RESUMEN
Background: Oral mucositis is a significant and common toxicity experienced by patients who receive high-dose chemotherapy as a preparatory regimen for a hematopoietic cell transplant (HCT). Photobiomodulation (PBM) has been found to be feasible with significant efficacy in preventing the progression of oral mucositis in adult patients undergoing HCT. The purpose of this study was to determine the feasibility and efficacy of PBM in pediatric oncology patients undergoing HCT. Method: Forty children and adolescents admitted to the transplant unit for an allogeneic HCT for acute lymphoblastic leukemia or acute myeloid leukemia were treated daily at six sites until day + 20 or engraftment. Results: There were 1,035 patient encounters, with successful treatment of four or more sites during 979 patient encounters for a feasibility 93.3% CI [0.926, 0.039]. We had estimated a meaningful effect size of 20% for PBM and estimated 51% of patients treated with PBM would have at least one day or more of Grade 3 mucositis. The rate of patients who received PBM and developed Grade 3 mucositis was 20% CI [0.091, 0.356]. Patients treated with PBM had fewer days of hospitalization (p = .009) and less severe mucositis in comparison to the matched control group (p = .03). Conclusion: PBM is feasible and effective in preventing and treating oral mucositis and is now supported by the Children's Oncology Group for prevention and treatment of oral mucositis in patients undergoing an allogeneic HCT or receiving head/neck radiation.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Terapia por Luz de Baja Intensidad , Mucositis , Estomatitis , Adulto , Niño , Adolescente , Humanos , Mucositis/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Terapia por Luz de Baja Intensidad/efectos adversos , Estomatitis/etiología , HospitalizaciónRESUMEN
OBJECTIVES: To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors. SAMPLE & SETTING: The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee. METHODS & VARIABLES: Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram. RESULTS: Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores. IMPLICATIONS FOR NURSING: Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.
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Agotamiento Profesional/prevención & control , Desgaste por Empatía/prevención & control , Enfermeras Pediátricas/psicología , Enfermería Oncológica , Enfermería Pediátrica , Adaptación Psicológica , Adulto , Aflicción , Agotamiento Profesional/etiología , Agotamiento Profesional/psicología , Desgaste por Empatía/etiología , Depresión/etiología , Educación Continua en Enfermería , Femenino , Estudios de Seguimiento , Pesar , Conductas Relacionadas con la Salud , Humanos , Satisfacción en el Trabajo , Masculino , Relaciones Enfermero-Paciente , Enfermeras Pediátricas/educación , Apoyo Nutricional , Proyectos Piloto , Resiliencia Psicológica , Adulto JovenRESUMEN
PURPOSE: We sought to identify factors, other than cancer-related treatment and presence/severity of chronic health conditions, which may be associated with late mortality risk among adult survivors of pediatric malignancies. METHODS: Using the Childhood Cancer Survivor Study cohort and a case-control design, 445 participants who died from causes other than cancer recurrence/progression or non-health-related events were compared with 7,162 surviving participants matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and time at-risk. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for overall/cause-specific mortality. Independent measures included number/severity of chronic conditions, medical care, health-related behaviors, and health perceptions/concerns. RESULTS: Adjusting for education, income, chemotherapy/radiation exposures, and number/severity of chronic health conditions, an increased risk for all-cause mortality was associated with exercising fewer than 3 days/week (OR = 1.72, CI 1.27-2.34), being underweight (OR = 2.58, CI 1.55-4.28), increased medical care utilization (P < 0.001), and self-reported fair to poor health (P < 0.001). Physical activity was associated with a higher risk of death among males (OR = 3.26, CI 1.90-5.61) reporting no exercise compared to those who exercised ≥3 times per week. Ever consuming alcohol was associated with a reduced risk of all-cause (OR = 0.61, CI 0.41-0.89) and other nonexternal causes of death (OR = 0.40, CI 0.20-0.79). Concerns/worries about future health (OR = 1.54, CI 1.10-2.71) were associated with increased all-cause mortality. CONCLUSIONS: Factors independent of cancer treatment and chronic health conditions modify the risk of death among adult survivors of pediatric cancer. IMPLICATIONS FOR CANCER SURVIVORS: Continued cohort observation may inform interventions to reduce mortality.
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Neoplasias/mortalidad , Sobrevivientes , Adulto , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Riesgo , AutoexamenRESUMEN
INTRODUCTION: Female childhood cancer survivors experience adverse health events secondary to cancer treatment. In healthy women, breastfeeding provides protection against many of these complications. Breastfeeding may be beneficial for mothers surviving childhood cancer by decreasing risks of, or ameliorating adverse late effects. Healthcare providers and survivors should be aware that successful lactation may be affected by previous cancer treatment. METHODS: The literature addressing lactation outcomes in cancer patients is reviewed, and processes that may disrupt breastfeeding are discussed. A summary of common late effects experienced by women is provided, and arguments are made for the potential amelioration of these complications by breastfeeding. RESULTS: Findings demonstrate that breastfeeding is beneficial for healthy mothers in regard to specific health conditions. There are limited data addressing breastfeeding outcomes among cancer survivors. Preliminary findings suggest that lactation is adversely affected among mothers treated for childhood cancer. CONCLUSIONS: Fundamental research is needed to determine rates of breastfeeding in childhood cancer survivors, identify specific cancer therapies and their effects on lactation, examine the efficacy of breastfeeding in risk reduction and/or amelioration of late effects, and develop interventions to increase breastfeeding among survivors of childhood cancer. IMPLICATIONS FOR CANCER SURVIVORS: As female childhood cancer survivors transition into adult medical care, it is important each patient be aware of her past medical history and the impact of treatment on her ability to successfully lactate. If lactation is possible, these women can choose to breastfeed their children, thereby engaging in a health behavior that may help protect them against many late effects of cancer treatment.
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Lactancia Materna , Neoplasias/mortalidad , Sobrevivientes , Densidad Ósea , Enfermedades Cardiovasculares/prevención & control , Consejo , Diabetes Mellitus/prevención & control , Femenino , Enfermedad de Hodgkin/mortalidad , Enfermedad de Hodgkin/fisiopatología , Enfermedad de Hodgkin/terapia , Humanos , Lactancia , Linfoma no Hodgkin/mortalidad , Linfoma no Hodgkin/fisiopatología , Linfoma no Hodgkin/terapia , Síndrome Metabólico/prevención & control , Neoplasias/fisiopatología , Neoplasias/terapia , Obesidad/prevención & control , Educación del Paciente como Asunto , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidad , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapiaRESUMEN
OBJECTIVES: To investigate the frequency and severity of side effects of methylphenidate among childhood survivors of acute lymphoblastic leukemia and brain tumors and identify predictors of higher adverse effect levels. METHODS: Childhood cancer survivors (N = 103) identified as having attention and learning problems completed a randomized, double-blind, 3-week, home-crossover trial of placebo, low-dose methylphenidate (0.3 mg/kg; 10 mg twice daily maximum) and moderate-dose methylphenidate (0.6 mg/kg; 20 mg twice daily maximum). Caregivers completed the Barkley Side Effects Rating Scale (SERS) at baseline and each week during the medication trial. Siblings of cancer survivors (N = 49) were recruited as a healthy comparison group. RESULTS: There was a significantly higher number and severity of symptoms endorsed on the SERS when patients were taking moderate dose compared with placebo or low dose, but not low dose compared with placebo. The number of side effects endorsed on the SERS was significantly lower during all 3 home-crossover weeks (placebo, low dose, moderate dose) when compared with baseline symptom scores. The severity of side effects was also significantly lower, compared with baseline screening, during placebo and low-dose weeks but not moderate-dose weeks. Both the number and severity of symptoms endorsed at baseline were significantly higher for patients compared with siblings. Female gender and lower IQ were associated with higher adverse effect levels. CONCLUSIONS: Methylphenidate is generally well tolerated by childhood cancer survivors. There is a subgroup at increased risk for side effects that may need to be closely monitored or prescribed a lower medication dose. The seemingly paradoxical findings of increased "side effects" at baseline must be considered when monitoring side effects and designing clinical trials.