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Winestone LE, Bhojwani D, Ghorashian S, Muffly L, Leahy AB, Chao K, Steineck A, Rössig C, Lamble A, Maude SL, Myers R, Rheingold SR. INSPIRED Symposium Part 4A: Access to CAR T Cell Therapy in Unique Populations with B Cell Acute Lymphoblastic Leukemia. Transplant Cell Ther 2024; 30:56-70. [PMID: 37821078 DOI: 10.1016/j.jtct.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
The approval of tisagenlecleucel (tisa-cel) for use in children with B cell acute lymphoblastic leukemia (B-ALL) was based on the phase 2 ELIANA trial, a global registration study. However, the ELIANA trial excluded specific subsets of patients facing unique challenges and did not include a sufficient number of patients to adequately evaluate outcomes in rare subpopulations. Since the commercialization of tisa-cel, data have become available that support therapeutic indications beyond the specific cohorts previously eligible for chimeric antigen receptor (CAR) T cells targeted to CD19 (CD19 CAR-T) therapy on the registration clinical trial. Substantial real-world data and aggregate clinical trial data have addressed gaps in our understanding of response rates, longer-term efficacy, and toxicities associated with CD19 CAR-T in special populations and rare clinical scenarios. These include patients with central nervous system relapsed disease, who were excluded from ELIANA and other early CAR-T trials owing to concerns about risk of neurotoxicity that have not been born out. There is also interest in the use of CD19 CAR-T for very-high-risk patients earlier in the course of therapy, such as patients with persistent minimal residual disease after 2 cycles of upfront chemotherapy and patients with first relapse of B-ALL. However, these indications are not specified on the label for tisa-cel and historically were not included in eligibility criteria for most clinical trials; data addressing these populations are needed. Populations at high risk of relapse, including patients with high-risk cytogenetic lesions, infants with B-ALL, patients with trisomy 21, and young adults with B-ALL, also may benefit from earlier treatment with CD19 CAR-T. It is important to prospectively study patient-reported outcomes given the differential toxicity expected between CD19 CAR-T and the historic standard of care, hematopoietic cell transplantation. Now that CD19 CAR-T therapy is commercially available, studies evaluating potential access disparities created by this very expensive novel therapy are increasingly pressing.
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Affiliation(s)
- Lena E Winestone
- Division of Allergy, Immunology, and BMT, Department of Pediatrics, UCSF Benioff Children's Hospitals, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
| | - Deepa Bhojwani
- Division of Pediatric Hematology-Oncology, Children's Hospital Los Angeles, Norris Comprehensive Cancer Center and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sara Ghorashian
- Haematology Department, Great Ormond Street Hospital, London UK, Developmental Biology and Cancer, UCL-Great Ormond Street Institute of Child Health, University College London, London United Kingdom
| | - Lori Muffly
- Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, California
| | - Allison Barz Leahy
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Chao
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Angela Steineck
- MACC Fund Center for Cancer and Blood Disorders, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claudia Rössig
- University Children's Hospital Muenster, Pediatric Hematology and Oncology, Muenster, Germany; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Adam Lamble
- Division of Hematology and Oncology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Shannon L Maude
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Regina Myers
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan R Rheingold
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Rothmund M, Sodergren S, Rohde G, de Rojas T, Paratico G, Albini G, Mur J, Darlington AS, Majorana A, Riedl D. Updating our understanding of health-related quality of life issues in children with cancer: a systematic review of patient-reported outcome measures and qualitative studies. Qual Life Res 2023; 32:965-976. [PMID: 36152110 PMCID: PMC9510324 DOI: 10.1007/s11136-022-03259-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a key concept in pediatric oncology. This systematic review aims to update the conceptual HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), covering physical, emotional, social and general HRQOL aspects, and to present a comprehensive overview of age- and disease-specific HRQOL issues in children with cancer. METHODS Medline, PsychINFO, the Cochrane Database for Systematic Reviews (CDSR), and the COSMIN database were searched (up to 31.12.2020) for publications using patient-reported outcome measures (PROMs) and qualitative studies in children with cancer (8-14-year) or their parents. Items and quotations were extracted and mapped onto the conceptual model for HRQOL in children with cancer mentioned above. RESULTS Of 2038 identified studies, 221 were included for data extraction. We identified 96 PROMS with 2641 items and extracted 798 quotations from 45 qualitative studies. Most items and quotations (94.8%) could be mapped onto the conceptual model. However, some adaptations were made and the model was complemented by (sub)domains for 'treatment burden', 'treatment involvement', and 'financial issues'. Physical and psychological aspects were more frequently covered than social issues. DISCUSSION This review provides a comprehensive overview of HRQOL issues for children with cancer. Our findings mostly support the HRQOL model by Anthony et al. (Qual Life Res 23(3):771-789, 2014), but some adaptations are suggested. This review may be considered a starting point for a refinement of our understanding of HRQOL in children with cancer. Further qualitative research will help to evaluate the comprehensiveness of the HRQOL model and the relevance of the issues it encompasses.
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Affiliation(s)
- Maria Rothmund
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | | | - Gudrun Rohde
- Department of Clinical Research, Faculty of Health and Sport Sciences, Kristiansand and Sorlandet Hospital, University of Agder, Kristiansand, Norway
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | | | - Gloria Paratico
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - Giorgia Albini
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - Johanna Mur
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alessandra Majorana
- Department of Oral Medicine and Paediatric Dentistry, University of Brescia, Brescia, Italy
| | - David Riedl
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria.
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3
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Cheng L, Reeve BB, Withycombe JS, Jacobs SS, Mack JW, Weaver M, Mann CM, Waldron MK, Maurer SH, Baker JN, Wang J, Hinds PS. Profiles of Symptom Suffering and Functioning in Children and Adolescents Receiving Chemotherapy. Cancer Nurs 2023; 46:E129-E137. [PMID: 35816032 PMCID: PMC9941076 DOI: 10.1097/ncc.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Some children and adolescents receiving chemotherapy experience few symptom-related adverse events, whereas others experience multiple adverse events. If oncology nurses could identify patients likely to have pronounced chemotherapy-related adverse events, tailored supportive care could be matched to these patients' symptom burdens. OBJECTIVE The aim of this study was to identify symptom profiles in children and adolescents before and after chemotherapy, and the sociodemographic and psychological factors associated with profile classification and change. METHODS Participants ranging from 7 to 18 years (n = 436) completed 6 Patient-Reported Outcomes Measurement Information System pediatric symptom measures within 72 hours preceding (T1) and 1 to 2 weeks after (T2) chemotherapy. Profile membership and change were determined by latent profile/latent transition analyses. Associations with profiles and profile transitions were examined using multinomial logit models and logistic regression. RESULTS Three symptom suffering profiles were identified at T1 and T2: high, medium, and low. The high symptom suffering profile included the fewest participants (T1, n = 70; T2, n = 55); the low symptom suffering profile included the most participants (T1, n = 200; T2, n = 207). Of the participants, 57% remained in the same profile from T1 to T2. Psychological stress was significantly associated with T1 and T2 profile classifications and profile transition; age was associated with profile classification at T1. CONCLUSION Three symptom suffering profiles existed in a sample of pediatric patients undergoing chemotherapy, indicating that children and adolescents have differing cancer treatment experiences. IMPLICATIONS FOR PRACTICE Oncology nurses could screen pediatric oncology patients for their symptom suffering profile membership and subsequently prioritize care efforts for those with a high suffering profile.
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Affiliation(s)
- Lei Cheng
- Author Affiliations: School of Nursing, Fudan University (Dr Cheng), Shanghai, China; Departments of Population Health Sciences and Pediatrics, Duke Cancer Institute, Duke University School of Medicine (Dr Reeve and Ms Mann), Durham, North Carolina; School of Nursing, Clemson University (Dr Withycombe), South Carolina; Division of Oncology, Children's National Hospital (Dr Jacobs); and Department of Pediatrics, The George Washington University (Dr Jacobs), Washington, DC; Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute and Boston Children's Hospital (Dr Mack), Boston, Massachusetts; Division of Pediatric Palliative Care and Division of Pediatric Oncology, Children's Hospital and Medical Center (Dr Weaver), Omaha, Nebraska; Department of Nursing Science, Professional Practice and Quality, Children's National Hospital (Drs Waldron and Hinds); and Department of Pediatrics, The George Washington University (Drs Waldron and Hinds), Washington, DC; Department of Pediatrics, University of Pittsburgh School of Medicine (Dr Mauer); and Division of Palliative Medicine and Supportive Care, UPMC Children's Hospital of Pittsburgh (Dr Mauer), Pennsylvania; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital (Dr Baker), Memphis, Tennessee; and Division of Biostatistics & Study Methodology, Children's National Hospital (Dr Wang); and The George Washington University School of Medicine and Health Sciences (Dr Wang), Washington, DC
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Identifying the Distinct Profiles of Transition Readiness in Chinese Pediatric Cancer Survivors. Cancer Nurs 2023; 46:189-197. [PMID: 36693220 DOI: 10.1097/ncc.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transition readiness is important for pediatric cancer survivors who need to move from pediatric to adult medical care. However, their transition readiness profiles merit further exploration. OBJECTIVES The aim of this study was to use a person-centered approach to identify transition readiness profiles of Chinese pediatric cancer survivors aged 12 to 18 years, diagnosed at least 6 months before the study. METHODS Transition readiness was assessed using the Chinese TRANSITION-Q Scale, and latent class analysis was performed to identify the transition readiness profiles as well as demographic and clinical factors associated with profile classification and to examine how self-efficacy and quality of life may differ between these profiles. RESULTS A total of 139 pediatric cancer survivors were included. Three different transition readiness profiles were identified: high transition readiness, medium transition readiness, and low transition readiness. Age, treatment status, and parental working status were significantly associated with the transition readiness profile classifications. Those who were in the low transition readiness profile were likely to have lower self-efficacy and mobility scores than those in the high or medium transition readiness profiles. CONCLUSIONS Three distinct transition readiness profiles existed in a sample of Chinese pediatric cancer survivors, indicating significant heterogeneity in their transition readiness. IMPLICATIONS FOR PRACTICE Knowledge of transition readiness profiles can assist clinicians in screening pediatric cancer survivors for their profile memberships and provide targeted interventions for those with a low transition profile.
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Hinds PS, Pinheiro LC, McFatrich M, Waldron M, Baker JN, Mowbray C, Maurer SH, Cheng Y, Reeve BB, Wang J. Recommended scoring approach for the pediatric patient-reported outcomes version of the Common Terminology Criteria for Adverse Events. Pediatr Blood Cancer 2022; 69:e29452. [PMID: 34866311 PMCID: PMC9038621 DOI: 10.1002/pbc.29452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Collecting symptom, function, and adverse event (AE) data directly from children and adolescents undergoing cancer care is more comprehensive and accurate than relying solely on their caregivers or clinicians for their interpretations. We developed the pediatric patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE) measurement system with input from children, parents, and clinicians. Here, we report how we determined the recommended Ped-PRO-CTCAE item scoring approach. METHODS Data from 271 patients were analyzed using three scoring approaches: (a) at the AE attribute (frequency, severity, interference) using ordinal and dichotomous measures; (b) a weighted composite AE item score by AE attribute (0.5 - frequency; 1.0 - severity; 1.5 - interference); and (c) overall number of AEs endorsed. Associations of each AE attribute, AE item score, and overall AE score with the Patient-Reported Outcome Measurement Information System (PROMIS) Pediatric measures were examined. The ability of the overall Ped-PRO-CTCAE AE score to identify patients with PROMIS symptom T-scores worse than reference population scores was assessed. Clinician preference for score information display was elicited through interviews with five pediatric oncology clinical trialists. RESULTS The diverse scoring approaches yielded similar outcomes, including positive correlations of the Ped-PRO-CTCAE attributes, AE item score, and the overall AEs score with the PROMIS Pediatric measures. Clinicians preferred the most granular display of scoring information (actual score reported by the child and corresponding descriptive term). CONCLUSIONS Although three scoring approaches yielded similar results, we recommend the AE attribute level of one score per Ped-PRO-CTCAE AE attribute for its simplicity of use in care and research.
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Affiliation(s)
- Pamela S Hinds
- Children's National Health System, Washington, District of Columbia, USA.,George Washington University, Washington, District of Columbia, USA
| | | | - Molly McFatrich
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Mia Waldron
- Children's National Health System, Washington, District of Columbia, USA.,George Washington University, Washington, District of Columbia, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Catriona Mowbray
- Children's National Health System, Washington, District of Columbia, USA
| | - Scott H Maurer
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yao Cheng
- Children's National Health System, Washington, District of Columbia, USA
| | - Bryce B Reeve
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Jichuan Wang
- Children's National Health System, Washington, District of Columbia, USA.,George Washington University, Washington, District of Columbia, USA
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6
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Meany HJ, Widemann BC, Hinds PS, Bagatell R, Shusterman S, Stern E, Jayaprakash N, Peer CJ, Figg WD, Hall OM, Sissung TM, Kim A, Fox E, London WB, Rodriguez-Galindo C, Minturn JE, Dome JS. Phase 1 study of sorafenib and irinotecan in pediatric patients with relapsed or refractory solid tumors. Pediatr Blood Cancer 2021; 68:e29282. [PMID: 34383370 DOI: 10.1002/pbc.29282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sorafenib,an orally bioavailable, multitarget tyrosine kinase inhibitor, and irinotecan, a topoisomerase I inhibitor, have demonstrated activity in pediatric and adult malignancies. We evaluated the toxicity, pharmacokinetic (PK), and pharmacogenomic (PGX) profile of sorafenib with irinotecan in children with relapsed or refractory solid tumors and assessed the feasibility of incorporating patient-reported outcome (PRO) measures as an adjunct to traditional endpoints. METHODS Sorafenib, continuous oral twice daily dosing, was administered with irinotecan, orally, once daily days 1-5, repeated every 21 days (NCT01518413). Based on tolerability, escalation of sorafenib followed by escalation of irinotecan was planned. Three patients were initially enrolled at each dose level. Sorafenib and irinotecan PK analyses were performed during cycle 1. PRO measurements were collected during cycles 1 and 2. RESULTS Fifteen patients were evaluable. Two of three patients at dose level 2 experienced dose-limiting toxicity (DLT), grade 3 diarrhea, and grade 3 hyponatremia. Therefore, dose level 1 was expanded to 12 patients and two patients had DLT, grade 4 thrombocytopenia, grade 3 elevated lipase. Nine of 15 (60%) patients had a best response of stable disease with four patients receiving ≥6 cycles. CONCLUSIONS The recommended dose for pediatric patients was sorafenib 150 mg/m2 /dose twice daily with irinotecan 70 mg/m2 /dose daily × 5 days every 21 days. This oral outpatient regimen was well tolerated and resulted in prolonged disease stabilization. There were no significant alterations in the PK profile of either agent when administered in combination. Patients were willing and able to report their subjective experiences with this regimen.
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Affiliation(s)
- Holly J Meany
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pamela S Hinds
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.,Division of Nursing, Children's National Hospital, Washington, District of Columbia
| | - Rochelle Bagatell
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Shusterman
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | - Emily Stern
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia
| | - Nalini Jayaprakash
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William D Figg
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - O Morgan Hall
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tristan M Sissung
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Aerang Kim
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Fox
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | - Carlos Rodriguez-Galindo
- Departments of Oncology and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jane E Minturn
- Perelman School of Medicine, Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Dome
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia.,The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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7
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Lyon ME, Cheng YI, Needle J, Friebert S, Baker JN, Jiang J, Wang J. The intersectionality of gender and poverty on symptom suffering among adolescents with cancer. Pediatr Blood Cancer 2021; 68:e29144. [PMID: 34061435 PMCID: PMC8406702 DOI: 10.1002/pbc.29144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine if the intersectionality of gender and poverty is associated with health disparities among adolescents with cancer. We hypothesized unobserved latent classes of patients exist with respect to cancer-related symptoms; and class classification varies by gender-poverty combinations. PROCEDURE Cross-sectional data were collected among adolescents with cancer and families (N = 126 dyads) at four tertiary pediatric hospitals. Adolescents were aged 14-21 years, English speaking, cancer diagnosis, not developmentally delayed, psychotic, homicidal, suicidal, or severely depressed. Latent class analysis and multinomial logit models were used for analysis. Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures, Short forms, evaluated anxiety, depressive symptoms, pain interference, and fatigue. Family-reported household income used 2016 Federal Poverty Level (FPL) guidelines. RESULTS Three distinct groups of patients were identified using PROMIS symptom patterns: High Distress-25%; High Physical/Low Psychological Distress-14%; and Low Distress-62%. Female adolescents living in households with incomes at or below the 2016 FPL had 30 times the odds of being classified in the High Distress class (higher probabilities of experiencing anxiety, depressive symptoms, pain interference, and fatigue) compared to those in the High Physical/Low Psychological Distress class (female and poverty: AOR = 30.27, 95% CI 1.23, 735.10), and this was statistically significant (β = 3.41, 95% CI 0.21, 6.60; p = .04) but not compared to those in Low Distress. CONCLUSION Adolescent females with cancer with households in poverty had significantly greater odds of experiencing high symptom distress, compared to those with high physical but low psychological distress. More comprehensive screening and intervention, as needed, may decrease disparities.
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Affiliation(s)
- Maureen E. Lyon
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, District of Columbia, USA
- Center for Translational Research/Children’s National Research Institute, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
- RELI Group, Inc., Baltimore, Maryland, USA
| | - Jennifer Needle
- Department of Pediatrics and Center for Bioethics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio, USA
| | - Justin N. Baker
- St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jiji Jiang
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Jichuan Wang
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Division of Biostatistics and Study Methodology, Center for Translational Research/Children’s National Research Institute, Children’s National Hospital, Washington, District of Columbia, USA
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Meryk A, Kropshofer G, Hetzer B, Riedl D, Lehmann J, Rumpold G, Haid A, Holzner B, Crazzolara R. Bridging the gap in outpatient care: Can a daily patient-reported outcome measure help? Cancer Rep (Hoboken) 2021; 5:e1421. [PMID: 34245127 PMCID: PMC8789604 DOI: 10.1002/cnr2.1421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Childhood patients have high risks for developing debilitating somatic and mental health side-effects as a consequence of the many different approaches employed in treating their cancer. Early recognition and close monitoring of clinical and psychological problems are essential in planning appropriate interventions and preventing further deterioration. CASE ePROtect was established as an easy-to-use application for daily self-reporting of symptoms during cancer therapy. ePROtect includes six to eight questions pertaining to seven common symptoms: appetite loss, fatigue, nausea, pain, physical functioning, cognitive impairments and sleep quality. The case of a child diagnosed with Burkitt leukemia developing chemotherapy-induced oral mucositis in home care is presented to show the therapeutic impact of early symptom detection with a daily web-based tool. CONCLUSION This case highlights how electronic patient-reported outcome measures (PROM) can directly facilitate patient care in real time and might be incorporated in future clinical routine.
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Affiliation(s)
- Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Haid
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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9
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Steineck A, Rosenberg AR. Why performance status? A case for alternative functional assessments in pediatric oncology clinical trials. Cancer 2021; 127:3511-3513. [PMID: 34196972 DOI: 10.1002/cncr.33741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Angela Steineck
- Cancer and Blood Disorders Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Cancer and Blood Disorders Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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10
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Riedl D, Rothmund M, Darlington AS, Sodergren S, Crazzolara R, de Rojas T. Rare use of patient-reported outcomes in childhood cancer clinical trials - a systematic review of clinical trial registries. Eur J Cancer 2021; 152:90-99. [PMID: 34090144 DOI: 10.1016/j.ejca.2021.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 04/12/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are the gold standard to assess the patients' subjective health status. While both the Food and Drug Administration and European Medicines Agency recommend the use of PROs as end-points in paediatric clinical trials to support claims for medical product labelling, it is not known how often PROs are actually used. The aim of this study was to assess the usage of PRO instruments in childhood cancer clinical trials investigating anti-cancer medication. METHODS In June 2020 ClinicalTrials and EudraCT were systematically searched for all trials including children and adolescents (≤21 years) with cancer registered between 2007 and 2020. The use of PRO measures and trials characteristics were analysed. To investigate which trial characteristics are associated with the use of PROs, a binary logistic regression was calculated. RESULTS Of 4789 identified trials, 711 were included. The most frequent reason for exclusion was age limitation (age >21 years). Of all included trials, only 8.2% used PROs as end-points; .6% as the primary end-point. The most commonly used questionnaire was the PedsQL™ (32.8%), followed by the Patient-Reported Outcomes Measurement Information System scales (12.1%). No association was observed between the use of PROs and trial region, number of centres, trial phase, time period or intervention type (all p > .05). The use of PROs did not substantially increase over time. Only 20.3% of the closed studies had published their results. CONCLUSION Despite recommendations of regulatory agencies, PRO assessment is extremely rare in paediatric oncology clinical trials. More efforts should be undertaken to facilitate implementation of PRO in paediatric trials to guarantee patient-centred research and treatments.
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Affiliation(s)
- David Riedl
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Rothmund
- University Clinic of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Roman Crazzolara
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa de Rojas
- Pediatric OncoGenomics Unit, Children's University Hospital Niño Jesús, Madrid, Spain.
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11
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Crane S, Croop JM, Lee J, Walski J, Haase J. Parents' Insights into Pediatric Oncology Phase I Clinical Trials: Experiences from Their Child's Participation. Semin Oncol Nurs 2021; 37:151162. [PMID: 34148742 PMCID: PMC8287078 DOI: 10.1016/j.soncn.2021.151162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Phase 1 clinical trials are essential in the development of novel therapies for childhood cancers. Children with cancer can participate in phase 1 clinical trials when no known curative therapy remains. Understanding the experiences of children and their families in these clinical trials can help ensure that participation supports the children's and parents' well-being. This article explores the specific aspects of pediatric oncology phase 1 trials that parents found particularly challenging. DATA SOURCES This qualitative, empirical phenomenology study considered 11 parents' experiences during the time their child with cancer participated in a phase 1 clinical trial. The primary study results were previously reported. This article reports parents' insights into the processes and procedures that occurred as part of participation in a pediatric oncology phase 1 trial. CONCLUSION Parents' experiences during the phase 1 clinical trials were primarily positive. However, data analysis revealed five aspects of these trials that were challenging for families: learning about clinical trials, being referred to another institution, research-only procedures, adhering to trial requirements, and oral medications. IMPLICATIONS FOR NURSING PRACTICE Although experiences during phase 1 clinical trials were positive overall, opportunities to enhance children's and parents' experiences warrant attention. Enhancing the education provided to families during recruitment and minimizing the logistical burdens associated with trial requirements through care coordination may alleviate challenges experienced by children and parents.
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Affiliation(s)
- Stacey Crane
- Cizik School of Nursing, University of Texas Health Science Center, Houston.
| | - James M Croop
- Division of Pediatric Hematology/Oncology, Riley Hospital for Children at IU Health, Indianapolis, IN
| | - Jill Lee
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Jamie Walski
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Joan Haase
- School of Nursing, Indiana University, Indianapolis, IN
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12
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Kummar S, Berlin J, Mascarenhas L, van Tilburg CM, Geoerger B, Lassen UN, Schilder RJ, Turpin B, Nanda S, Keating K, Childs BH, Chirila C, Laetsch TW, Hyman DM, Drilon A, Hong DS. Quality of Life in Adult and Pediatric Patients with Tropomyosin Receptor Kinase Fusion Cancer Receiving Larotrectinib. Curr Probl Cancer 2021; 45:100734. [PMID: 33865615 DOI: 10.1016/j.currproblcancer.2021.100734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
Neurotrophic tyrosine receptor kinase (NTRK) gene fusions lead to chimeric tropomyosin receptor kinase (TRK) fusion proteins, which act as primary oncogenic drivers in diverse tumor types in adults and children. Larotrectinib, a highly selective and central nervous system-active TRK inhibitor, has shown high objective response rates, durable disease control, and a favorable safety profile in patients with TRK fusion cancer. The impact of larotrectinib on health-related quality of life (HRQoL) was evaluated in adult and pediatric patients in two phase I/II clinical trials (NAVIGATE; NCT02576431 and SCOUT; NCT02637687). Patients completed HRQoL questionnaires (EORTC QLQ-C30, EQ-5D-5L, and PedsQL) at baseline and at planned treatment cycle visits. Changes in questionnaire scores were evaluated over time, and by tumor type and treatment response. Questionnaires from 40 adult and 17 pediatric (2-19 years of age) patients receiving larotrectinib were completed at baseline and at least one post-baseline timepoint. Meaningful within-patient HRQoL improvements occurred at one or more timepoints in 60% of adults and 76% of pediatric patients. Sustained improvements in EORTC QLQ-C30 and PedsQL scores were rapid, occurring within 2 months of treatment initiation in 68% and 71% of patients, respectively. Improvements were observed regardless of tumor type and appeared to correlate with clinical efficacy. The rapid within-patient HRQoL improvements in adult and pediatric patients with TRK fusion cancer are consistent with the clinical profile of larotrectinib. Our results provide valuable information for use of this agent in this patient population. A plain language summary of this article is available in the supplementary appendix.
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Affiliation(s)
- Shivaani Kummar
- Stanford Cancer Institute, Stanford University, Palo Alto, CA.
| | | | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Cornelis M van Tilburg
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Birgit Geoerger
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Ulrik N Lassen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Russell J Schilder
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Brian Turpin
- Division of Pediatric Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shivani Nanda
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ
| | - Karen Keating
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ
| | | | | | - Theodore W Laetsch
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center/Children's Health, Dallas, TX
| | - David M Hyman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - David S Hong
- University of Texas MD Anderson Cancer Center, Houston, TX.
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13
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Hammack Johnson A, Cazzell M, Turner-Henson A. Bio-behavioural research in a rare disease population: a doctoral student's experience. Nurse Res 2020; 28:16-23. [PMID: 32583653 DOI: 10.7748/nr.2020.e1715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Novice researchers who aspire to contribute to the body of knowledge concerning rare diseases face unique challenges in developing and conducting studies. These include unknown effect sizes in previous research, limitations in recruitment and enrolment, and managing data from a multi-site sample. AIM To describe the challenges in researching rare diseases and possible solutions using a doctoral student exemplar from a cross-sectional correlational study of fatigue. DISCUSSION The authors discuss the lessons learned from the study, including the challenges in recruitment, communication, collecting biological data and managing data in general. They posit possible solutions, including improving multi-site coordination, feasible methods for exploring sleep and stress, and measures to prevent equipment and data loss. CONCLUSION Rare populations, such as young survivors of childhood brain tumours, deserve a voice in building the body of knowledge needed for more precise, personalised healthcare. It is possible with foresight for the novice researcher to make such a contribution. IMPLICATIONS FOR PRACTICE Improved knowledge and assessment of symptoms during childhood will improve the detection of health risk factors and enable earlier intervention.
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Affiliation(s)
| | - Mary Cazzell
- Nursing research and evidence-based practice, Cook Children's Medical Center, Fort Worth, Texas
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14
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Snaman J, McCarthy S, Wiener L, Wolfe J. Pediatric Palliative Care in Oncology. J Clin Oncol 2020; 38:954-962. [PMID: 32023163 DOI: 10.1200/jco.18.02331] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pediatric palliative care aims to alleviate suffering and improve the quality of life of children with serious disease and increase support for their parents and other family members. Integration of palliative care into the routine care of children, adolescents, and young adults with cancer has resulted in improved outcomes in patients and their families. The field of pediatric palliative oncology-encompassing primary palliative care provided by the multidisciplinary oncology team as well as subspecialty palliative care provided by the palliative care team for more complex cases-is unique from palliative care in adults given its focus on care of the child and the larger family. In this review, we focus on advancements in the specific domains within pediatric palliative oncology care including family-centered communication, assessment and management of physical symptoms and distress, psychosocial concerns, and spiritual considerations of the patient, parents, and siblings.
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Affiliation(s)
- Jennifer Snaman
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
| | | | - Lori Wiener
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, Boston, MA
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15
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Cuviello A, Boss R, Shah N, Battles H, Beri A, Wiener L. Utilization of palliative care consultations in pediatric oncology phase I clinical trials. Pediatr Blood Cancer 2019; 66:e27771. [PMID: 31012246 PMCID: PMC7023673 DOI: 10.1002/pbc.27771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Accepted: 04/08/2019] [Indexed: 11/09/2022]
Abstract
Pediatric phase I clinical oncology trials represent a unique cohort of patients who have not responded to standard therapies and remain highly vulnerable to treatment toxicity and/or disease burden. Incorporating a palliative care consultation into the care plan for those with relapsed/refractory cancer where chance of cure is limited is generally recommended. A retrospective chart review of pediatric phase I trials revealed that palliative care was consulted in <20% of patients, most often for symptom management. Efforts to increase the use of palliative services in this population may enhance quality of life for children and families enrolled in phase I studies.
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Affiliation(s)
- Andrea Cuviello
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD, 21287, USA,National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, MD 20892
| | - Renee Boss
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, MD, 21287, USA
| | - Nirali Shah
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, MD 20892
| | - Haven Battles
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, MD 20892
| | - Andrea Beri
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, MD 20892
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, MD 20892
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16
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Hinds PS, Wang J, Cheng YI, Stern E, Waldron M, Gross H, DeWalt DA, Jacobs SS. PROMIS pediatric measures validated in a longitudinal study design in pediatric oncology. Pediatr Blood Cancer 2019; 66:e27606. [PMID: 30663254 DOI: 10.1002/pbc.27606] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE This study assessed the responsiveness to change over time and theorized associations of Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric measures in children and adolescents in treatment for cancer to determine measure readiness for use in cancer clinical trials. METHODS We administered eight PROMIS (three symptom, two psychological, and three performance) pediatric short-form measures and the Symptom Distress Scale (SDS) to 96 pediatric oncology patients at three time points during a course of chemotherapy. We assessed responsiveness using paired t tests and generalized estimating equation (GEE) models, calculated standardized response mean (SRM) values for PROMIS measures, and examined scores over three data points (T1-T3). Guided by the theory of unpleasant symptoms (TOUS), we examined associations among the PROMIS measures, the SDS, and other variables using GEE. RESULTS The paired t tests showed statistically significant changes in two psychological measures and one performance measure from T1 to T2; three symptom, two psychological and two performance measures from T2 to T3; and three symptom and two psychological measures from T1 to T3. Findings from GEE models indicate PROMIS pediatric measures had statistically significant short-term and long-term changes, controlling for demographic and clinical variables. One performance measure did not achieve significant change at any time point. We found positive support for theorized relationships in the TOUS. CONCLUSIONS Most of the PROMIS pediatric measures demonstrated changes over time and had significant relationships as theorized, thus supporting concurrent and construct validity of these measures when administered to pediatric oncology patients during a course of chemotherapy. This evidence supports the measures' readiness for use in clinical trials.
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Affiliation(s)
- Pamela S Hinds
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, The George Washington University, Washington, District of Columbia
| | - Jichuan Wang
- Department of Pediatrics, The George Washington University, Washington, District of Columbia.,Department of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia
| | - Yao I Cheng
- Department of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia
| | - Emily Stern
- Department of Hematology/Oncology, Children's National Health System, Washington, District of Columbia
| | - Mia Waldron
- Department of Nursing Science, Professional Practice and Quality, Children's National Health System, Washington, District of Columbia
| | - Heather Gross
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, North Carolina
| | - Darren A DeWalt
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, North Carolina
| | - Shana S Jacobs
- Department of Pediatrics, The George Washington University, Washington, District of Columbia.,Department of Hematology/Oncology, Children's National Health System, Washington, District of Columbia
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17
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Silva-Rodrigues FM, Hinds PS, Nascimento LC. The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit? J Pediatr Oncol Nurs 2019; 36:436-447. [PMID: 31027449 DOI: 10.1177/1043454219844225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.
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Affiliation(s)
| | - Pamela S Hinds
- Children's National Health System, Washington, DC, USA.,George Washington University, Washington, DC, USA
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18
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Macpherson C, Wang J, DeWalt D, Stern E, Jacobs S, Hinds P. Comparison of Legacy Fatigue Measures With the PROMIS Pediatric Fatigue Short Form. Oncol Nurs Forum 2018; 45:106-114. [DOI: 10.1188/18.onf.106-114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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