Evaluation of the need for hospital-based pediatric palliative care in a single center

Introduction/Aim: Cancer is one of the leading causes of death for children . Evidence suggests that these children experience substantial suffering from physical and emotional symptoms. Over the past two decades, paediatric palliative care has emerged as an approach that aims to ease suffering for children and their families coping with any life-threatening illness. Our aim is to encourage the expansion of palliative care centers for children with cancer and integration of these into healthcare services to assist clinicians and policy makers in developing services that address these needs. Material and Method: Our study is a single-center retrospective cohort study. The records of 39 patients who were followed up in the pediatric oncology clinic between 2010-2021 and died were reviewed retrospectively. Results: The age of diagnosis of patients was the most in the 6-12 range (n=16; 41%) and the least in the adolescent (n=11; 28.2%) age range. The cause of death was related to a disease in 79.5%. Treatment-related deaths were seen in eight patients, four of which were chemotherapy toxicity, two were engraftment failure in autologous hematopoietic stem cell transplantation, and two were post-transplant GVHD. 76.9% of the patients died in the intensive care unit. Conclusion: In our study, patients with cancer and those who lost their lives were evaluated retrospectively in terms of symptom load, invasive procedures, and psychosocial needs and the need for end-of-life palliative care. Many studies have confirmed that the timely integration of palliative care into routine oncological care has many advantages, such as improvements in physical and psychological symptoms, quality of life and prognosis, as well as reducing costs. In Turkey, palliative treatment is tried to be provided to late stage pediatric cancer patients by pediatric intensive care units and pediatric oncologists. This both increases the workload of physicians and causes intensive care bed occupation. The development and expansion of palliative care on late stage pediatric cancer patients will contribute significantly to the quality of life of both children and their families.

The effects of administered interventions on quality of life of children with cancer in Turkey: A systematic review and meta-analysis

OBJECTIVE

The present systematic review and meta-analysis aimed to analyse the effects of administered interventions on the quality of life of children with cancer in Turkey.

METHODS

The quantitative studies conducted with paediatric oncology patients, analysing the quality of life of Turkish children, and published papers from 2009 to 2019 were searched. Joanna Briggs Institution MAStARI Experimental and Quasi-Experimental Research Control List and Quality Index were used for methodological assessment. Five studies comprising a total of 264 samples were included. Four studies were nonrandomised controlled trials, and one was a quasi-experimental study.

RESULTS

Tests for heterogeneity showed that the studies, which included interventions increasing the quality of life of children with cancer, were heterogeneous. The common effect size of all studies on quality of life was determined as having a strong positive effect.

CONCLUSIONS

This meta-analysis and systematic review contribute to the knowledge of Turkish health care professionals regarding these interventions by producing results with high levels of evidence on the improvement of the quality of life among children with cancer. The present study also significantly raises awareness and encourages health care professionals to implement interventions for the improvement of quality of life among children with cancer.

Adrenocortical tumours in children: a review of surgical management at a tertiary care centre

BACKGROUND

Adrenocortical tumours (ACT) are rare tumours of childhood usually presenting with endocrine dysfunction. This retrospective study is designed to review our institutional experience in surgical management.

METHODS

Records of children treated for ACT between 1999 and 2019 were reviewed retrospectively.

RESULTS

The median age of 24 children was 78 months. Fourteen patients had adrenocortical carcinoma, nine had adrenocortical adenoma and one had neuroendocrine differentiation of ACT. Endocrine dysfunction was noted in 79% of the patients. Five patients had preoperative chemotherapy but none had a decrease in tumour size. Transabdominal approach was used in all but two patients who had thoracoabdominal incision for excision of giant tumours and ipsilateral lung metastases. Two patients had visceral excision to achieve R0 resection. Five patients, four of whom had spillage and one with partial resection died of widespread disease. Two patients with stage 4 adrenocortical carcinoma are still on chemotherapy. All patients with stage I-III disease who had total excision without spillage (n = 17) are disease-free for 2-170 months.

CONCLUSIONS

Our results show the importance of excision in ACT without spillage for survival. However, multicentre prospective studies should enhance the knowledge of children about ACT and develop alternative therapies for stage III and IV cases.

Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment

PURPOSE

Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey.

METHODS

A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease.

RESULTS

Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative.

CONCLUSION

The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.