9 results on '"Fu, L."'
Search Results
2. Interdisciplinary care of pediatric oncology patients: A survey of clinicians in Central America and the Caribbean.
- Author
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Graetz DE, Chen Y, Devidas M, Antillon-Klussmann F, Fu L, Quintero K, Fuentes-Alabi SL, Gassant PY, Kaye EC, Baker JN, Rodriguez Galindo C, and Mack JW
- Subjects
- Child, Humans, Interdisciplinary Communication, Caribbean Region, Central America, Medical Oncology, Neoplasms therapy
- Abstract
Background: Quality cancer care depends on interdisciplinary communication. This study explored the communication practices of interdisciplinary clinicians, the types of healthcare services for which they engage in interdisciplinary collaboration, and the association between interdisciplinary care and perceived quality of care, as well as job satisfaction., Methods: We conducted a survey of interdisciplinary clinicians from cancer centers in Guatemala, Honduras, Panama, El Salvador, and Haiti. The survey included 68 items including previously validated tools and novel questions., Results: Total 174 interdisciplinary clinicians completed the survey: nurses (n = 60), medical subspecialists (n = 35), oncologists (n = 22), psychosocial providers (n = 20), surgeons (n = 12), pathologists (n = 9), radiologists (n = 9), and radiation oncologists (n = 5). Oncologists reported daily communication with nurses (95%) and other oncologists (91%). While 90% of nurses reported daily communication with other nurses, only 66% reported daily communication with oncologists, and more than 50% of nurses reported never talking to pathologists, radiologists, radiation oncologists, or surgeons. Most clinicians described interdisciplinary establishment of cancer treatment goals and prognosis (84%), patient preferences (81%), and determination of first treatment modality (80%). Clinicians who described more interdisciplinary collaboration had higher job satisfaction (p = .04) and perceived a higher level of overall quality of care (p = .004)., Conclusions: Clinicians in these limited resource settings describe strong interdisciplinary collaboration contributing to higher job satisfaction and perceived quality of care. However, nurses in these settings reported more limited interdisciplinary communication and care. Additional studies are necessary to further define clinical roles on interdisciplinary care teams and their associations with patient outcomes., (© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
- Published
- 2023
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3. Delayed Enucleation With Neoadjuvant Chemotherapy in Advanced Intraocular Unilateral Retinoblastoma: AHOPCA II, a Prospective, Multi-Institutional Protocol in Central America.
- Author
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Luna-Fineman S, Chantada G, Alejos A, Amador G, Barnoya M, Castellanos ME, Fu L, Fuentes-Alabi S, Girón V, Goenz MA, Maldonado C, Méndez G, Morales RA, Ortiz R, Sanchez G, Wilson M, and Rodríguez-Galindo C
- Subjects
- Antineoplastic Combined Chemotherapy Protocols adverse effects, Carboplatin administration & dosage, Central America, Chemotherapy, Adjuvant, Child, Child, Preschool, Disease Progression, Etoposide administration & dosage, Female, Humans, Infant, Male, Neoplasm Staging, Progression-Free Survival, Prospective Studies, Retinal Neoplasms mortality, Retinal Neoplasms pathology, Retinoblastoma mortality, Retinoblastoma pathology, Risk Factors, Time Factors, Treatment Refusal, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Eye Enucleation adverse effects, Eye Enucleation mortality, Neoadjuvant Therapy adverse effects, Neoadjuvant Therapy mortality, Retinal Neoplasms therapy, Retinoblastoma therapy, Time-to-Treatment
- Abstract
Purpose: Treatment abandonment because of enucleation refusal is a limitation of improving outcomes for children with retinoblastoma in countries with limited resources. Furthermore, many children present with buphthalmos and a high risk of globe rupture during enucleation. To address these unique circumstances, the AHOPCA II protocol introduced neoadjuvant chemotherapy with delayed enucleation., Patients and Methods: Patients with advanced unilateral intraocular disease (International Retinoblastoma Staging System [IRSS] stage I) were considered for upfront enucleation. Those with diffuse invasion of the choroid, postlaminar optic nerve, and/or anterior chamber invasion received six cycles of adjuvant chemotherapy (vincristine, carboplatin, and etoposide). Patients with buphthalmos and those with a perceived risk for enucleation refusal and/or abandonment were given two to three cycles of chemotherapy before scheduled enucleation followed by adjuvant chemotherapy to complete six cycles, regardless of pathology., Results: A total of 161 patients had unilateral IRSS stage I disease; 102 underwent upfront enucleation, and 59 had delayed enucleation. The estimated 5-year abandonment-sensitive event-free and overall survival rates for the group were 0.81 ± 0.03 and 0.86 ± 0.03, respectively. The 5-year estimated abandonment-sensitive event-free survival rates for patients undergoing upfront and delayed enucleation were 0.89 ± 0.03 and 0.68 ± 0.06, respectively ( P = .001). Compared with AHOPCA I, abandonment for patients with IRSS stage I retinoblastoma decreased from 16% to 4%., Conclusion: AHOPCA describes the results of advanced intraocular retinoblastoma treated with neoadjuvant chemotherapy. In eyes with buphthalmos and patients with risk of abandonment, neoadjuvant chemotherapy can be effective when followed by enucleation and adjuvant chemotherapy. Our study suggests that this approach can save patients with buphthalmos from ocular rupture and might reduce refusal of enucleation and abandonment.
- Published
- 2019
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4. Outcome of children treated for relapsed acute myeloid leukemia in Central America.
- Author
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Marjerrison S, Antillon F, Bonilla M, Fu L, Martinez R, Valverde P, Vasquez R, Howard SC, Ribeiro RC, and Sung L
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- Adolescent, Central America epidemiology, Child, Child, Preschool, Disease-Free Survival, Female, Humans, Leukemia, Promyelocytic, Acute pathology, Male, Recurrence, Retrospective Studies, Survival Rate, Time Factors, Leukemia, Promyelocytic, Acute mortality, Leukemia, Promyelocytic, Acute prevention & control
- Abstract
Background: Relapsed childhood acute myeloid leukemia (AML) outcomes have not been documented in resource-limited settings. We examined survival after relapse for children with AML (non-APML) and acute promyelocytic leukemia (APML) in Central America., Procedure: We retrospectively evaluated outcomes of children with first relapse of AML (non-APML) and APML in Guatemala, Honduras, or El Salvador diagnosed between 1997 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined., Results: We identified 140 children with relapsed AML (non-APML), and 24 with relapsed APML. Two-year subsequent EFS and OS (±SE) were 7.0 ± 2.5% and 9.1 ± 2.8%, respectively. Worse outcomes were associated with Hispanic or Indigenous heritage, white blood cell count at diagnosis ≥50 × 10(9) /L, and time to relapse <18 months. For those with relapsed APML, subsequent 2-year EFS and OS were 36.7 ± 10.8% and 43.4 ± 12.1%, although few patients survived beyond 3 years. 15.2% of all patients were managed solely with palliative intent following first relapse., Conclusions: Children with relapsed AML in Central America rarely survive, so palliative strategies should be considered following relapse in this population. However, children with late relapse or with APML may have a prolonged period of remission with second treatment, and consideration of re-treatment may be appropriate., (© 2014 Wiley Periodicals, Inc.)
- Published
- 2014
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5. Treatment of childhood acute lymphoblastic leukemia in central America: a lower-middle income countries experience.
- Author
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Navarrete M, Rossi E, Brivio E, Carrillo JM, Bonilla M, Vasquez R, Peña A, Fu L, Martinez R, Espinoza CM, Lacayo LF, Rodriguez H, Batista R, Barr R, Howard SC, Ribeiro RC, Masera G, Biondi A, Conter V, and Valsecchi MG
- Subjects
- Adolescent, Central America, Child, Child, Preschool, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Immunophenotyping, Income, Infant, Infant, Newborn, Male, Neoplasm Recurrence, Local etiology, Neoplasm Recurrence, Local mortality, Neoplasms, Second Primary etiology, Neoplasms, Second Primary mortality, Poverty, Precursor Cell Lymphoblastic Leukemia-Lymphoma complications, Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality, Prognosis, Remission Induction, Survival Rate, Withholding Treatment economics, Developing Countries, Neoplasm Recurrence, Local therapy, Neoplasms, Second Primary therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Withholding Treatment statistics & numerical data
- Abstract
Background: Five Asociación de Hemato-Oncología de Centroamérica (AHOPCA) countries have used an adapted BFM-based protocol for childhood acute lymphoblastic leukemia (ALL)., Procedure: In the AHOPCA-ALL 2008 protocol, patients were stratified by age, white blood cell count, immunophenotype, central nervous system involvement, day 8 prednisone response, and morphologic bone marrow response to induction therapy. Patients at Standard Risk (SR) received a three-drug induction regimen, a reinduction phase, and maintenance with protracted intrathecal therapy. Those at Intermediate (IR) and High Risk (HR) received, in addition, daunorubicin during induction therapy, a consolidation phase and two or three reinduction phases respectively., Results: From August 2008 through July 2012, 1,313 patients were enrolled: 353 in SR, 548 in IR, 412 in HR. During induction therapy, 3.0% of patients died, 2.7% abandoned treatment, 1.1% had resistant ALL, and 93.2% achieved morphological complete remission (CR). Deaths and abandonment in first CR occurred in 2.7% and in 7.0% of patients, respectively. The relapse rate at a median observation time of 2.1 years was 15.0%. At 3 years, the event-free survival (EFS) and overall survival (OS), with abandonment considered as an event, were 59.4% (SE 1.7) and 68.2% (SE 1.6). Three-year EFS was 68.5% (SE 3.0), 62.1% (SE 2.6), and 47.8% (SE 3.2) for SR, IR, and HR groups. Adolescents had a significantly higher relapse rate (P = 0.001)., Conclusions: This experience shows that common international studies are feasible in lower-middle income countries. Toxic deaths, abandonment of treatment, and relapses remain major obstacles to the successful treatment. Alternative treatment strategies may be beneficial., (© 2013 Wiley Periodicals, Inc.)
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- 2014
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6. Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America.
- Author
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Marjerrison S, Antillon F, Fu L, Martinez R, Vasquez R, Bonilla M, Howard SC, and Sung L
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- Central America, Child, Cohort Studies, Disease-Free Survival, Female, Humans, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma pathology, Prognosis, Recurrence, Retrospective Studies, Treatment Outcome, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy
- Abstract
Background: Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America., Methods: A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined., Results: There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 10(9) /L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively., Conclusions: Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013. © 2012 American Cancer Society., (Copyright © 2012 American Cancer Society.)
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- 2013
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7. Treatment-related mortality in children with acute myeloid leukaemia in Central America: incidence, timing and predictors.
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Gupta S, Bonilla M, Valverde P, Fu L, Howard SC, Ribeiro RC, and Sung L
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- Central America, Child, Child, Preschool, Cohort Studies, Developed Countries, El Salvador epidemiology, Female, Guatemala epidemiology, Honduras epidemiology, Humans, Incidence, Male, Outcome Assessment, Health Care methods, Retrospective Studies, Socioeconomic Factors, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute therapy
- Abstract
Background: Cure rates in paediatric acute myeloid leukaemia in low-income countries lag behind those in high-income countries, in part secondary to higher rates of treatment-related mortality. Patterns of treatment-related mortality are likely to differ between low and high-income centres. Understanding low-income setting patterns is necessary before effective interventions aimed at decreasing treatment-related mortality can be designed. Our aim was to describe the incidence, timing and predictors of treatment-related mortality among Central American children with acute myeloid leukaemia., Patients and Methods: We evaluated patients younger than 21 years diagnosed with acute myeloid leukaemia from 2000 to 2008 in El Salvador, Honduras or Guatemala. Biologic, socioeconomic and nutritional variables collected prospectively were examined as potential predictors of treatment-related mortality., Results: Among 279 patients, treatment-related mortality occurred in 65 (23%). Of 65 deaths, 51 (78.5%) occurred before or during induction, resulting in an early death rate of 18.3%. The most common causes of treatment-related mortality were infection (29/65; 45%) and haemorrhage (13/65; 20%). Infection accounted for 33% of treatment-related mortality before remission induction therapy versus 40% during induction and 77% after induction (P = 0.03). Rates of treatment-related mortality did not vary between time periods 1 and 2 (24.8% versus 21.4%; P = 0.32). Only lower initial platelet count predicted early death (odds ratio per 10 × 10(9)/L = 0.88, 95% Confidence Interval (CI) 0.79-0.97; P < 0.001)., Conclusions: Treatment-related mortality remains a significant cause of treatment failure. Supportive care interventions are needed. Children presenting with low initial platelet counts were at highest risk of induction death, suggesting that transfusion practices should be evaluated., (Copyright © 2011 Elsevier Ltd. All rights reserved.)
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- 2012
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8. Retinoblastoma in Central America: report from the Central American Association of Pediatric Hematology Oncology (AHOPCA).
- Author
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Luna-Fineman S, Barnoya M, Bonilla M, Fu L, Baez F, and Rodríguez-Galindo C
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- Carboplatin administration & dosage, Central America, Child, Child, Preschool, Combined Modality Therapy, Disease-Free Survival, Etoposide administration & dosage, Female, Humans, Infant, Infant, Newborn, Male, Neoplasm Staging, Survival Rate, Vincristine administration & dosage, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Eye Neoplasms diagnosis, Eye Neoplasms metabolism, Eye Neoplasms therapy, Retinoblastoma diagnosis, Retinoblastoma mortality, Retinoblastoma therapy
- Abstract
Background: Retinoblastoma is highly curable in high income countries. Low income countries have poor results due to advanced disease and lack of resources. Central American Association of Pediatric Hematology Oncology (AHOPCA) aimed to standardize the approach and to improve outcomes of patients with retinoblastoma., Procedure: One hundred seventy-one patients, age <18 years newly diagnosed with retinoblastoma were treated according to laterality and stage. Therapeutic modalities were: surgery (enucleation), local control (laser therapy, cryotherapy), chemotherapy, and radiation therapy. Chemotherapy consisted of vincristine, etoposide, and carboplatin (6 cycles). Outcomes were measured by overall survival. Events were abandonment of therapy and death., Results: One hundred seventy-one patients (129 unilateral, 42 bilateral) were treated. Median age was 2 years 4 months; 112 (66%) were diagnosed before 3 years of age. 119 (92%) eyes in patients with unilateral disease were Reese-Ellsworth IV or V versus 52 (62%) eyes in patients with bilateral disease. Extraocular disease was more prevalent in unilateral disease (65% vs. 50%). Older age at diagnosis correlated with higher stage. Estimated overall survival at 60 months was 0.48 ± 0.04. Outcome of patients with bilateral disease was significantly better than unilateral (62% ± 0.09 vs. 42% ± 0.05, P = 0.0006). Thirty-eight patients (22%) refused or abandoned therapy., Conclusions: Protocol-directed therapy for retinoblastoma in Central America is possible. Patients present with advanced disease and outcome is significantly worse than in middle and high-income countries. Refusal and abandonment of therapy are societal events that affect outcome. Initiatives aimed at improving early diagnosis, while dedicated treatment centers are developed, are critical., (Copyright © 2011 Wiley Periodicals, Inc.)
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- 2012
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9. Measurement of health-related quality of life in survivors of cancer in childhood in Central America: feasibility, reliability, and validity.
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Fu L, Talsma D, Baez F, Bonilla M, Moreno B, Ah-Chu M, Pena A, Furlong W, and Barr RD
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- Adolescent, Central America, Child, Child, Preschool, Disease-Free Survival, Female, Humans, Male, Neoplasms mortality, Neoplasms physiopathology, Survival Rate, Health Status Indicators, Interviews as Topic, Neoplasms psychology, Quality of Life, Surveys and Questionnaires
- Abstract
Cancer is the commonest cause of disease-related death in children over 5 years of age in various parts of Latin America, but the survival rates are improving. This study assessed the health status and health-related quality of life (HRQL) of more than 200 survivors of cancer in childhood in the countries of a Central American consortium devoted to pediatric hematology-oncology. Patients' self-reports and parental proxy assessments were collected using interviewer-administered Spanish-language questionnaires, and physicians provided assessments using self-complete questionnaires, based on the complementary Health Utilities Index (HUI) Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems. Inter-rater agreement, measured by intra-class correlation (ICC), was fair to moderate (0.34
0.60) for all 3 pairs of assessors for readily assessable attributes: HUI2 sensation, HUI3 vision, HUI3 hearing, and HUI3 ambulation. Less than 40% of the patients reported being in perfect health. More than 20% reported being in health states with HRQL scores corresponding to moderate or severe disability, notably in the attributes of emotion and cognition. The results reflect a common profile in survivors of cancer in childhood, including those from industrialized societies. This study illustrates the feasibility of collecting reliable and valid information on HRQL in the developing country context, raising the prospect that such information could be used to influence clinical practice. - Published
- 2006
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