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Objective:Central-line–associated bloodstream infections (CLABSIs) are associated with significant morbidity among pediatric oncology-hematology patients, and risk factors remain largely unknown in the setting of hospital at home (HAH). Children in HAH receive intensive treatment (eg, chemotherapy and parenteral nutrition), with frequent central-line handling; thus, they may be at higher risk for CLABSI.Methods:We conducted a monocentric retrospective study of patients with a central line included in our HAH program from January 1 to December 31, 2016. HAH patient characteristics for children developing CLABSIs were compared to those who did not, based on blood cultures positive for infection and clinical data of all patients included.Results:Overall, 492 HAH stays were analyzed, with 144 patients. The overall CLABSI rate in these patients was 2.6 per 1,000 central-line days. Children who developed CLABSIs were younger (median age, 2.5 vs 8.8 years; P < .001), suffered more from hematological pathologies (malignant or nonmalignant, 75% vs 52%; P = .02), and had more frequently undergone hematopoietic stem-cell transplantation (30.8% vs 6.5%; P = .01). In addition, these patients often had a tunneled externalized catheter as the central line and were more frequently given parenteral nutrition at home (46% vs 8%; P < .001).Conclusions:CLABSI rates for children in HAH were more similar to those of inpatients than to rates previously reported for ambulatory patients. The factors associated with infection identified herein should be further validated in multicentric studies and considered to improve HAH practices, parallel to prevention measures used in the inpatient setting.

Desmoplastic small round cell tumor (DSRCT) is an aggressive sarcoma occurring in the young, teenager, and adult populations. The aim of this study is to compare initial tumor presentation, therapeutic management and scalability between pediatric and adult DSRCT patients and investigate the possibility of specific therapeutic approaches. A multicenter retrospective study of 81 Franco-Belgian medical files with DSRCT harboring Ewing sarcoma-Wilm tumor transcript was made. Median age was 17 years (3 to 58) with 42 children (13.5 y [3;17]) and 39 adults (28 y [18;58]). No significant differences were found between the 2 groups regarding initial symptoms and metastasis at diagnosis. The therapeutic approaches were similar for both groups: use of neoadjuvant chemotherapy (78.6% vs. 79.5%, P=1), primary surgery (71.4% vs. 69.2%, P=0.73), adjuvant chemotherapy (54.8% vs. 61.5%, P=0.99), radiotherapy (23.8% and 10.3%, P=0.11) and intraperitoneal chemotherapy (14.3% vs. 2.6%; P=0.11). Median time to recurrence was 12 versus 18 months (P=0.13). Overall survival at 2 years and recurrence free were 46.4% versus 60.1% (P=0.83) and 14.3% versus 16%, respectively (P=0.16). Clinical presentation, initial therapeutics and outcome of DSRCT are equivalent suggesting that similar management should be considered for children and adults with DSRCT.

During the first lockdown of the coronavirus disease 2019 (COVID-19) pandemic, we developed a teleconsultation model and conducted a survey-based study with the aim to evaluate satisfaction and emotions of health workers (HWs), to assess the feasibility of teleconsultations, and to evaluate technical issues.This is a prospective monocentric exploratory study based on synchronous, video consultations between HWs and pediatric patients treated for blood or solid malignancies or blood benign diseases. Every HW completed an online survey which covered technical aspects, data concerning satisfaction, quality of the interaction with the patient, and emotions felt after the teleconsultation. A score was calculated for each aspect.Eleven specialists participated in the study, and we selected 84 questionnaires. With a satisfaction rate of 74%, HWs felt mostly calm (80%), relaxed (70%), stress-free (69%), and relieved (65%). We calculated the following median scores: an overall satisfaction score of 6.67 (0 to 10), a global feeling score of 8.79 (3.33 to 10.00), and a quality score of 7.34 (2.50 to 10.00). A strong correlation between the quality of teleconsultation and the satisfaction of the HWs has been highlighted (r=0.588).Our series is an encouragingly positive experience from the perspective of the HWs, their feelings, and perceptions.

Complementary and Alternative Medicines (CAM) are increasingly used in the therapeutic arsenal, particularly for pain management. Foot reflexology (FR) is still poorly evaluated, specifically in the pediatric population. The aim of this study was to evaluate the effectiveness of FR sessions in children experiencing chronic or persistent pain.We conducted a prospective study in two pediatric centers from January 2011 to January 2014. Sessions of FR were offered to children regardless of their age, experiencing persistent pain (72h) or chronic pain (3 months). A form was completed by the patient before and after each FR sessions. The effectiveness of the session was evaluated using a Visual Analogue Scale (VAS) for both pain and anxiety.One hundred and twenty-two patients suffering from persistent pain were included. We observed a significant decrease of mean VAS pain scores after each session (respectively P0.001, P0.001 and P=0.015) and of mean VAS anxiety scores (P0.001) for all sessions). Seventy patients suffering from chronic pain were included. Decrease in VAS pain scores was statistically significant after each reflexology session for children suffering from headache and musculoskeletal pain (P0.001). Anxiety was significantly lower after each session (P0.001).In 192 pediatric patients, FR significantly reduce pain and anxiety in children suffering from persistent or chronic pain. This CAM could have a place in pain management in children but needs to be evaluated in larger cohorts.

ObjectivesKetamine, anN-methyl-D-aspartate receptor antagonist, is effective at relieving adult cancer pain, although there have been very few reports to date regarding its use in children and in adolescents and young adults (AYA). This study assessed the efficacy, safety and opioid-sparing effects of low doses of ketamine added to opioid analgesics to alleviate persistent cancer pain.MethodsThis prospective, multicentre, observational trial collected data regarding demographics, pain characteristics, pain score assessment within the first 48 hours of ketamine administration, tolerance and satisfaction from 38 patients aged 2–24 years prescribed with ketamine as an adjuvant antalgic for refractory cancer pain in 10 French paediatric oncology centres.ResultsThe mean visual analogue scale pain score decreased from 6.7 to 4.3 out of 10 (n=39, pConclusionsLow doses of ketamine as an adjuvant to opioids significantly reduced the intensity of pain in half of the study population. A tendency towards better pain control is shown, although a lack of statistical power somewhat limits our conclusions, especially in children. Nevertheless, ketamine may be a useful option for improving the treatment of refractory pain in children and AYA with cancer.

Purpose Our Home Care Unit (HCU) undertakes close to twenty pediatric palliative care engagements per year. We investigated the factors underlying such care by independent home health nurses. Methods This was a retrospective, observational, single-center study. Home nurses who had provided palliative pediatric care in the past 16 months were included. Results Fifty-six questionnaires were sent out (response rate of 44.6%). Eight home nurses had never provided pediatric palliative care. Three-quarters of the home nurses (76%) acknowledged having misgivings accepting these duties. The factors that facilitated providing this care were the availability of the HCU doctor and nurses, the proactiveness of the HCU team, and house calls. In 76% of cases, the involvement of the home nurses exceeded the strictly professional setting. Forty-six percent of the home nurses were amenable to undertaking another pediatric palliative care engagement, although 48% deemed the remuneration to be somewhat lacking. Conclusion The analysis allowed us to identify several prerequisites for these care engagements: the availability and the proactiveness of the HCU team, communication, and planning. This study showed the pronounced personal involvement of home nurses in complex situations, with both the child and their entire family. Home nurses appear to be skilled at using the resources available to manage the exhaustion that can arise with such an engagement. Facilitating and respecting the choice to stay home of the child and their family was meaningful to them. The personal and professional enrichment were a source of motivation despite certain limitations (availability, remuneration).

Resume Introduction Notre service d’hospitalisation a domicile (HAD) est specialise pour les enfants atteints de cancer et possede une activite palliative importante. Cette etude decrit les caracteristiques des patients suivis en fin de vie par l’HAD, afin de comprendre les facteurs pouvant influencer le lieu de deces. Methodes Nous avons mene une etude observationnelle retrospective monocentrique sur les patients pediatriques d’onco-hematologie, traites au moins un jour en HAD lors des 3 derniers mois de vie, et decedes entre le 1er juillet 2013 et le 31 decembre 2015. L’analyse statistique etait descriptive et analytique. Resultats Soixante-quatorze patients suivis en HAD sont decedes au cours de cette periode, parmi lesquels 8 ont ete exclus. Quarante-trois patients parmi ces 66 (65 %) sont decedes a domicile. Lors des 3 derniers mois de vie, les patients d’oncologie ont moins de jours d’hospitalisation conventionnelle que les patients d’hematologie. L’implication des medecins generalistes, des infirmieres liberales et les informations delivrees aux familles etaient plus importantes dans le groupe des patients decedes a domicile. Aucune association significative n’a ete retrouvee entre l’âge du patient, sa pathologie, l’eloignement du domicile par rapport a l’hopital et le lieu de deces. Conclusion Notre service d’HAD a une activite majeure en soins palliatifs et un nombre important de patients decede a domicile. Une collaboration efficiente entre l’equipe d’onco-hematologie et le service d’HAD, ainsi qu’entre l’HAD et les soignants liberaux permet d’optimiser les soins palliatifs.

Resume Introduction Notre service d’hospitalisation a domicile a developpe l’administration de chimiotherapies (CT) intraveineuses (IV) a domicile pour des enfants atteints de cancer. Methodes Analyse retrospective, monocentrique avec identification des patients ayant recu au moins une cure de chimiotherapie en hospitalisation a domicile en 2015. Resultats Deux cent quarante-quatre sequences de chimiotherapies ont ete realisees en 2015 pour des enfants. Nous avons identifie deux types de chimiotherapies a domicile. Le pediatre onco-hematologue de l’hopital de jour prescrit la chimiotherapie. L’enfant recoit le j1 a l’hopital. L’hospitalisation a domicile prend le relais pour les jours suivants. Pour une cure remplacant une hospitalisation conventionnelle, le medecin traitant examine l’enfant et valide l’absence de contre-indication clinique. Le pediatre onco-hematologue de l’hospitalisation a domicile, verifie les valeurs biologiques et prescrit la chimiotherapie. Dans tous les cas, la chimiotherapie est preparee par la pharmacie hospitaliere, livree a domicile ou en hopital de jour et l’equipe d’hospitalisation a domicile coordonne les soins et forme les infirmiers diplomes d’etat liberaux. Pour les deux prises en charge, l’equipe d’hospitalisation a domicile recupere les bilans, valide informatiquement la chimiotherapie, gere le materiel et organise les venues a l’hopital. Une collaboration etroite entre le service d’hospitalisation a domicile, les intervenants liberaux et les medecins oncologues referents est indispensable pour le bon fonctionnement. Discussion Ce type de fonctionnement permet de mettre en place une chimiotherapie a domicile pour un nombre croissant de patients. Il permet de limiter le nombre de transports pour des enfants habitant souvent a grande distance de l’hopital de reference et dont les traitements necessitent de nombreuses hospitalisations.

Background Germ cell tumors with somatic malignant transformation (GCT with SMT) are rare in children and poorly described. Data are missing to determine if therapies should target the GCT, the SMT compound, or both simultaneously. Patients and methods A retrospective national study was conducted in the Societe Francaise des cancers de l'Enfant (SFCE) Centers. Medical records from patients aged 0 to 18 years diagnosed with GCT with SMT between 2000 and 2015 were analyzed. Any stages and primary sites were considered as well as synchronous and metachronous cases. Results Fifteen patients were identified. Thirteen patients had synchronous GCT with SMT. In the latter cases, primaries were ovary (5), mediastinum (3), pineal gland (3), sacrococcyx (1), and parametrium (1). SMT histologies were central primitive neuroectodermal tumor (5), embryonal rhabdomyosarcomas (3) or thyroid papillary adenocarcinoma, leukemia, poorly differentiated carcinoma, mixed sarcomas, and miscellaneous histology (1 case each). Chemotherapy was targeted against the GCT (3), the SMT (6), or both components (3). The last patient received surgery exclusively. Partial or complete response to chemotherapy was observed in 5/10 assessable cases: 2/3 patients treated with GCT-dedicated chemotherapy, 3/6 patients treated with SMT-dedicated therapy, and 0/1 treated with combined therapy. In addition, 2 patients with mediastinal GCT primary had metachronous SMT, with acute myeloid leukemia and thyroid papillary adenocarcinoma, 8 months and 8 years, respectively, after the diagnoses of GCT. Two patients (1 synchronous and 1 metachronous) were cured with surgery exclusively. At the end of follow-up, 6 patients died of their disease including all 4 with postsurgical macroscopic residue. Conclusions GCT with SMT constitutes a very rare entity in children and adolescents. Surgical removal of the tumor is the cornerstone of the treatment and might be sufficient in selected cases. In the remaining cases, the best management is still unknown and should take into account both components and their respective chemosensitivity. Long-term surveillance is advised for patient with unresected teratoma as late transformation can occur.

Introduction Plus de 200 adolescents et jeunes adultes (AJA, 15–25 ans) atteints d’un cancer sont pris en charge chaque annee par le DAJAC du CLB-IHOPe a Lyon. On observe chez ces patients pendant et apres le traitement une diminution du niveau d’activite physique et de l’hygiene de vie. Aujourd’hui ils survivent a leur maladie dans pres de 80 % des cas mais ont dans le meme temps 6 fois plus de risque que leurs pairs de developper un second cancer primitif [1] . Materiels et methodes PREVAPAJA vise a favoriser l’APA et l’information des AJA par une demarche integree aux parcours de soins. Cette etude de faisabilite articule 4 etapes autour d’un programme d’APA : T1/un bilan d’AP (IPAQ, QLQ-C30, EVA fatigue, TM6) initial ; T2/un bilan d’AP final apres 4 (± 2) mois d’accompagnement en APA ; T3/un entretien portant sur les freins et facilitateurs a la poursuite d’une activite physique et l’adoption de comportements favorables a la sante globale ; T4/un appel telephonique a un an portant sur la mise en œuvre des moyens de prevention des risques de second cancer primitif. Resultats Soixante-trois patients (39♂, 24♀) ont accepte de participer a l’etude, âges en moyenne de 19 ans (15 a 25 ans) et suivis pour des tumeurs germinales, lymphomes, tumeurs osseuses malignes et sarcomes des tissus mous. A l’issu de leur programme d’APA, leur niveau d’AP, leur qualite de vie, leur fatigue et leur distance au TM6 se sont ameliores de facon statistiquement significative. L’analyse des entretiens a permis d’identifier des facilitateurs/freins a la pratique d’AP pendant les traitements. Conclusion PREVAPAJA constitue un dispositif novateur inscrivant la promotion de la sante des jeunes apres cancer comme un levier d’action de prevention tertiaire. Les analyses finales sont prevues pour avril 2018.

Resume Introduction Les adolescents et jeunes adultes (AJA, 15–25 ans) atteints d’un cancer sont pris en charge soit en oncologie adulte soit en pediatrie. La gestion des aplasies febriles (AF) differe selon les equipes : surveillance et indications d’hospitalisation souvent plus strictes en pediatrie. L’objectif de cette etude est d’evaluer si ces differences de pratique influencent la survenue de complications. Methodes Etude retrospective des dossiers des AJA traites dans notre etablissement entre le 01/09/2000 et le 31/05/2013 dans le protocole Euro-E-W-I-N-G99. Analyse des AF survenant pendant la chimiotherapie d’induction. Resultats Quarante-quatre patients ont ete inclus (18 en services adultes, 26 en pediatrie). Au decours des 260 cures de VIDE, le nombre median d’AF est de 2 par patient en secteur adulte et 3 par patient en pediatrie ( p = 0,2). Le nombre median d’hospitalisations pour AF est de 1,5 par patient adulte et 3 par patient pediatrique ( p = 0,008), avec une duree cumulee d’hospitalisation de 4,5 jours par patient en secteur adulte et 16 jours en pediatrie ( p = 0,008). Il n’y a pas de difference significative de survie, nombre d’infections documentees, transfusions, adaptations de dose, reports de cure, transferts en reanimation, infections postoperatoires. Conclusion Les AJA pris en charge en secteur adulte sont moins hospitalises pour AF que ceux traites en pediatrie, sans difference de morbi-mortalite : la prise en charge pourrait etre homogeneisee.

Our home-care unit (HCU) is specialized for pediatric cancer patients and has a strong palliative care activity. We believe that the introduction of home-care services can influence the place of palliative care and of death as well as the length of hospitalization. We aimed at describing characteristics and care course of patients treated in our HCU, and tried to identify some factors contributing to home care at the end of life.We conducted a retrospective, observational, monocentric study about patients in pediatric onco-hematology, treated at least one day in our home-care unit, who died between July 1st 2013 and December 31st 2015. Statistical analysis was descriptive and analytic.A total of 74 patients known by our HCU died during study period. Eight were excluded. Forty-three out of 66 patients died at home. During the last 3 months of life, oncology patients have significantly less classical hospitalization, when compared to hematology patients. The implication of general physicians (GP) and nurses and information given to the family increase the possibility for home death. No significant association was found between ages at death, distance between home and hospital, other life conditions and place of death.Our HCU has a strong palliative care activity and a high rate of children dying at home. Good collaborations between our pediatric onco-hematology team and our HCU as well as between our HCU and caregivers optimize palliative care.

Management of adolescents and young adults (AYAs) differs between adult and pediatric units, especially regarding febrile neutropenia (FN). In our previous study, we found that AYAs treated in adult units were significantly less hospitalized for FN than in pediatric units, without difference in morbimortality. The objective of this work was to assess the economic impact of these practices.This study retrospectively collected data from the medical records of AYAs treated at the Comprehensive Cancer Center Léon Bérard, Lyon, France, in the Euro-E-W-I-N-G99 protocol between September 1, 2000 and May 31, 2013. We focused on FN occurring after VIDE (vincristine, ifosfamide, doxorubicin, etoposide) courses. Costs were calculated using a micro-costing technique from the hospital's perspective (in 2014-Euro); the time horizon was the induction period. Multivariate analyses were performed on the total cost and cost of FN. Uncertainty was captured by sensitivity analyses.Forty-four AYAs (18 in the adult sector, 26 in the pediatric sector) received 260 courses of VIDE. Mean cost of care was €37,544 in the pediatric sector, including €11,948 (32%) for FN (€11,851 in hospitalization), versus €34,677 in the adult sector, including €6,143 (18%) for FN (€5,789 in hospitalization). Cost for FN was significantly higher in pediatric units (difference in mean cost of €5,830 per patient, 95% bootstrapped confidence interval [1,939.1; 10,028.9]). In multivariate analysis, the only factor significantly influencing this cost difference was the sector of care. The most sensitive parameter was the unit cost of conventional hospitalization.These results support the adult sector strategy, in agreement with the results of our first work showing comparable effectiveness.

Our home care unit (HCU) developed the administration of IV chemotherapy at home for some pediatric oncologic patients.We conducted a retrospective monocentric analysis, leading to identify patients with at least one sequence of chemotherapy at home in 2015.Two hundred and forty four sequences of home chemotherapy have been administered in 2015. We identified two situations for home IV chemotherapy. Pediatric oncologist of day hospital prescribes the sequence. The chemotherapy is delivered at hospital for the first day. HCU takes over for the next days at home. For a sequence replacing a conventional hospitalization, the attending physician examines the patient, and confirm the clinical validation. The pediatric oncologist of HCU checks lab exams, and prescribes the chemotherapy. For both situations, IV chemotherapy is prepared by our hospital pharmacy, delivers at home or at day hospital, and HCU team manages home material and organizes hospitalization.This kind of organization allows setting up home IV CT for more and more patients. It allows to limit daily hospitalization for some patients living far from the hospital, and whose therapies lead to several hospitalizations.

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. To assess the safety and effectiveness of such treatment at a single center. We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. Eleven gastrostomies were performed in 11 children and young adults (3–20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects — local leakage and granulation tissue formation — both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. The procedure and devices were well tolerated and mostly effective in our cohort.

Introduction et but de l’etude La greffe de cellules souches hematopoietiques (GCSH), qu’elle soit allogenique ou autologue, altere l’etat nutritionnel de l’enfant. La principale raison est une toxicite gastro-intestinale, pouvant conduire a l’installation rapide d’une denutrition en absence de support nutritionnel adequat. Le maintien d’un etat nutritionnel correct pourrait diminuer le taux de certaines complications telles que les infections, et donc indirectement la duree d’hospitalisation [1] , [2] , [3] . L’objectif principal de l’etude etait de decrire la prise en charge nutritionnelle chez des patients pediatriques recevant une allo- ou une auto-GCSH en secteur protege sur la periode de janvier 2014 a decembre 2014. Materiel et methodes Les donnees anthropometriques et nutritionnelles des enfants ayant beneficie d’une allo- ou auto-GCSH ont ete analysees de facon retrospective jusqu’a 6 mois post-GCSH selon le type de pathologie, de conditionnement et de support nutritionnel utilise. Les donnees qualitatives ont ete exprimees en nombre de sujets et pourcentages, et comparees par le test du Chi2 ou de Fisher en fonction des effectifs. Les donnees quantitatives ont ete exprimees en moyenne et ecart-type. Les moyennes ont ete comparees par un test t de Student apres analyse des variances. Resultats et analyse statistique Quarante-deux enfants ont beneficie d’une GCSH, 13 d’une auto-GCSH et 29 d’une allo-GCSH. Parmi ces patients, quatre etaient denutris avant la greffe (10,8 %). La difference de poids durant l’hospitalisation etait en moyenne de -2,7 % (± 6,3 %). Onze patients presentaient une perte de poids superieure a 10 % a 6 mois apres la greffe (26,8 %). La prise en charge nutritionnelle est decrite dans le Tableau 1 . L’ajout de lipides ou une NP ternaire ont ete realises chez 13 patients (31 %), pour une duree moyenne de 8,2 jours/27,1 jour de NP. Cinquante pour cent des patients denutris lors de l’entree ont beneficie d’un double support NE et NP. Nous n’avons pas mis en evidence de relation entre l’etat nutritionnel a 6 mois, le taux d’infections et la duree de sejour. Conclusion Dans cette population, la denutrition reste frequente avant GCSH. Malgre l’administration d’un support nutritionnel, 26,8 % des patients presentaient une perte de poids majeure a 6 mois apres GCSH. La NE est peu utilisee en pratique.

Adolescents and young adults (AYA, 15-25years old) with cancer are treated either in adult or pediatric units. Management of febrile neutropenia (FN) is different between these units. Monitoring rules and indications of hospitalization are often stricter in pediatrics. This study evaluates if these differences influence the occurrence of complications.The medical records of AYA patients treated in our institution in the Euro-E-W-I-N-G99 protocol between 01/09/2000 and 31/05/2013 were retrospectively analyzed. We studied febrile neutropenias occurring after VIDE courses, during the induction period.Forty-four patients were included (18 from adult units, 26 from pediatrics). Median age at inclusion was 19.6. After 260 courses of VIDE, we observed a median of 2 FN per adult and 3 per pediatric patient (P=0.2). Hospitalization occurred in median 1.5 time per adult and 3 per pediatric patient (P=0.008). Median cumulated length of stay was 4.5days for adults versus 16 days for pediatric patients (P=0.008). There was no significant difference for survival, number of documented infections, transfusions, dose modifications, chemotherapy delay, need for intensive care, infection after post-induction surgery.AYA treated in adult services are less frequently hospitalized for FN with no difference in morbi-mortality. Homogeneous recommendations could be made for these patients, whatever the units they are treated in.