Pediatric Cancer Hospital Research Articles

THE IMPACT OF HEALING GARDENS ON IMPROVING PSYCHOLOGICAL RECOVERY OF CHILDREN –APPLICATION ON PEDIATRIC CANCER HOSPITAL IN EGYPT

There is an increasing interest in using healing gardens in general hospitals and in pediatric hospitals in particular since it has an important psychological impact on children for instance it reduces stress. The paper focuses on the impact of health care on hospitalized children, theories of environmental restoration and design guidelines for healing gardens in children's hospitals.The paper aims to prove the relation between the design of healing garden and hospitalized children behavior to discover if certain elements of design principles have indeed a positive impact on psychological recovery of children, and if so, what are these elements and how they can be improved.The paper examined the perceptions of 25 children towards the healing garden in the pediatric cancer hospital in Egypt and the results revealed that, 80% of children showed satisfaction toward the garden. 20% of them gave no negative comments. Additionally, fifth likert scale was conducted to identify the impact of healing garden on psychological recovery of children. The results showed that not only 95.6% of 50 specialized therapists and psychiatrists admitted that the communication with nature has a positive effect on psychological recovery of children. The most important survey was made with 50 volunteers who discussed the effectiveness of 25 elements from 6 design principles for a healing garden in pediatric cancer hospital. These principles was agreed on by the volunteers with different percentage sense of control (74.8%), Social support(74.6%), positive distractions(67.6%), sensorial dimensions(53.2%), movement and exercise(60.4 %) and Natural distractions(89.2%).Finally, the paper is concluding that healing gardens have an important role in increasing the communication between sick children and nature, improving cognitive performance and promoting psychological recovery

"Getting to know you and your child" screening questionnaire: Results from a Chicago-based collaborative.

150 Background: In 2013 the Institute of Medicine recommended that supportive oncology services be initiated at time of cancer diagnosis. Providers of pediatric cancer care in the Chicago metro area, supported by The Coleman Foundation, created and pilot tested a standard psycho-social stressors screening instrument for children with cancer and their families. Methods: The collaborative conducted structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; and collected input from social workers and oncology providers on stressors throughout the care continuum. The resulting tool was piloted in English and Spanish at 7 pediatric cancer hospitals. Providers qualitatively reported assessment of its usefulness. Results: Patients/family (n = 57) completed the “getting to know you and your child” instrument which inquired about caregivers, siblings, child’s likes/hobbies, school situation, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported that almost all families found the tool useful “to think about support needs”; one said it was invasive. The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.49 (range 0-11). The most frequent stressors were support from friends, family, community (30%), paying for food (26%), job flexibility (26%), school concerns (25%), emotional support for family (25%), and medical costs (23%). All who reported temporary housing also reported difficulty paying for a place to live (p < 0.0001). Providers reported that the standard tool generated new insight into family structures, challenges and needs informing resolution efforts. Provider recommended adjustments: simplify terms for siblings, hobbies and spiritual, adding question about pets in the home. Conclusions: Pilot testing of a psycho-social screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Four of the seven sites involved in the pilot are now implementing this tool as a standard practice; the remaining sites are performing analyses on how to incorporate the tool into their care processes.

Cognitive Interview-Based Validation of the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events in Adolescents with Cancer

ContextThe National Cancer Institute created the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) to allow direct input on symptomatic adverse events (AEs) from adult patients in oncology trials. ObjectivesThis study sought to determine the youngest age to complete the PRO-CTCAE, evaluated comprehension of PRO-CTCAE among adolescents, tested new items not currently in PRO-CTCAE, and tested a parent-proxy version. MethodsFrom seven pediatric cancer hospitals, 51 adolescents (13–20 years) receiving cancer treatment participated, along with 40 parent proxies. We evaluated 55 AEs from the PRO-CTCAE library (97 questions) and seven new AEs not in PRO-CTCAE that assess symptom frequency, severity, interference, or presence. Questions were distributed across three forms to reduce burden. Cognitive interviews with retrospective probing were completed in age groups of 13–15 and 16–20 year olds. Proxies were interviewed independently. ResultsIn general, the 16–20 year olds and the parent proxies were able to understand and complete the PRO-CTCAE and newly designed AE questions. Five PRO-CTCAE terms (bloating of the abdomen, anxiety, flashing lights in front of your eyes, hot flashes, and bed sores) and the wording of the questions about AE severity were challenging for a few adolescents and proxies. The 13–15 year olds had greater challenges completing the PRO-CTCAE. ConclusionThis study extends use of the adult PRO-CTCAE for adolescents as young as 16 years and proposes new questions for seven new symptomatic AEs and a parent-proxy version of PRO-CTCAE. Additional testing of the new questions and alternative language for more challenging PRO-CTCAE items is recommended in adults.

Receipt of Life-Sustaining Treatments for Taiwanese Pediatric Patients Who Died of Cancer in 2001 to 2010: A Retrospective Cohort Study.

Aggressive life-sustaining treatments have the potential to be continued beyond benefit, but have seldom been systematically/nationally explored in pediatric cancer patients. Furthermore, factors predisposing children dying of cancer to receive life-sustaining treatments at end of life (EOL) have never been investigated in a population-based study. This population-based study explored determinants of receiving life-sustaining treatments in pediatric cancer patients’ last month of life.For this retrospective cohort study, we used administrative data on 1603 Taiwanese pediatric cancer patients who died in 2001 to 2010. Individual patient-level data were linked with encrypted identification numbers from the National Register of Deaths Database, Cancer Registration System database, National Health Insurance claims datasets, and Database of Medical Care Institutions Status. Life-sustaining treatments included intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), and mechanical ventilation. Associations of patient, physician, hospital, and regional factors with receiving ICU care, CPR, and mechanical ventilation in the last month of life were evaluated by multilevel generalized linear mixed models.In their last month of life, 22.89%, 46.48%, and 61.45% of pediatric cancer patients received CPR, mechanical ventilation, and ICU care, respectively, with no significant decreasing trends from 2001 to 2010. Patients were more likely to receive all three identified life-sustaining treatments at EOL if they were diagnosed with a hematologic malignancy or a localized disease, died within 1 year of diagnosis, and received care from a pediatrician. Receipt of ICU care or mechanical ventilation increased with increasing EOL-care intensity of patients’ primary hospital, whereas use of mechanical ventilation decreased with increasing quartile of hospice beds in the patients’ primary hospital region.Taiwanese pediatric cancer patients received aggressive life-sustaining treatments in the month before death. Healthcare policies and interventions should aim to help pediatricians treating at-risk pediatric cancer patients and hospitals with a tendency to provide aggressive EOL treatments to avoid the expense of life-sustaining treatments when chance of recovery is remote and to devote resources to care that produces the greatest benefits for children, parents, and society.

Biorepository for Pediatric Cancer with Minimal Resources: Meeting the Challenges.

Conducting high throughput -omics research requires high quality, data-rich biospecimens to unravel factors underlying childhood cancers; this is an extra burden in a limited resources country. For this purpose, Children's Cancer Hospital (CCHE), the largest pediatric cancer hospital worldwide, established a cutting-edge Biorepository and Biospecimen Research Facility (CCHE-BBR). To present a step-by-step guide to establishing a hospital-based biorepository with limited resources, and working in collaboration with different hospital facilities to supply the research community with high quality data-rich biospecimens fit for a wide range of research purposes. This approach will foster research in the era of personalized precision medicine. CCHE-IRB approved the collection and storage of biospecimens from patients and parents for future research. We focused on staff training, recruiting qualified scientists, and establishing the infrastructure. The CCHE Biorepository developed strict standardized procedures for sample acquisition, processing, annotation, storage, and distribution based on ISBER Best Practices and CAP-accreditation guidelines. We collect samples at different clinical time points (e.g., at remission and/or relapse) as well as parents' samples for genetic studies. Using CaTissue®, an electronic storage management system, allowed sample annotation and full integration with clinical data and the cancer registry. In 2 years, we succeeded in establishing a well-designed biorepository within our regulations, bylaws, and SOPs, and with a minimal budget. We store high quality blood derivatives, CSF, and malignant/normal tissue samples. Building a high quality biorepository with minimal-resources to encourage research is possible. Having the suitable infrastructure with a significant number of clinically annotated samples can play a major role in international research projects, sharing samples and/or data with other groups.

Pediatric brain tumors in a low/middle income country: does it differ from that in developed world?

Central nervous system (CNS) tumors are the most frequent solid tumors in children and adolescents. The epidemiology of these tumors differs in areas of the world. However, very little data is available in the low/middle income countries (LMIC). The aim of this study is to describe the characteristics of primary childhood brain tumors treated at a leading LMIC pediatric cancer hospital and its difference from that in other countries. One thousand one hundred fourteen children and adolescent having CNS tumors were treated in the largest pediatric cancer hospital in the Middle East during a period of 5½ years. They were diagnosed histopathologically in 80.2 %, through medical imaging in 19.4 % and via both tumor markers and imaging in the remaining 0.4 % of cases. Through epidemiological analysis was performed using all available patients' data revealed that 96 % of the patients had primary brain tumors, while only 4 % the primary lesion was in the spinal cord. The most common histological type was astrocytic tumor (30.0 %, pilocytic (GI) = 13.2 %, GII = 10.5 % and GIII + IV (high grade) = 6.3 %) followed by embryonal tumor (23.2 %, medulloblastoma = 18.7 %, PNET = 2.8 %, ATRT = 1.5 % and ependymoblastoma = 0.2 %) then ependymoma in 8.7 %, craniopharyngeoma in 5.3 %. The mean age at diagnosis was 7.1 ± 4.2 years which did not differ significantly by gender nor residency but it differed by the pathological subtype. The frequency of each pathological type was different among different age groups. Though the present study was a hospital-based analysis in a low/middle income country, yet it did not differ from the well-established population-based study reports in the high income countries.

Investigation and Management of a Rhizomucor Outbreak in a Pediatric Cancer Hospital in Egypt

We describe an outbreak of mucormycosis in a pediatric oncology hospital during December 2010 and the measures taken to stop it. The outbreak began with two consecutive cases of laboratory-documented mucormycosis infections within 1 week. Investigations to track the source were conducted immediately. Air plate cultures from machines and ducts supplying patients' rooms revealed the growth of Rhizomucor. Of five affected patients, all had acute leukemia and three were histopathologically proven. All patients were treated with liposomal amphotericin B after mucormycosis was diagnosed. Posaconazole was used as a secondary prophylaxis in one case. Three patients died.

The financial burden of unexpected hospitalizations for childhood cancer patients and their families.

267 Background: Complications of therapy, such as infection, pain, or dehydration, may cause financial stress for childhood cancer patients due to unexpected hospitalizations. Treatment for childhood cancer is typically provided at tertiary health care centers, requiring rural patients to travel long distances for care. We evaluated the perceived financial burden of unanticipated hospitalizations, insurance, and rurality on childhood cancer patients and their families. Methods: A single-site, cross-sectional survey of primary caretakers of childhood cancer patients was performed from July 2010-July 2012. Eligible patients were treated at a pediatric cancer hospital, diagnosed age ≤21 years and were ≤5 years from diagnosis (N=310). Financial burden was rated on a visual analog scale of 0-100. Multivariable linear regression models were used to calculate coefficients and 95% Confidence Intervals (CI) of financial burden by number of unexpected hospitalizations (0, 1-4, ≥5) and time since diagnosis. Results: The average age at diagnosis was 7.0 (SD 5.6) years. The most common diagnosis was leukemia (47.4%). The mean number of unexpected hospitalizations was 4.2 (SD 7.3). Patients did not differ on number of unexpected hospitalizations by current age, gender, race/ethnicity, or household income. In multivariable analyses, patients 1-5 years past diagnosis with ≥5 unexpected hospitalizations reported financial burden was 22.6 (95% CI 6.2-39.1, p=0.007) points higher than those with no hospitalization and 13.7 (95% CI 2.8-23.6 p=0.007) points higher than those with 1-4 hospitalizations. Patients <1 year from diagnosis did not differ. While type of insurance (public vs. private) did not impact burden, rural patients reported 15.0 (95% CI 6.8-23.2, p<0.001) points higher financial burden than urban patients. Conclusions: A high number of unexpected hospitalizations and rural residence were associated with greater financial burden for families of childhood cancer patients. Efforts to reduce unexpected admissions by managing side effects in outpatient visits, utilizing home health nurses and collaborating with local primary care physicians for remote patients could help ease the financial burden.

Morocco

Morocco

Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients

Pneumatosis intestinalis in children is associated with a wide variety of underlying conditions and often has a benign course. The CT features of this condition have not been systematically investigated. Defining benign pneumatosis intestinalis as pneumatosis intestinalis that resolved with medical management alone, we sought to: (1) determine whether the incidence of benign pneumatosis intestinalis had increased at our pediatric cancer hospital; (2) characterize CT features of benign pneumatosis intestinalis; and (3) determine the relationship between imaging features and clinical course of benign pneumatosis intestinalis in this cohort. Radiology reports from November 1994 to December 2006 were searched for "pneumatosis intestinalis," "free intraperitoneal air," and "portal venous air or gas." Corresponding imaging was reviewed by two radiologists who confirmed pneumatosis intestinalis and recorded the presence of extraluminal free air, degree of intramural gaseous distension, number of involved bowel segments, and time to pneumatosis resolution. The search revealed 12 boys and 4 girls with pneumatosis intestinalis; 11 were hematopoietic stem cell transplant recipients. The annual incidences of benign pneumatosis have not changed at our institution. Increases in intramural distension marginally correlated with the number of bowel segments involved (P=0.08). Three patients had free air and longer times to resolution of pneumatosis (P=0.03). Male children may be at increased risk of benign pneumatosis intestinalis. The incidence of benign pneumatosis at our institution is proportional to the number of hematopoietic stem cell transplants. The degree of intramural distension may correlate with the number of bowel segments involved. Patients with free air have a longer time to resolution of benign pneumatosis.

Increased Influenza Vaccination of Healthcare Workers at a Pediatric Cancer Hospital: Results of a Comprehensive Influenza Vaccination Campaign

A comprehensive influenza vaccination campaign improved vaccination rates among healthcare workers with direct patient care responsibilities from 45% during the 2003-2004 influenza season to 80% during the 2004-2005 season. A strategy of weekly feedback to unvaccinated employees was the most important factor in enhancing the rate of vaccination acceptance and was particularly effective among the nursing staff.

Pediatric cancer: analysis of hospital records

To analyze pediatric cancer hospital records regarding the occurrence of new cases; to verify the relation between sex, age, race, origin and the disease clinical extension; to describe the mortality of children with cancer; to explore the association of new cases with proposed demographic variables, disease clinical extension and vital status. Observational, descriptive, longitudinal study in children up to 14 years old, from Santa Catarina. Three hundred and seventy-one new cases of cancer were treated in a regional reference outpatient clinic (1994-98) and recorded according to the International Classification of Childhood Cancer. Multiple Correspondence Analysis was applied to evaluate the categorical variables. Three-hundred and seventy-one new cases of cancer were recorded with constant distribution in each year. Cancer affected preschoolers (41.5%) and males (55.8%). Leukemia was observed in 36.6% of the cases. Non-localized stage on the diagnosis occurred in 55.7%. The death occurred in 55.7% of the cases with non-localized disease and 16.3% with localized disease. At the end of the study 58.8% of the children were alive. We observed more cases of cancer at pre-school age and among male subjects. Leukemia is the most frequent type of cancer. Non-localized disease predominates on the diagnosis. The death frequency is higher in the group with non-localized disease. There is direct association with non-localized disease, living vital status, school age, adolescent age, female, and for non-localized disease with death vital status, infant age, pre-school age and male.