42 results on '"Sung, Lillian"'
Search Results
2. Feasibility of three times weekly symptom screening in pediatric cancer patients
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Calligan, Maryann, Chakkalackal, Lauren, Dadzie, Grace, Tardif-Theriault, Cassandra, Cook, Sadie, Vettese, Emily, Soman, Dilip, Kuczynski, Susan, Schechter, Tal, Dupuis, L. Lee, and Sung, Lillian
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- 2023
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3. Reliability and validity of proxy-SSPedi and mini-SSPedi in pediatric patients 2-7 years receiving cancer treatments
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Tomlinson, Deborah, Dupuis, L. Lee, Johnston, Donna L., Kuczynski, Susan, Patel, Serina, Schechter, Tal, Vettese, Emily, Mairs, Mark, Tomlinson, George A., and Sung, Lillian
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- 2022
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4. Feeling scared or worried self-report in children receiving cancer treatments using the Symptom Screening in Pediatrics Tool (SSPedi)
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Hyslop, Shannon, Tomlinson, Deborah, Baggott, Christina, Dix, David, Gibson, Paul, Johnston, Donna L., Orsey, Andrea D., Portwine, Carol, Price, Vicky, Vanan, Magimairajan, Kuczynski, Susan, Spiegler, Brenda, Tomlinson, George A., Dupuis, L. Lee, and Sung, Lillian
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- 2021
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5. Second malignant neoplasms within 5 years from first primary diagnosis in pediatric oncology patients in Canada: a population-based retrospective cohort study.
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Ricci, Christina, Subburaj, Divya, Lim, Kate, Shukla, Neetu, Kaur, Jaskiran, Lin Xie, Laverty, Meghan, Zakaria, Dianne, Pole, Jason, Pelland-Marcotte, Marie-Claude, Barber, Randy, Israels, Sara J., Thai-Hoa Tran, Oberoi, Sapna, Renzi, Samuele, MacDonald, Tamara, Sung, Lillian, and Kulkarni, Ketan
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CHILD patients ,PEDIATRIC oncology ,CANCER patients ,COHORT analysis ,YOUNG adults - Abstract
Introduction: From the advancement of treatment of pediatric cancer diagnosis, the five-year survival rate has increased significantly. However, the adverse consequence of improved survival rate is the second malignant neoplasm. Although previous studies provided information on the incidence and risk of SMN in long term survivors of childhood cancer, there is still scarce information known for short term (< 5 years) prognosis. This study aims to assess the incidence, characteristics, management, and outcome of children who develop SMN malignancies within 5 years of diagnosis of their initial cancer. Method: This is a retrospective cohort study of early Second Malignant Neoplasms (SMN) in pediatric oncology patients. The Cancer in Young People - Canada (CYP-C) national pediatric cancer registry was used and reviewed pediatric patients diagnosed with their first cancer from 2000-2015. Results: A total of 20,272 pediatric patients with a diagnosis of a first malignancy were analyzed. Of them, 0.7% were diagnosed with a SMN within the first 5 years following their first cancer diagnosis. Development of a SMN impacted survival, shown by an inferior survival rate in the SMN cohort (79.1%) after three years compared to that of the non-SMN cohort (89.7%). Several possible risk factors have been identified in the study including the use of epipodophyllotoxins, exposure to radiation, and hematopoietic stem cell 169 transplant. Discussion: This is the first national study assessing the incidence, 170 characteristics, risk factors and outcome of early SMN in Canadian children 171 from age 0-15 from 2000-2015. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Facilitators and barriers to clinical practice guideline-consistent supportive care at pediatric oncology institutions: a Children’s Oncology Group study
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Sugalski, Aaron J., Lo, Tammy, Beauchemin, Melissa, Grimes, Allison C., Robinson, Paula D., Walsh, Alexandra M., Santesso, Nancy, Dang, Ha, Fisher, Brian T., Wrightson, Andrea Rothfus, Yu, Lolie C., Sung, Lillian, and Dupuis, L. Lee
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- 2021
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7. Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review
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Koenig, Christa, Schneider, Christine, Morgan, Jessica E., Ammann, Roland A., Sung, Lillian, and Phillips, Bob
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- 2020
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8. Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review
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Koenig, Christa, Schneider, Christine, Morgan, Jessica E., Ammann, Roland A., Sung, Lillian, and Phillips, Bob
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- 2020
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9. Severely bothersome fatigue in children and adolescents with cancer and hematopoietic stem cell transplant recipients
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Tomlinson, Deborah, Baggott, Christina, Dix, David, Gibson, Paul, Hyslop, Shannon, Johnston, Donna L., Orsey, Andrea, Portwine, Carol, Price, Victoria, Vanan, Magimairajan, Kuczynski, Susan, Spiegler, Brenda, Tomlinson, George A., Dupuis, L. Lee, and Sung, Lillian
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- 2019
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10. Taste changes in children with cancer and hematopoietic stem cell transplant recipients
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Loves, Robyn, Tomlinson, Deborah, Baggott, Christina, Dix, David, Gibson, Paul, Hyslop, Shannon, Johnston, Donna L., Orsey, Andrea D., Portwine, Carol, Price, Victoria, Schechter, Tal, Vanan, Magimairajan, Kuczynski, Susan, Spiegler, Brenda, Tomlinson, George A., Dupuis, L. Lee, and Sung, Lillian
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- 2019
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11. Initial development of Supportive care Assessment, Prioritization and Recommendations for Kids (SPARK), a symptom screening and management application
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Cook, Sadie, Vettese, Emily, Soman, Dilip, Hyslop, Shannon, Kuczynski, Susan, Spiegler, Brenda, Davis, Hailey, Duong, Nathan, Ou Wai, Stacee, Golabek, Robert, Golabek, Patryk, Antoszek-Rallo, Adam, Schechter, Tal, Lee Dupuis, L., and Sung, Lillian
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- 2019
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12. Longitudinal evaluation of Supportive care Prioritization, Assessment and Recommendations for Kids (SPARK), a symptom screening and management application
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Vettese, Emily, Cook, Sadie, Soman, Dilip, Kuczynski, Susan, Spiegler, Brenda, Davis, Hailey, Duong, Nathan, Schechter, Tal, Dupuis, L. Lee, and Sung, Lillian
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- 2019
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13. Sodium thiosulfate for prevention of cisplatin-induced hearing loss: updated survival from ACCL0431
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Orgel, Etan, Freyer, David R, Krailo, Mark D, Villaluna, Doojduen, Esbenshade, Adam, and Sung, Lillian
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Oncology ,Thiosulfates ,Humans ,Cisplatin ,Hearing Loss ,Article - Published
- 2022
14. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model
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Anthony, Samantha J., Selkirk, Enid, Sung, Lillian, Klaassen, Robert J., Dix, David, Scheinemann, Katrin, and Klassen, Anne F.
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- 2014
15. Defining Bloodstream Infections Related to Central Venous Catheters in Patients With Cancer: A Systematic Review
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Tomlinson, Deborah, Mermel, Leonard A., Ethier, Marie-Chantal, Matlow, Anne, Gillmeister, Biljana, and Sung, Lillian
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- 2011
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16. Initial development of the Symptom Screening in Pediatrics Tool (SSPedi)
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Tomlinson, Deborah, Dupuis, L. Lee, Gibson, Paul, Johnston, Donna L., Portwine, Carol, Baggott, Christina, Zupanec, Sue, Watson, Julie, Spiegler, Brenda, Kuczynski, Susan, Macartney, Gail, and Sung, Lillian
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- 2014
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17. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer
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Oberoi, Sapna, Yang, Jiayu, Woodgate, Roberta L., Niraula, Saroj, Banerji, Shantanu, Israels, Sara J., Altman, Gary, Beattie, Sara, Rabbani, Rasheda, Askin, Nicole, Gupta, Abha, Sung, Lillian, Abou-Setta, Ahmed M., and Zarychanski, Ryan
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Adult ,Online Only ,Oncology ,Research ,Neoplasms ,Humans ,Anxiety ,Mindfulness ,Original Investigation ,Randomized Controlled Trials as Topic - Abstract
Key Points Question Are mindfulness-based interventions associated with decreased anxiety in adults with cancer? Findings In this systematic review and meta-analysis of 28 randomized clinical trials with 3053 participants, mindfulness-based interventions were associated with reductions in the severity of anxiety in adults with cancer up to 6 months after delivery of mindfulness sessions compared with usual care, waitlist control, or no intervention; a concomitant reduction in the severity of depression and improvement in health-related quality of life was also observed. None of the trials used mindfulness-based interventions in children with cancer. Meaning Mindfulness-based interventions were associated with a reduction in anxiety and depression in adults with cancer., This systematic review and meta-analysis of 28 randomized controlled trials examines the effectiveness in mindfulness-based interventions in reducing anxiety and depression in adult patients with cancer., Importance Mindfulness-based interventions (MBIs), grounded in mindfulness, focus on purposely paying attention to experiences occurring at the present moment without judgment. MBIs are increasingly used by patients with cancer for the reduction of anxiety, but it remains unclear if MBIs reduce anxiety in patients with cancer. Objective To evaluate the association of MBIs with reductions in the severity of anxiety in patients with cancer. Data Sources Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from database inception to May 2019 to identify relevant citations. Study Selection Randomized clinical trials (RCTs) that compared MBI with usual care, waitlist controls, or no intervention for the management of anxiety in cancer patients were included. Two reviewers conducted a blinded screening. Of 101 initially identified studies, 28 met the inclusion criteria. Data Extraction and Synthesis Two reviewers independently extracted the data. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of RCTs, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Summary effect measures were reported as standardized mean differences (SMDs) and calculated using a random-effects model. Main Outcomes and Measures Our primary outcome was the measure of severity of short-term anxiety (up to 1-month postintervention); secondary outcomes were the severity of medium-term (1 to ≤6 months postintervention) and long-term (>6 to 12 months postintervention) anxiety, depression, and health-related quality of life of patients and caregivers. Results This meta-analysis included 28 RCTs enrolling 3053 adults with cancer. None of the trials were conducted in children. Mindfulness was associated with significant reductions in the severity of short-term anxiety (23 trials; 2339 participants; SMD, −0.51; 95% CI, −0.70 to −0.33; I2 = 76%). The association of mindfulness with short-term anxiety did not vary by evaluated patient, intervention, or study characteristics. Mindfulness was also associated with the reduction of medium-term anxiety (9 trials; 965 participants; SMD, −0.43; 95% CI, −0.68 to −0.18; I2 = 66%). No reduction in long-term anxiety was observed (2 trials; 403 participants; SMD, −0.02; 95% CI, −0.38 to 0.34; I2 = 68%). MBIs were associated with a reduction in the severity of depression in the short term (19 trials; 1874 participants; SMD, −0.73; 95% CI; −1.00 to −0.46; I2 = 86%) and the medium term (8 trials; 891 participants; SMD, −0.85; 95% CI, −1.35 to −0.35; I2 = 91%) and improved health-related quality of life in patients in the short term (9 trials; 1108 participants; SMD, 0.51; 95% CI, 0.20 to 0.82; I2 = 82%) and the medium term (5 trials; 771 participants; SMD, 0.29; 95% CI, 0.06 to 0.52; I2 = 57%). Conclusions and Relevance In this study, MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. Future trials should explore the long-term association of mindfulness with anxiety and depression in adults with cancer and determine its efficacy in more diverse cancer populations using active controls.
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- 2020
18. Predicting microbiologically defined infection in febrile neutropenic episodes in children: global individual participant data multivariable meta-analysis
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Phillips, Robert S, Sung, Lillian, Amman, Roland A, Riley, Richard D, Castagnola, Elio, Haeusler, Gabrielle M, Klaassen, Robert, Tissing, Wim JE, Lehrnbecher, Thomas, Chisholm, Julia, Hakim, Hana, Ranasinghe, Neil, Paesmans, Marianne, Hann, Ian M, Stewart, Lesley A, PICNICC Collaboration, on behalf of the, Bauters, Tieneke, Laureys, Genevieve, Guided Treatment in Optimal Selected Cancer Patients (GUTS), and University of Zurich
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Pediatrics ,Cancer Research ,PEDIATRIC ONCOLOGY PATIENTS ,YOUNG-PEOPLE ,Logistic regression ,0302 clinical medicine ,Risk Factors ,Medicine and Health Sciences ,1306 Cancer Research ,030212 general & internal medicine ,610 Medicine & health ,Prospective cohort study ,Child ,neutropenic sepsis ,RISK ,Random effects model ,Prognosis ,ANTIBIOTIC MANAGEMENT ,CANCER ,Oncology ,paediatric oncology ,030220 oncology & carcinogenesis ,Predictive value of tests ,Meta-analysis ,2730 Oncology ,Erratum ,medicine.medical_specialty ,BACTEREMIA ,BIOMARKERS ,Neutropenia ,Infections ,PATIENT ,03 medical and health sciences ,infectious complications ,FEVER ,Predictive Value of Tests ,medicine ,Mucositis ,Humans ,Febrile Neutropenia ,business.industry ,Biology and Life Sciences ,medicine.disease ,Confidence interval ,Cancérologie ,meta-analysis ,supportive care ,SYSTEMATIC REVIEWS ,10036 Medical Clinic ,Clinical Study ,business ,RA - Abstract
Background:Risk-stratified management of fever with neutropenia (FN), allows intensive management of high-risk cases and early discharge of low-risk cases. No single, internationally validated, prediction model of the risk of adverse outcomes exists for children and young people. An individual patient data (IPD) meta-analysis was undertaken to devise one.Methods:The 'Predicting Infectious Complications in Children with Cancer' (PICNICC) collaboration was formed by parent representatives, international clinical and methodological experts. Univariable and multivariable analyses, using random effects logistic regression, were undertaken to derive and internally validate a risk-prediction model for outcomes of episodes of FN based on clinical and laboratory data at presentation.Results:Data came from 22 different study groups from 15 countries, of 5127 episodes of FN in 3504 patients. There were 1070 episodes in 616 patients from seven studies available for multivariable analysis. Univariable analyses showed associations with microbiologically defined infection (MDI) in many items, including higher temperature, lower white cell counts and acute myeloid leukaemia, but not age. Patients with osteosarcoma/Ewings sarcoma and those with more severe mucositis were associated with a decreased risk of MDI. The predictive model included: malignancy type, temperature, clinically 'severely unwell', haemoglobin, white cell count and absolute monocyte count. It showed moderate discrimination (AUROC 0.723, 95% confidence interval 0.711-0.759) and good calibration (calibration slope 0.95). The model was robust to bootstrap and cross-validation sensitivity analyses.Conclusions:This new prediction model for risk of MDI appears accurate. It requires prospective studies assessing implementation to assist clinicians and parents/patients in individualised decision making., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2016
19. Quality of life in pediatric acute myeloid leukemia: Report from the Children's Oncology Group.
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Nagarajan, Rajaram, Gerbing, Robert, Alonzo, Todd, Johnston, Donna L., Aplenc, Richard, Kolb, Edward A., Meshinchi, Soheil, Barakat, Lamia P., and Sung, Lillian
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ACUTE myeloid leukemia ,QUALITY of life ,CAUCASIAN race ,ONCOLOGY ,CHILDREN - Abstract
Introduction: Objectives were used to describe guardian proxy‐report and child self‐report quality of life (QoL) during chemotherapy for pediatric acute myeloid leukemia (AML) patients. Methods: Patients enrolled on the phase 3 AML trial AAML1031 who were 2‐18 years of age with English‐speaking guardians were eligible. Instruments used were the PedsQL Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. Assessments were obtained at the beginning of Induction 1 and following completion of cycles 2‐4. Potential predictors of QoL included the total number of nonhematological grade 3‐4 Common Terminology Criteria for Adverse Event (CTCAE) submissions. Results: There were 505 eligible guardians who consented to participate and 348 of their children provided at least one self‐report assessment. The number of submitted CTCAE toxicities was significantly associated with worse physical health summary scores (β ± standard error (SE) −3.00 ± 0.69; P < 0.001) and general fatigue (β ± SE −2.50 ± 0.66; P < 0.001). Older age was significantly associated with more fatigue (β ± SE −0.58 ± 0.25; P = 0.022). Gender, white race, Hispanic ethnicity, private insurance status, risk status, bortezomib assignment, and duration of neutropenia were not significantly associated with QoL. Discussion: The number of CTCAE toxicities was the primary factor influencing QoL among children with AML. Reducing toxicities should improve QoL; identifying approaches to ameliorate them should be a priority. [ABSTRACT FROM AUTHOR]
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- 2019
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20. Severity, change over time, and risk factors of anxiety in children with cancer depend on anxiety instrument used.
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Lazor, Tanya, Pole, Jason D., De Souza, Claire, Schechter, Tal, Grant, Ronald, Davis, Hailey, Duong, Nathan, Stein, Eliana, Cook, Sadie, Tigelaar, Leonie, and Sung, Lillian
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HEMATOPOIETIC stem cell transplantation ,CHILDHOOD cancer ,WORRY ,ANXIETY ,DISEASE risk factors - Abstract
Objective: The primary objective was to describe severity of anxiety among children and adolescents receiving chemotherapy for cancer or undergoing hematopoietic stem cell transplantation (HSCT). Secondary objectives were to describe how anxiety changes over time and determine factors associated with anxiety.Methods: Participants were aged 8 to 18 and either receiving chemotherapy for cancer or undergoing HSCT for any indication. Respondents self-reported three anxiety measurement instruments at chemotherapy cycle or HSCT conditioning start and 3 weeks later.Results: The proportion of participants with severe anxiety ranged from 10/77 (13.0%) to 22/77 (28.6%) depending on instrument used. Change over time also varied across instruments, with significant improvement observed with PedsQL (procedural) (P = 0.037) and PROMIS (P = 0.013). Factors associated with anxiety similarly varied by instrument. Older age was associated with more anxiety on the PedsQL (worry) (P = 0.036), and higher household income was associated with less anxiety on the MASC-10 (P = 0.028).Conclusions: While we found that a small proportion of patients met or exceeded thresholds for severe anxiety, we also noted that severity, change over time, and predictors of anxiety varied depending on instrument used. Future research should ensure that selected instruments measure the construct of interest and describe how anxiety is conceptualized in the study. [ABSTRACT FROM AUTHOR]- Published
- 2019
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21. The social impact of early psychological maturity in adolescents with cancer.
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Anthony, Samantha J., Robertson, Taylor, Selkirk, Enid, Dix, David, Klaassen, Robert J., Sung, Lillian, and Klassen, Anne F.
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SOCIAL impact ,TEENAGERS - Abstract
Objective: There is a growing need to assess the long-term quality of life (QOL) of pediatric oncology patients since many children now survive their disease. This paper highlights the subjective perspectives of pediatric cancer patients and specifically explores how experiencing cancer at a young age impacts adolescents in the areas of social functioning, peer relationships, and QOL. The findings emerged from a qualitative research study that explored how pediatric oncology patients ascribe meaning to their illness.Methods: Study participants were recruited from four Canadian academic pediatric hospitals. In this study, we used an interpretative description approach. Semistructured interviews were completed, transcribed verbatim, and coded through the method of constant comparison.Results: A total of 37 children and adolescents (n = 19 female; 51%) participated. The majority of participants were diagnosed with leukemia (n = 16; 43%) or lymphoma (n = 9; 24%). Sixty-two percent of participants were adolescents between the ages of 13 and 18 years (n = 23). Data illustrated a unique adolescent experience, which has been reported as a subset of the original population. Adolescent participants noted an accelerated experience of maturation, which invited reflections of gratitude as well as feelings of isolation and disconnect from peers. Participants were saddened to have "missed out" on normative parts of childhood.Conclusion: Findings highlighted experiences of accelerated maturity that prompted adverse social outcomes for adolescent participants, which impacted their QOL. Future research is needed to explore the intersection of accelerated maturity attributed to illness, social functioning, and QOL. Peer support through technology engagement is suggested for this population. [ABSTRACT FROM AUTHOR]- Published
- 2019
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22. Enrollment on clinical trials does not improve survival for children with acute myeloid leukemia: A population-based study.
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Truong, Tony H., Pole, Jason D., Barber, Randy, Dix, David, Kulkarni, Ketan P., Martineau, Emilie, Randall, Alicia, Stammers, David, Strahlendorf, Caron, Strother, Douglas, and Sung, Lillian
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ACUTE myeloid leukemia in children ,CLINICAL trials ,PROGRESSION-free survival ,CHILDHOOD cancer ,ONCOLOGY - Abstract
Background: It is questionable whether enrollment on clinical trials offers any survival advantage at the population level over standard-of-care treatment. The objectives of this study were to describe the impact of trial enrollment on event-free survival and overall survival in pediatric acute myeloid leukemia (AML) using the Cancer in Young People in Canada (CYP-C) database.Methods: Children were included if they had had AML newly diagnosed between ages birth and 14 years from 2001 to 2012. CYP-C is a national pediatric cancer population-based database that includes all cases of pediatric cancer diagnosed and treated at 1 of the 17 tertiary pediatric oncology centers in Canada. Univariate and Cox proportional hazards models were used to evaluate the impact of initial trial enrollment on survival.Results: In total, 397 eligible children with AML were included in the analysis, of whom 94 (23.7%) were enrolled on a clinical trial at initial diagnosis. The most common reason for non-enrollment was that no trial was available. The event-free survival rate at 5 years was 57.8% ± 5.2% for those enrolled versus 54.8% ± 2.9% for those not enrolled (P = .75). The overall survival rate at 5 years was 70.1% ± 4.9% for those enrolled versus 66.3% ± 2.8% for those not enrolled (P = .58). Enrollment on a trial was not associated with improved event-free or overall survival in multiple regression analyses.Conclusions: Enrollment on a clinical trial was not associated with improved survival for children with AML in a population-based cohort. Rationale for trial enrollment should not include the likelihood of benefit compared with non-enrollment. [ABSTRACT FROM AUTHOR]- Published
- 2018
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23. Describing symptoms using the Symptom Screening in Pediatrics Tool in hospitalized children with cancer and hematopoietic stem cell transplant recipients.
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Johnston, Donna L., Hyslop, Shannon, Tomlinson, Deborah, Baggott, Christina, Gibson, Paul, Orsey, Andrea, Dix, David, Price, Vicky, Vanan, Magimairajan, Portwine, Carol, Kuczynski, Susan, Spiegler, Brenda, Tomlinson, George A., Dupuis, Laura Lee, and Sung, Lillian
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CHILDHOOD cancer ,CHILDREN'S health ,CANCER diagnosis ,CANCER chemotherapy ,HEMATOPOIETIC stem cell transplantation - Abstract
Abstract: Objectives were to describe any bothersome symptom and severely bothersome symptoms in inpatient children with cancer and hematopoietic stem cell transplant (HSCT) recipients. We included children 8–18 years of age with cancer or HSCT recipients who were receiving active treatment for cancer, admitted to hospital, and expected to be in hospital 3 days later. We administered the self‐report Symptom Screening in Pediatrics Tool (SSPedi). We described those who identified any degree of symptom bother (at least “a little”) and those who rated the degree of bother as severe (“a lot” or “extremely”). Factors associated with severe symptoms and total SSPedi scores were examined using multiple logistic and linear regression. Among the 302 patients, 298 (98.7%) reported having any bothersome symptom and 181 (59.9%) had at least one severely bothersome symptom. In multiple regression, older children were significantly more likely to have at least one severely bothersome symptom (15–18 and 11–14 years vs. 8–10 years;
P = 0.008) and to have higher total SSPedi scores (P = 0.0003). Those with relapsed disease were more likely to have at least one severely bothersome symptom (odds ratio 2.1, 95% confidence interval 1.1–4.3;P = 0.037) and HSCT recipients were more likely to have higher symptom scores (β = 3.48, standard error = 1.6;P = 0.030). Almost all children receiving cancer therapies experience bothersome symptoms and 60% have at least one severely bothersome symptom. Older children experienced more severely bothersome symptoms and higher symptom scores. Future studies should follow children longitudinally to better understand the symptom trajectory and should institute interventions to manage symptoms. [ABSTRACT FROM AUTHOR]- Published
- 2018
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24. Longitudinal analysis of quality-of-life outcomes in children during treatment for acute lymphoblastic leukemia: A report from the Children's Oncology Group AALL0932 trial.
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Zheng, Daniel J., Lu, Xiaomin, Schore, Reuven J., Balsamo, Lyn, Devidas, Meenakshi, Winick, Naomi J., Raetz, Elizabeth A., Loh, Mignon L., Carroll, William L., Sung, Lillian, Hunger, Stephen P., Angiolillo, Anne L., Kadan‐Lottick, Nina S., and Kadan-Lottick, Nina S
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QUALITY of life ,LYMPHOBLASTIC leukemia ,LYMPHOBLASTIC leukemia treatment ,LEUKEMIA in children ,ONCOLOGY ,HEALTH outcome assessment ,DIAGNOSIS ,GENETICS ,ALEXITHYMIA ,COMPARATIVE studies ,HUMAN reproduction ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RESEARCH funding ,EVALUATION research - Abstract
Background: Children with average-risk acute lymphoblastic leukemia (AR-ALL) face many challenges that can adversely affect their quality of life (QOL). However, to the authors' knowledge, patterns and predictors of QOL impairment during therapy have not been well characterized to date.Methods: Patients with AR-ALL who were enrolled on the Children's Oncology Group AALL0932 trial were offered participation in this prospective cohort study if they were aged ≥4 years at the time of diagnosis and had an English-speaking parent. At approximately 2 months, 8 months, 17 months, 26 months, and 38 months (boys only) after diagnosis, parents completed the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0 (PedsQL4.0) and McMaster Family Assessment Device instruments for QOL (physical, emotional, and social functioning) and family functioning, respectively. The proportions of individuals scoring in the impaired range (2 standard deviations below the population mean) were calculated at each time point. Longitudinal impairment patterns and predictors were examined.Results: A total of 594 participants with AR-ALL were diagnosed at a mean age of 6.0 years (standard deviation, 1.6 years). At 2 months, a substantial proportion of participants had impaired scores for physical (36.5%; 95% confidence interval [95% CI], 32.3%-40.8%) and emotional (26.2%; 95% CI, 22.5%-30.2%) functioning compared with population norms of 2.3%. These elevations persisted at 26 months. Emotional impairment at 2 months (odds ratio, 3.4; 95% CI, 1.5-7.7) was found to significantly predict emotional impairment at 26 months. In repeated measures analysis with multivariate modeling, unhealthy family functioning (odds ratio, 1.5; 95% CI, 1.1-2.1) significantly predicted emotional impairment controlling for age and sex. QOL outcomes were similar between sexes at the end of therapy (26 months for girls and 38 months for boys).Conclusions: Many children with AR-ALL experience physical and emotional functioning impairment that begins early in treatment and persists. Early screening may identify high-risk patients who might benefit from family-based interventions. Cancer 2018;124:571-9. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]- Published
- 2018
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25. A randomized control intervention trial to improve social skills and quality of life in pediatric brain tumor survivors.
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Barrera, Maru, Atenafu, Eshetu G., Sung, Lillian, Bartels, Ute, Schulte, Fiona, Chung, Joanna, Cataudella, Danielle, Hancock, Kelly, Janzen, Laura, Saleh, Amani, Strother, Douglas, Downie, Andrea, Zelcer, Shayna, Hukin, Juliette, and McConnell, Dina
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SOCIAL skills in children ,QUALITY of life ,BRAIN tumors ,TUMORS in children ,SOCIAL skills ,PATIENTS - Abstract
Background: To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS).Methods: We conducted a randomized control trial in which PBTS (8-16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2-hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self-reported, proxy-reported (caregiver), and teacher-reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow-up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis.Results: Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow-up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect.Conclusions: Participating in group social skills intervention can improve self-reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence. [ABSTRACT FROM AUTHOR]- Published
- 2018
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26. Most children with cancer are not enrolled on a clinical trial in Canada: a population-based study.
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Pole, Jason D., Barber, Randy, Bergeron, Rose-Émilie, Carret, Anne Sophie, Dix, David, Kulkarni, Ketan, Martineau, Emilie, Randall, Alicia, Stammers, David, Strahlendorf, Caron, Strother, Douglas R., Truong, Tony H., and Sung, Lillian
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CHILDHOOD cancer ,CANCER diagnosis ,CANCER treatment ,TUMORS in children ,CLINICAL trials ,GLIOMAS ,LYMPHOBLASTIC leukemia ,ONCOLOGY ,TUMORS ,RETROSPECTIVE studies ,PATIENT selection - Abstract
Background: Primary objective was to describe the proportion of children newly diagnosed with cancer enrolled on a therapeutic clinical trial. Secondary objectives were to describe reasons for non-enrollment and factors associated with enrollment on trials.Methods: In this retrospective cohort study, we included children newly diagnosed with cancer between 0 and 14 years of age and diagnosed from 2001 to 2012. We used data from the Cancer in Young People in Canada (CYP-C) national pediatric cancer population-based database. CYP-C captures all cases of pediatric cancer (0-14 years) diagnosed and treated at one of the 17 tertiary pediatric oncology centers in Canada. Non-enrollment was evaluated using univariate and multiple logistic regression analysis.Results: There were 9204 children with cancer included, of whom 2533 (27.5%) were enrolled on a clinical trial. The most common reasons cited for non-enrollment were lack of an available trial (52.2%) and physician choice (11.2%). In multiple regression, Asian and Arab/west Asian race were associated with lower enrollment (P = 0.006 and P = 0.032 respectively). All cancer diagnoses were more likely to be enrolled compared to astrocytoma and children with acute lymphoblastic leukemia had an almost 18-fold increased odds of enrollment compared to astrocytoma (P < 0.0001). Greater distance from the tertiary care center was independently associated with non-enrollment (P < 0.0001).Conclusions: In Canada, 27.5% of children with cancer are enrolled onto therapeutic clinical trials and lack of an available trial is the most common reason contributing to non-enrollment. Future research should better understand reasons for lack of trial availability and physician preferences to not offer trials. [ABSTRACT FROM AUTHOR]- Published
- 2017
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27. Association between prolonged neutropenia and reduced relapse risk in pediatric AML: A report from the children's oncology group.
- Author
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Sung, Lillian, Aplenc, Richard, Alonzo, Todd A., Gerbing, Robert B., Wang, Yi‐Cheng, Meshinchi, Soheil, and Gamis, Alan S.
- Abstract
Objective was to describe the relationship between the number of sterile site infections and duration of neutropenia during the first four cycles of chemotherapy and the risk of recurrence and overall survival in children with newly diagnosed acute myeloid leukemia (AML). AAML0531 was a Children's Oncology Group randomized phase 3 clinical trial that included 1022 children with de novo AML. For this analysis, we focused on non-Down syndrome favorable and standard risk patients who completed at least 4 cycles of chemotherapy without recurrence or withdrawal during protocol therapy. Those receiving hematopoietic stem cell transplantation in first remission were excluded. Five hundred and sixty-nine patients were included; 274 (48.2%) were favorable risk. The median cumulative time with neutropenia between Induction II to completion of Intensification II was 96 (range 54-204) days. Number of sterile site infections did not influence the risk of relapse or overall survival. However, longer duration of neutropenia was associated with a lower risk of relapse (hazard ratio 0.81 per 20 days neutropenia, p = 0.007). Longer duration of neutropenia was associated with a reduced risk of relapse for children with favorable and standard risk AML. Toxicity may be influenced by pharmacogenomics suggesting that individualized chemotherapy dosing may be an effective strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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28. Advancing a comprehensive cancer care agenda for children and their families: Institute of Medicine Workshop highlights and next steps.
- Author
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Kirch, Rebecca, Reaman, Gregory, Feudtner, Chris, Wiener, Lori, Schwartz, Lisa A., Sung, Lillian, and Wolfe, Joanne
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CHILDHOOD cancer ,QUALITY of life ,WELL-being ,TUMORS in children ,PALLIATIVE treatment - Abstract
This article highlights key findings from the "Comprehensive Cancer Care for Children and Their Families" March 2015 joint workshop by the Institute of Medicine (IOM) and the American Cancer Society. This initiative convened more than 100 family members, clinician investigators, advocates, and members of the public to discuss emerging evidence and care models and to determine the next steps for optimizing quality-of-life outcomes and well-being for children and families during pediatric cancer treatment, after treatment completion, and across the life spectrum. Participants affirmed the triple aim of pediatric oncology that strives for every child with cancer to be cured; provides high-quality palliative and psychosocial supportive, restorative, and rehabilitative care to children and families throughout the illness course and survivorship; and assures receipt of high-quality end-of-life care for patients with advancing disease. Workshop outcomes emphasized the need for new pediatric cancer drug development and identified critical opportunities to prioritize palliative care and psychosocial support as an integral part of pediatric cancer research and treatment, including the necessity for adequately resourcing these supportive services to minimize suffering and distress, effectively address quality-of-life needs for children and families at all stages of illness, and mitigate the long-term health risks associated with childhood cancer and its treatment. Next steps include dismantling existing silos and enhancing collaboration between clinical investigators, disease-directed specialists, and supportive care services; expanding the use of patient-reported and parent-reported outcomes; effectively integrating palliative and psychosocial care; and clinical communication skills development. CA Cancer J Clin 2016;66:398-407. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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29. A comparison of discharge strategies after chemotherapy completion in pediatric patients with acute myeloid leukemia: a report from the Children’s Oncology Group.
- Author
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Miller, Tamara P., Getz, Kelly D., Kavcic, Marko, Li, Yimei, Huang, Yuan-Shun V., Sung, Lillian, Alonzo, Todd A., Gerbing, Robert, Daves, Marla, Horton, Terzah M., Pulsipher, Michael A., Pollard, Jessica, Bagatell, Rochelle, Seif, Alix E., Fisher, Brian T., Gamis, Alan S., and Aplenc, Richard
- Subjects
PEDIATRICS ,ACUTE myeloid leukemia ,CANCER chemotherapy ,CANCER treatment ,ONCOLOGY ,PATIENTS - Abstract
While most children receive acute myeloid leukemia (AML) chemotherapy as inpatients, there is variability in timing of discharge after chemotherapy completion. This study compared treatment-related morbidity, mortality and cumulative hospitalization in children with AML who were discharged after chemotherapy completion (early discharge) and those who remained hospitalized. Chart abstraction data for 153 early discharge-eligible patients enrolled on a Children’s Oncology Group trial were compared by discharge strategy. Targeted toxicities included viridans group streptococcal (VGS) bacteremia, hypoxia and hypotension. Early discharge occurred in 11% of courses post-Induction I. Re-admission occurred in 80–100%, but median hospital stay was 7 days shorter. Patients discharged early had higher rates of VGS (adjusted risk ratio (aRR) = 1.67, 95% CI = 1.11–2.51), hypoxia (aRR = 1.92, 95% CI = 1.06–3.48) and hypotension (aRR = 4.36, 95% CI = 2.01–9.46), but there was no difference in mortality. As pressure increases to shorten hospitalizations, these results have important implications for determining discharge practices in pediatric AML. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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30. Methodological issues identified during cognitive interviews in the development of a pediatric cancer symptom screening tool.
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Tomlinson, Deborah, Mol Van Otterloo, Sophie, O'Sullivan, Cathy, Gibson, Paul, Johnston, Donna L, Portwine, Carol, Spiegler, Brenda, Baggott, Christina, Tolend, Mirkamal, Dupuis, L Lee, and Sung, Lillian
- Subjects
COGNITIVE interviewing ,CHILDHOOD cancer ,SYMPTOMS ,CANCER treatment ,RESEARCH methodology ,DIAGNOSIS ,TUMOR diagnosis ,TUMORS & psychology ,COGNITION ,PEDIATRICS ,PSYCHOMETRICS ,EARLY detection of cancer - Abstract
The article discusses the lessons learned and methodological issues, as well as challenges, that became apparent during the cognitive interviews (CIs) with children and parents and its importance in the development of an screening tool for pediatric cancer symptom. Topics include the use of the Symptom Screening in Pediatrics Tool (SSPedi), children who received treatment for cancer, and the importance of regularly reviewing the interview script.
- Published
- 2016
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31. Effect of Prophylactic Low Level Laser Therapy on Oral Mucositis: A Systematic Review and Meta-Analysis.
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Oberoi, Sapna, Zamperlini–Netto, Gabriele, Beyene, Joseph, Treister, Nathaniel S., and Sung, Lillian
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MEDICAL lasers ,ORAL mucosa diseases ,SYSTEMATIC reviews ,RANDOMIZED controlled trials ,HEMATOPOIETIC stem cell transplantation ,RANDOM effects model ,TUMORS in children ,THERAPEUTICS - Abstract
Background: Objective was to determine whether prophylactic low level laser therapy (LLLT) reduces the risk of severe mucositis as compared to placebo or no therapy. Methods: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched until February 2014 for randomized controlled trials (RCTs) comparing prophylactic LLLT with placebo or no therapy in patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT). All analyses used random effects models. Results: Eighteen RCTs (1144 patients) were included. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). LLLT also reduced the following outcomes when compared to placebo/no therapy: severe mucositis at the time of anticipated maximal mucositis (RR 0.34, 95% CI 0.20 to 0.59), overall mean grade of mucositis (standardized mean difference −1.49, 95% CI −2.02 to −0.95), duration of severe mucositis (weighted mean difference −5.32, 95% CI −9.45 to −1.19) and incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37). Conclusion: Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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32. Low Socioeconomic Status Is Associated with Worse Survival in Children with Cancer: A Systematic Review.
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Gupta, Sumit, Wilejto, Marta, Pole, Jason D., Guttmann, Astrid, and Sung, Lillian
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CHILDHOOD cancer ,SOCIOECONOMIC factors ,SYSTEMATIC reviews ,ONCOLOGY ,HEALTH outcome assessment ,EPIDEMIOLOGY of cancer ,HIGH-income countries - Abstract
Background: While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. Methods: We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. Results: Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. Conclusions: Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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33. Infectious Events Prior to Chemotherapy Initiation in Children with Acute Myeloid Leukemia.
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Portwine, Carol, Mitchell, David, Johnston, Donna, Gillmeister, Biljana, Ethier, Marie-Chantal, Yanofsky, Rochelle, Dix, David, Cellot, Sonia, Lewis, Victor, Price, Victoria, Silva, Mariana, Zelcer, Shayna, Bowes, Lynette, Michon, Bruno, Stobart, Kent, Brossard, Josee, Beyene, Joseph, and Sung, Lillian
- Subjects
ACUTE myeloid leukemia in children ,CANCER chemotherapy ,CANCER complications ,NEUTROPENIA ,CANCER diagnosis ,GRAM-negative bacteria ,RETROSPECTIVE studies - Abstract
Background: The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia. Methods: We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy. Results: Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation. Conclusion: It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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34. Facilitating accrual to cancer control and supportive care trials: the clinical research associate perspective.
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VanHoff, David, Hesser, Tanya, Kelly, Katherine Patterson, Freyer, David, Stork, Susan, and Sung, Lillian
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CLINICAL trials ,CLINICAL medicine research ,ONCOLOGY ,PATIENT selection ,CANCER patients - Abstract
Background Accrual to Cancer Control and Supportive Care (CCL) studies can be challenging. Our objective was to identify facilitators and perceived barriers to successful Children's Oncology Group (COG) CCL accrual from the clinical research associate (CRA) perspective. Methods A survey was developed that focused on the following features from the institutional perspective: (1) Components of successful accrual; (2) Barriers to accrual; (3) Institutional changes that could enhance accrual; and (4) How COG could facilitate accrual. The survey was distributed to the lead CRA at each COG site with at least 2 CCL accruals within the previous year. The written responses were classified into themes and sub-themes. Results 57 sites in the United States (n = 52) and Canada (n = 5) were contacted; 34 (60%) responded. The four major themes were: (1) Staff presence and dynamics; (2) Logistics including adequate numbers of eligible patients; (3) Interests and priorities; and (4) Resources. Suggestions for improvement began at the study design/conception stage, and included ongoing training/support and increased reimbursement or credit for successful CCL enrollment. Conclusions The comments resulted in suggestions to facilitate CCL trials in the future. Soliciting input from key team members in the clinical trials process is important to maximizing accrual rates. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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35. Immigrant to Canada, newcomer to childhood cancer: a qualitative study of challenges faced by immigrant parents.
- Author
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Klassen, Anne F., Gulati, Sonia, Watt, Lisa, Banerjee, Ananya T., Sung, Lillian, Klaassen, Robert J., Dix, David, Poureslami, Iraj M., and Shaw, Nicola
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IMMIGRANT families ,HEALTH care industry ,CAREGIVERS ,GROUNDED theory - Abstract
Background: Given the increasing numbers of immigrant families in Canada, it is imperative that healthcare providers (HCPs) understand the caregiving experiences of immigrant family caregivers. Our study aimed to explore any special challenges faced by immigrant parents of children with cancer and to identify supportive factors. Methods: A constructivist grounded theory approach was used. Participants included 50 first generation Chinese and South Asian parents of children with cancer who were at least six months post-diagnosis. Recruitment took place at six Canadian pediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi. Analysis involved coding and the use of the constant comparison method. Interviewing continued until no new themes emerged. Results: While immigrant parents described many challenges faced by any parent of a child with cancer, the context of being an immigrant made certain experiences particularly challenging. Parents described challenges in the following areas: managing caregiving demand and financial strain, accessing support from others, and interfacing with the healthcare system. Parents described receiving a range of practical, emotional, social and informational support from extended family, their workplace, other cancer families, community organizations and HCPs. Conclusions: Our study addresses an important gap in the research literature by providing practical insight into the experiences of immigrant family caregivers. Our findings may help to inform the development of pediatric oncology policies and programs in ways that respond to the unique needs and challenges of culturally and linguistically diverse families. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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36. Exploring predictors of optimism among parents of children with cancer.
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Fayed, Nora, Klassen, Anne F., Dix, David, Klaassen, Robert, and Sung, Lillian
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OPTIMISM ,PARENTS of sick children ,CHILDHOOD cancer ,ONCOLOGY ,PARENT-child relationships ,CROSS-sectional method ,PROGNOSIS ,REGRESSION analysis - Abstract
Objective: To explore predictors of optimism in parents of children with cancer. Methods: A cross-sectional multi-centre study of 411 parents of children in active treatment for cancer was conducted. The Life Orientation Test-Revised was used to assess optimism. Other appropriate items and standardized questionnaires were used to assess parent and child characteristics. Predictors of optimism were explored using simple and multiple linear regression modelling techniques. Results: The presence of positive intrapsychic traits, such as self-esteem and mastery, was more predictive of parental optimism than factors related to child cancer, such as the child's prognosis. Intrapsychic traits combined with an absence of parental depression, the parents' perception of the child's prognosis and parent education level predicted over 50% of the variance in parent optimism. Correlations between parents' and oncologists' view of the child's prognosis were low. Conclusions: Positive intrapsychic traits are important predictors of optimism in the presence of a parent's positive view of the child's prognosis and higher education levels in the absence of depression. The results also favour the perspective of optimism as a trait of the parent who is resilient to a life stressor, such as dealing with childhood cancer. Additional knowledge about the role of optimism in caregiving for a child with cancer is needed before it can be explored for assessment or intervention purposes. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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37. Late events occurring five years or more after successful therapy for childhood rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group
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Sung, Lillian, Anderson, James R., Donaldson, Sarah S., Spunt, Sheri L., Crist, William M., and Pappo, Alberto S.
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- *
RHABDOMYOSARCOMA , *MUSCLE tumors , *CHILDHOOD cancer , *ONCOLOGY - Abstract
The aim of our study was to describe late failures in children who initially survived event-free five years from a diagnosis of rhabdomyosarcoma. Charts of children enrolled in the Intergroup Rhabdomyosarcoma Study Group (IRSG) trials III, IV pilot and IV (1984–1997) who survived five years event-free and subsequently experienced an adverse event (disease recurrence, second malignant neoplasm or death from other causes) were reviewed. Of the 2534 enrolled patients, 1160 were event-free at five years and 48 subsequently experienced a late event. The estimated 10-year event rate for the 1160 patients who were alive and event-free at five years was 9% (95% Confidence Interval (CI) 5%, 13%). Patients with both advanced disease (Group III/IV) and large primary tumours at diagnosis (
> 5 cm) were at the highest risk for late events (19%; 95% CI 8%, 30%). Late events after successful treatment for rhabdomyosarcoma occur in 9%. Those with advanced disease and large primary tumours have the highest risk of late events. [Copyright &y& Elsevier]- Published
- 2004
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38. Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review.
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Koenig, Christa, Schneider, Christine, Morgan, Jessica E, Ammann, Roland A, Sung, Lillian, and Phillips, Bob
- Abstract
Purpose: Prompt antibiotic therapy is standard of care for patients with fever and neutropenia (FN) during chemotherapy for cancer. We systematically reviewed the association between time to antibiotics (TTA) and clinical outcomes.Methods: The search covered seven databases; confounding biases and study quality were assessed with the ROBINS-I tool. Safety (death, intensive care unit (ICU) admission, sepsis) and treatment adequacy (relapse of infection, persistence or recurrence of fever) were assessed as primary outcomes.Results: Of 6296 articles identified, 13 observational studies were included. Findings regarding safety were inconsistent. Three studies controlling for triage bias showed a possible association between longer TTA and impaired safety. Meta-analysis for TTA ≤ 60 min versus > 60 min was feasible on four studies, with three studies each reporting on death (OR 0.78, 95%CI 0.16-3.69) and on ICU admission (OR 1.43, 95%CI 0.57-3.60). No study reported data on treatment adequacy. Triage bias, i.e. faster treatment of patients with worse clinical condition, was identified as a relevant confounding factor.Conclusion: There seems to be an association between longer TTA and impaired safety. More knowledge about TTA effects on safety are important to optimise treatment guidelines for FN. Controlling for triage and other biases is necessary to gain further evidence.Trial Registration: Registration: PROSPERO [http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018092948]. [ABSTRACT FROM AUTHOR]- Published
- 2019
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39. Clostridioides difficile infection in paediatric patients with cancer and haematopoietic stem cell transplant recipients.
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Haeusler, Gabrielle M., Lehrnbecher, Thomas, Agyeman, Phillip K.A., Loves, Robyn, Castagnola, Elio, Groll, Andreas H., van de Wetering, Marianne, Aftandilian, Catherine C., Phillips, Bob, Chirra, Krishna M., Schneider, Christine, Dupuis, Lee L., and Sung, Lillian
- Subjects
- *
RESEARCH , *CONFIDENCE intervals , *MULTIPLE regression analysis , *ORAL drug administration , *RETROSPECTIVE studies , *ACQUISITION of data , *VANCOMYCIN , *PATIENTS , *TUMORS in children , *CLOSTRIDIUM diseases , *SEVERITY of illness index , *RISK assessment , *CANCER patients , *DISEASE relapse , *METRONIDAZOLE , *MEDICAL records , *DISEASE prevalence , *DESCRIPTIVE statistics , *HEMATOPOIETIC stem cell transplantation , *ODDS ratio , *LONGITUDINAL method , *TRANSPLANTATION of organs, tissues, etc. , *DISEASE risk factors , *EVALUATION , *CHILDREN , *ADOLESCENCE - Abstract
Epidemiology of Clostridioides difficile infection (CDI) in paediatric cancer patients is uncertain. The primary objective was to describe the prevalence of CDI outcomes among paediatric patients receiving cancer treatments. Secondary objectives were to describe clinical features of CDI, propose a definition of severe CDI and to determine risk factors for CDI clinical outcomes. A multi-centre retrospective cohort study that included paediatric patients (1–18 years of age) receiving cancer treatments with CDI. Severe CDI definition was achieved by consensus. Univariable and multivariable regression was conducted to evaluate risk factors for CDI outcomes. There were 627 eligible patients who experienced 721 CDI episodes. The prevalence of clinical cure was 82.9%, recurrence was 9.6%, global cure was 75.0% and repeated new CDI episode was 12.8%. The proposed definition of severe CDI was the presence of colitis, pneumatosis intestinalis, pseudomembranous colitis, ileus or surgery for CDI, occurring in 70 (9.7%) episodes. In univariable regression, initial oral metronidazole or initial oral vancomycin were not significantly associated with failure to achieve clinical cure or CDI recurrence. In multiple regression, oral metronidazole was significantly associated with higher odds (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.0–2.7) and oral vancomycin was significantly associated with lower odds (OR 0.4, 95% CI 0.2–0.8) of repeated new episodes. The prevalence of clinical cure was 82.9% and recurrence was 9.6% in pediatric patients receiving cancer treatments. Severe CDI, as per our proposed definition, occurred in 9.7% episodes. Initial oral vancomycin was significantly associated with a reduction in repeated new CDI episodes. • In children with cancer and C. difficile infection (CDI), 82.9% had clinical cure. • Recurrence of CDI occurred in 9.6%. • A definition for severe CDI was derived and occurred in 9.7%. • Oral vancomycin was significantly associated with reduced repeated CDI episodes. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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40. Validation of the Proxy Version of Symptom Screening in Pediatrics Tool in Children Receiving Cancer Treatments.
- Author
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Hyslop, Shannon, Dupuis, L. Lee, Baggott, Christina, Dix, David, Gibson, Paul, Kuczynski, Susan, Johnston, Donna L., Orsey, Andrea, Portwine, Carol, Price, Vicky, Spiegler, Brenda, Tomlinson, Deborah, Vanan, Magimairajan, Tomlinson, George A., and Sung, Lillian
- Subjects
- *
CHILDHOOD cancer , *PEDIATRICS , *CANCER treatment , *CANCER patient medical care , *HEMATOPOIETIC stem cell transplantation , *TUMORS in children , *CANCER patients , *CONFIDENCE intervals , *STATISTICAL correlation , *DISCRIMINANT analysis , *LYMPHOBLASTIC leukemia , *RESEARCH methodology , *INTER-observer reliability , *RESEARCH methodology evaluation , *EARLY detection of cancer , *CHILDREN , *TUMOR treatment ,RESEARCH evaluation - Abstract
Objectives: Primary objectives were to evaluate the interrater reliability and validity of proxy-report Symptom Screening in Pediatrics Tool (SSPedi) in children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients. Secondary objective was to describe the interrater reliability of each SSPedi item.Methods: Respondents were children aged eight to 18 years with cancer or HSCT recipients, and their parents or guardians. We enrolled two pediatric respondent groups. The more symptomatic group was receiving active treatment for cancer, admitted to hospital, and expected to be in a hospital three days later. The less symptomatic group either was in maintenance therapy for acute lymphoblastic leukemia or had completed cancer treatments. Convergent validity was evaluated by comparing proxy-reported mucositis, nausea and vomiting, pain, and total SSPedi scores, with child self-reported validated scales, and we hypothesized fair correlations. Discriminant validity was evaluated by comparing proxy-reported total SSPedi scores between groups. Interrater reliability of each SSPedi item was evaluated.Results: Four hundred thirty-nine child and parent or guardian pairs were recruited. Mean difference in proxy-reported SSPedi scores between the more and less symptomatic groups was 8.2, 95% CI 6.6-9.8. All hypothesized relationships among measures were observed. Intraclass correlation coefficients for SSPedi items ranged from 0.34 (problems with thinking) to 0.80 (diarrhea).Conclusion: Proxy-report SSPedi is reliable and valid in children aged 8 years to 18 years with cancer and HSCT recipients. Future work should support proxy-reported symptom assessment in clinical settings where children are not able to self-report or communicate bothersome symptoms. [ABSTRACT FROM AUTHOR]- Published
- 2018
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41. Cognitive Interview-Based Validation of the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events in Adolescents with Cancer.
- Author
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Reeve, Bryce B., McFatrich, Molly, Pinheiro, Laura C., Freyer, David R., Basch, Ethan M., Baker, Justin N., Withycombe, Janice S., Sung, Lillian, Mack, Jennifer W., Waldron, Mia K., Mowbray, Catriona, Palma, Diana, and Hinds, Pamela S.
- Subjects
- *
CANCER in adolescence , *ADVERSE health care events , *ONCOLOGY , *COGNITIVE interviewing , *CLINICAL trials , *CANCER treatment , *TUMOR diagnosis , *AGE distribution , *COMPARATIVE studies , *GUARDIAN & ward , *INTERVIEWING , *RESEARCH methodology , *MEDICAL cooperation , *PARENTS , *READABILITY (Literary style) , *RESEARCH , *RESEARCH funding , *TERMS & phrases , *EVALUATION research , *RETROSPECTIVE studies ,TUMORS & psychology - Abstract
Context: The 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.Objectives: This 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.Methods: From 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.Results: In 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.Conclusion: This 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. [ABSTRACT FROM AUTHOR]- Published
- 2017
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42. Classification of treatment-related mortality in children with cancer: a systematic assessment.
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Alexander, Sarah, Pole, Jason D, Gibson, Paul, Lee, Michelle, Hesser, Tanya, Chi, Susan N, Dvorak, Christopher C, Fisher, Brian, Hasle, Henrik, Kanerva, Jukka, Möricke, Anja, Phillips, Bob, Raetz, Elizabeth, Rodriguez-Galindo, Carlos, Samarasinghe, Sujith, Schmiegelow, Kjeld, Tissing, Wim, Lehrnbecher, Thomas, Sung, Lillian, and International Pediatric Oncology Mortality Classification Group
- Subjects
- *
CHILDHOOD cancer , *CANCER-related mortality , *CLINICAL trials , *CANCER invasiveness , *ONCOLOGY , *HEALTH outcome assessment , *CANCER treatment , *TUMOR treatment , *AGE distribution , *ANTINEOPLASTIC agents , *CHILD mortality , *CONSENSUS (Social sciences) , *CAUSES of death , *DRUG side effects , *HEMATOPOIETIC stem cell transplantation , *INFANT mortality , *RISK assessment , *TERMS & phrases , *TIME , *TUMORS , *TREATMENT effectiveness - Abstract
Treatment-related mortality is an important outcome in paediatric cancer clinical trials. An international group of experts in supportive care in paediatric cancer developed a consensus-based definition of treatment-related mortality and a cause-of-death attribution system. The reliability and validity of the system was tested in 30 deaths, which were independently assessed by two clinical research associates and two paediatric oncologists. We defined treatment-related mortality as death occurring in the absence of progressive cancer. Of the 30 reviewed deaths, the reliability of classification for treatment-related mortality was noted as excellent by clinical research associates (κ=0·83, 95% CI 0·60-1·00) and paediatric oncologists (0·84, 0·63-1·00). Criterion validity was established because agreement between the consensus classifications by clinical research associates and paediatric oncologists was almost perfect (0·92, 0·78-1·00). Our approach should allow comparison of treatment-related mortality across trials and across time. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
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