on the first day of the MT session between 3 p.m. and 5 p.m., with observations conducted by independent observers. In addition to traditional statistical analysis, network analysis was used to explore the combined interactions of all parameters, effectively discerning the distinctive roles played by each one during therapy sessions and their influence on all others. Network analysis highlighted distinct patterns of interactions among parameters during the various sessions, emphasizing the role of positive emotions and a calm setting, the child's ability to take the initiative in sessions, their sense of agency, and the parent's role in guiding them. Significant differences were recorded at each time point between all variables considered. The results of this innovative study may pave the way for future multicenter studies aimed at further exploring the role of MT in children undergoing both curative and palliative treatments for cancer.

Clinical Features and Treatment Outcome of Pediatric Acute Promyelocytic Leukemia in Combined Military Hospital, Dhaka

Background: Acute promyelocytic leukemia (APML) is a relatively rare blood disease in children that is highly curable with current treatment strategies. It is a distinct type of AML characterized by chromosomal translocations involving the retinoid acid receptor (RAR-A) gene on chromosome 17. It accounts for 20-25% of all AML cases. The aim of this study was to describe the diagnostic features of pediatric APL and the result with ATRA and ATO based protocol. Methods: It was a descriptive type of cross-sectional study with purposively selected 10 newly diagnosed APML patients treated in the Pediatric Oncology unit of the Department of Pediatrics in CMH Dhaka during the period of 2018 to 2022. Diagnosis of all patients were done by aspirating bone marrow morphology and cytogenetic t(15:17) or t(11:17) transcript. Informed written consent was taken from parents. Data were collected by semi-structured questionnaire and analyzed by Statistical Package for Social Sciences (SPSS version 25). Results: Among 10 respondents median age was 4.2 years with female predominant (60%). Most common clinical presentations at diagnosis were fever (100%), bleeding manifestations (100%), Hepatomegaly (90%) bony tenderness (90%), splenomegaly (70%), and lymphadenopathy (70%). Almost all the patients had low Hb &amp; low platelet count &amp; WBC were variable. Cytogenetic analysis revealed 90% had PML/RARA positive &amp; 30% had FLT3/ITD positive. All of these patients were treated with trans-retinoic acid (ATRA) based treatment, which led to 80% cases ATRA syndrome. Other common toxicities noticed febrile neutropenia (50%), severe headache (30%), hyperpigmented skin (10%), pseudotumor cerebri (10%) and others. There were 10% relapse cases, which later proceeded to relapse protocol and were in remission. The remaining 90% of patients were alive and in remission until the last day of follow-up. Conclusion: With ATRA-based treatment overall survival is good achieved remission and only 10% of patients developed relapse. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 1-9

The Mortality Rate in Neutopenic Children Population in Oncology an Algerian Study

Febrile neutropenia consecutive to the administration of chemotherapy constitutes the most serious and the most frequent complication of cytotoxic chemotherapies. It is often a sign of infection, being able to quickly turn in septicemia if no treatment is begun; it thus constitutes an emergency for diagnosis and therapeutics. The objective of this work is to study the epidemiological, clinical, biological, etiologic and evolutionary characteristics of the episodes of febrile neutropenia, to evaluate the importance of the infectious risk and the main involved germs, to identify the difficulties of the management and the follow-up of the children having developed a febrile neutropenia and finally. During our retrospective study concerning the episodes of febrile neutropenias diagnosed in the pediatric oncology unit of the pediatric department of the university hospital of Alger over a period of 04 years (from 1 January 2017 to 31 December 2020). 205 patients having solid tumor were collected. Among them 45 cases presented febrile episodes, the average age was 5.75 years with a maximum frequency of them were male, and the main motive for consultation was the fever. The average deadline of occurrence of neutropenia was of 14.6 days. A documentation of the fever is obtained clinically at 20 % of the cases, while in 80 % of the cases, the fever remains unknown origin. The infectious sites found are: a) Skin (6.6%), digestive (4.4%), respiratory (8.8%). b) The average duration of the neutropenia was of 18.8 days. Upon completing this work, we emphasize the need of prompt and appropriate management of the hematological emergency that is febrile neutropenia by an adapted empirical antibiotic therapy after a good bacteriological investigation, without forgetting the importance of prophylaxis based mainly on hygienic mucocutaneous measures and the information/education of parents about the risk of infection and means of prevention.

Fall prevention in a pediatric unit: a best practice implementation project.

Inpatient falls account for 6% to 24% of pediatric safety incidents and can lead to increased length of hospital stay, increased cost of care, and decreased satisfaction with care. A review of a pediatric hematology, oncology, neurology, and rehabilitation unit in a hospital in the southern United States revealed an average of one to two falls monthly. This project aimed to promote evidence-based practices (EBPs) regarding fall prevention in the pediatric unit. This project used the JBI Evidence Implementation Framework to promote EBPs regarding pediatric fall prevention. A baseline audit was conducted to identify gaps between evidence and current practice. Barriers to EBPs were identified, strategies were implemented to promote EBPs, and a follow-up audit was conducted to measure the effectiveness of the improvement strategies. The baseline audit revealed 100% compliance with all criteria except for Criterion 1 (using a validated assessment tool), which scored 0%, and Criterion 5 (communication between nurses at shift handover), which scored 69%. In the follow-up audit, Criterion 1 remained at 0%, but Criterion 5 rose to 82%. This project identified areas of non-compliance with best practice recommendations for the prevention and assessment of pediatric fall risk. Interventions were implemented, with positive results. Further investigation is needed to assess the long-term effectiveness of the interventions. http://links.lww.com/IJEBH/A196.

Short-term chemotherapy-related complications and undernutrition in children diagnosed with cancer at Korle Bu Teaching Hospital, Accra, Ghana: A prospective cohort study.

Undernutrition in children with cancer is associated with complications during cancer therapy. The study objective was to determine the association between specific anthropometric parameters and short-term chemotherapy-related complications and mortality. This was a hospital-based, prospective cohort study of children, age ≤12 years, with a new cancer diagnosis at the Paediatric Oncology Unit, Korle Bu Teaching Hospital, Ghana. Socio-demographic information, cancer characteristics and anthropometric measurements were obtained at enrolment. Participants were followed up for twelve weeks from commencement of chemotherapy and selected treatment-related complications such as anaemia and thrombocytopenia requiring transfusions, prolonged neutropenia resulting in treatment delays, febrile neutropenia, mucositis and death were recorded. A total of 133 participants were recruited with a median age of 4.5 years. Eighty-one (60.9%) were diagnosed with solid tumours, 31 (23.3%) had leukaemias and 21 (15.8%) had lymphomas. Of the anthropometric parameters assessed, only arm anthropometry using upper arm muscle area (UAMA) and mid-upper arm circumference (MUAC) were associated with complications. Participants with wasting were more likely to develop anaemia and mucositis. However, the incidence of prolonged neutropenia was significantly higher among participants with average UAMA (p = 0.043) and low average UAMA (p = 0.049) compared to those with low UAMA. Risk of neutropenia was also significantly less among those with wasting by MUAC compared to those well-nourished (p = 0.045). Twenty-three participants (17.3%) died with a greater proportion (11/44; 25%) occurring in those who were wasted using MUAC. These findings underscore the need for nutritional surveillance at diagnosis and during chemotherapy, particularly where co-morbid disease is prevalent.