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Ballantyne E, Evans C, Shepherd L, Fulbright H, Wakeling S, Phillips B, Morgan JE. A systematic review of combined surgery and brachytherapy approaches for children and young people with relapsed and refractory rhabdomyosarcoma (Local-REFoRMS). Pediatr Blood Cancer 2024; 71:e30952. [PMID: 38566349 DOI: 10.1002/pbc.30952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
Approximately one third of children with rhabdomyosarcoma relapse or have refractory disease. Treatment approaches include a combination of systemic therapies and local therapies, directed at tumour site(s). This review was conducted to evaluate the effectiveness and safety of the combination of surgery and brachytherapy as local therapy for treating children and young people with relapsed/refractory rhabdomyosarcoma. This review identified studies based on a previous systematic review looking at the treatments for children and young people under 18 years old with relapsed/refractory rhabdomyosarcoma. Studies conducted after 2000 were included. Survival outcomes, relapse rates, adverse events and functional outcomes were extracted. From 16,965 records identified in the baseline systematic review, 205 included the words 'AMORE' or 'brachytherapy', and were screened for eligibility in this substudy. Thirteen studies met the inclusion criteria for Local-REFoRMS, including over 55 relapsed and refractory rhabdomyosarcoma patients. Most studies were retrospective cohort studies conducted within Europe. Most patients had embryonal disease within the head and neck or bladder/prostate regions, and received local therapy for first relapse. Approximately one quarter of patients relapsed following surgery and brachytherapy, with local relapses occurring more than metastatic relapse. Adverse events and functional outcomes were infrequently reported, but related to the site of surgery and brachytherapy. Study quality was limited by inconsistent reporting and potential selection bias. Outcomes following surgery and brachytherapy for a selected group of relapsed and refractory rhabdomyosarcoma show reasonable benefits, but reporting was often unclear and based on small sample sizes.
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Affiliation(s)
- Euan Ballantyne
- Calderdale and Huddersfield Foundation Trust, Lindley, Huddersfield, UK
| | - Connor Evans
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | - Lucy Shepherd
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | | | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital NHS Trust, Leeds, UK
| | - Jessica E Morgan
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital NHS Trust, Leeds, UK
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O'Donnell N, Phillips B, Morgan JE, Howell D. 'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors. BMJ Open 2024; 14:e082779. [PMID: 38688668 DOI: 10.1136/bmjopen-2023-082779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE AND DESIGN Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb. SETTING A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods. PARTICIPANTS 32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female). RESULTS Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies. CONCLUSIONS This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.
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Affiliation(s)
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Debra Howell
- Department of Health Sciences, University of York, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2024; 109:438. [PMID: 38636959 DOI: 10.1136/archdischild-2024-327234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Davies HT, Preston J, Phillips B. Consent and assent in paediatric practice: it's the conversation that matters. Arch Dis Child 2024:archdischild-2023-326454. [PMID: 38575205 DOI: 10.1136/archdischild-2023-326454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Hugh T Davies
- Oxford 'A' National Health Service Research Ethics Committee, Oxford, UK
| | - Jenny Preston
- Senior Patient and Public Involvement Manager, NIHR Alder Hey Clinical Research Facility, Liverpool, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Evans C, Shepherd L, Bryan G, Fulbright H, Crowther S, Wakeling S, Stewart A, Stewart C, Chisholm J, Gibson F, Phillips B, Morgan JE. A systematic review of early phase studies for children and young people with relapsed and refractory rhabdomyosarcoma: The REFoRMS-SR project. Int J Cancer 2024; 154:1235-1260. [PMID: 38071594 DOI: 10.1002/ijc.34808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 02/07/2024]
Abstract
Rhabdomyosarcoma is the commonest soft tissue sarcoma in children. Around one-third of children with rhabdomyosarcoma experience relapse or have refractory disease, which is associated with a poor prognosis. This systematic review of early phase studies in pediatric relapsed/refractory rhabdomyosarcoma was conducted to inform future research and provide accurate information to families and clinicians making difficult treatment choices. Nine databases and five trial registries were searched in June 2021. Early phase studies of interventions for disease control in patients under 18 years old with relapsed/refractory rhabdomyosarcoma were eligible. No language/geographic restrictions were applied. Studies conducted after 2000 were included. Survival outcomes, response rates, quality of life and adverse event data were extracted. Screening, data extraction and quality assessment (Downs and Black Checklist) were conducted by two researchers. Owing to heterogeneity in the included studies, narrative synthesis was conducted. Of 16,965 records screened, 129 published studies including over 1100 relapsed/refractory rhabdomyosarcoma patients were eligible. Most studies evaluated systemic therapies. Where reported, 70% of studies reported a median progression-free survival ≤6 months. Objective response rate was 21.6%. Adverse events were mostly hematological. One-hundred and seven trial registry records of 99 studies were also eligible, 63 of which report they are currently recruiting. Study quality was limited by poor and inconsistent reporting. Outcomes for children with relapsed/refractory rhabdomyosarcoma who enroll on early phase studies are poor. Improving reporting quality and consistency would facilitate the synthesis of early phase studies in relapsed/refractory rhabdomyosarcoma (PROSPERO registration: CRD42021266254).
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Affiliation(s)
- Connor Evans
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Shepherd
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gemma Bryan
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | | | | | - Julia Chisholm
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Great Ormond Street Hospital, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jessica E Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2024; 109:351. [PMID: 38503439 DOI: 10.1136/archdischild-2024-327058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2024; 109:248. [PMID: 38373750 DOI: 10.1136/archdischild-2024-326912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Blundell H, Morgan JE, Neumann E, Phillips B, Thorbinson C, Bate J. Variation in central venous catheter care and management: a review of UK paediatric oncology principal treatment centre practice. Arch Dis Child 2024; 109:257-258. [PMID: 38199818 DOI: 10.1136/archdischild-2023-326315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Helen Blundell
- Department of Children's Haematology and Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Eloise Neumann
- Paediatric Oncology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Leeds Children's Hospital, Leeds, UK
| | - Colin Thorbinson
- Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jessica Bate
- Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2024; 109:167. [PMID: 38253424 DOI: 10.1136/archdischild-2023-326805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, YO10 5DD, UK
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Aldiss S, Hollis R, Phillips B, Ball-Gamble A, Brownsdon A, Chisholm J, Crowther S, Dommett R, Gower J, Hall NJ, Hartley H, Hatton J, Henry L, Langton L, Maddock K, Malik S, McEvoy K, Morgan JE, Morris H, Parke S, Picton S, Reed-Berendt R, Saunders D, Stewart A, Tarplee-Morris W, Walsh A, Watkins A, Weller D, Gibson F. Research priorities for children's cancer: a James Lind Alliance Priority Setting Partnership in the UK. BMJ Open 2023; 13:e077387. [PMID: 38128939 DOI: 10.1136/bmjopen-2023-077387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To engage children who have experienced cancer, childhood cancer survivors, their families and professionals to systematically identify and prioritise research questions about childhood cancer to inform the future research agenda. DESIGN James Lind Alliance Priority Setting Partnership. SETTING UK health service and community. METHODS A steering group oversaw the initiative. Potential research questions were collected in an online survey, then checked to ensure they were unanswered. Shortlisting via a second online survey identified the highest priority questions. A parallel process with children was undertaken. A final consensus workshop was held to determine the Top 10 priorities. PARTICIPANTS Children and survivors of childhood cancer, diagnosed before age 16, their families, friends and professionals who work with this population. RESULTS Four hundred and eighty-eight people submitted 1299 potential questions. These were refined into 108 unique questions; 4 were already answered and 3 were under active study, therefore, removed. Three hundred and twenty-seven respondents completed the shortlisting survey. Seventy-one children submitted questions in the children's surveys, eight children attended a workshop to prioritise these questions. The Top 5 questions from children were taken to the final workshop where 23 questions in total were discussed by 25 participants (young adults, carers and professionals). The top priority was 'can we find effective and kinder (less burdensome, more tolerable, with fewer short and long-term effects) treatments for children with cancer, including relapsed cancer?' CONCLUSIONS We have identified research priorities for children's cancer from the perspectives of children, survivors, their families and the professionals who care for them. Questions reflect the breadth of the cancer experience, including diagnosis, relapse, hospital experience, support during/after treatment and the long-term impact of cancer. These should inform funding of future research as they are the questions that matter most to the people who could benefit from research.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Bob Phillips
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Alex Brownsdon
- Patient Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | - Julia Chisholm
- The Royal Marsden NHS Foundation Trust, Sutton, UK
- Institute of Cancer Research Sutton, Sutton, UK
| | - Scott Crowther
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Coventry, UK
| | | | - Jonathan Gower
- James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| | - Nigel J Hall
- Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Helen Hartley
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jenni Hatton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise Henry
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Loveday Langton
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | | | | | - Keeley McEvoy
- Medical Needs Teaching Service, Leeds Children's Hospital, Leeds, UK
| | - Jessica Elizabeth Morgan
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Helen Morris
- Children, Teenage and Young Adult Cancer Operational Delivery Network, South West, Bristol, UK
| | - Simon Parke
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Rosa Reed-Berendt
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dan Saunders
- The Christie NHS Foundation Trust, Manchester, UK
| | - Andy Stewart
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Perth, UK
| | | | - Amy Walsh
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, Keswick, UK
| | - Anna Watkins
- Parent Representative on the Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | - David Weller
- The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Phillips B, Mackenzie-Croft N. Festive period episodes of Doctor Who and population mortality. BMJ 2023; 383:2833. [PMID: 38110228 DOI: 10.1136/bmj.p2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Bob Phillips
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, LS1 3EX, UK
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12
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 109:71. [PMID: 38097253 DOI: 10.1136/archdischild-2023-326698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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13
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:1028. [PMID: 37977595 DOI: 10.1136/archdischild-2023-326532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, YO10 5NB, UK
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Aldiss S, Hart-Spencer P, Langton L, Malik S, McEvoy K, Morgan JE, Reed-Berendt R, Hollis R, Phillips B, Gibson F. What matters to you? Engaging with children in the James Lind Alliance Children's Cancer Priority Setting Partnership. Res Involv Engagem 2023; 9:110. [PMID: 38037183 PMCID: PMC10688066 DOI: 10.1186/s40900-023-00518-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Previous priority setting exercises have sought to involve children, but in the final reporting, it is evident that few children had been engaged through the process. A primary aim in the Children's Cancer Priority Setting Partnership was to find out from children what they want research to focus on. We report on our experience to inform methods of engagement with children in future James Lind Alliance Priority Setting Partnerships and similar exercises. METHODS We followed the James Lind Alliance process, collecting and shortlisting questions via online surveys with adult survivors of childhood cancer, carers, and professionals, and holding a final workshop. Alongside this, a parallel process to collect and prioritise questions from children was undertaken. We created animations for parents/carers to explain the project and surveys to children, gathered questions via online surveys and held a workshop with children to identify their priorities. RESULTS Sixty-one children and young people with cancer and 10 siblings, aged 3-21 years, submitted 252 potential questions/topics via the surveys. Submissions were refined into 24 summary questions. These questions were discussed at a workshop with eight children; they also added more questions on topics of importance to them. Workshop participants prioritised the Top 5 questions; top priority was, 'How can we make being in hospital a better experience for children and young people? (like having better food, internet, toys, and open visiting so other family members can be more involved in the child's care)'. The Top 5 also included cancer prevention, treatments closer to home, early diagnosis, and emotional support. These questions were taken to the final workshop at which the Top 10 priorities were decided, all five children's priorities were reflected in the final Top 10. CONCLUSIONS We have demonstrated that it is possible to successfully involve children directly in setting priorities for future research. Future priority setting exercises on topics relevant to children, should seek to include their views. The Children's Cancer Top 10 priorities reflect the voices of children and should inform the funding of future research.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, GU2 7YH, UK.
| | | | - Loveday Langton
- Children's Cancer Priority Setting Partnership Steering Group, London, UK
| | | | - Keeley McEvoy
- Medical Needs Teaching Service, Leeds Children's Hospital, Leeds, UK
| | - Jessica E Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rosa Reed-Berendt
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | | | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Child Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:940. [PMID: 37903535 DOI: 10.1136/archdischild-2023-326382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, YO10 5NB, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:862. [PMID: 37726153 DOI: 10.1136/archdischild-2023-326276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:775. [PMID: 37591535 DOI: 10.1136/archdischild-2023-326113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Jones GL, Folan AM, Phillips B, Anderson RA, Ives J. Reproduction in life and death: should cancer patients with a poor prognosis be offered fertility preservation interventions? Reprod Fertil 2023; 4:RAF-23-0047. [PMID: 37869895 PMCID: PMC10692684 DOI: 10.1530/raf-23-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
In the context of a cancer diagnosis, fertility preservation interventions are used to mitigate the potential impact of gonadotoxic cancer treatment upon fertility. They provide patients with cancer the option to freeze their reproductive material to have their own biological child following treatment. The evidence suggests some clinicians are less likely to have fertility preservation discussions with patients who have an aggressive or metastatic cancer which has a poor prognosis. Although this is contrary to current policy recommendations, there is a lack of guidance relating to offering fertility preservation in the context of a poor prognosis to support clinicians. Controversy surrounds posthumous reproduction, and whether the wishes of the cancer patient, when living and deceased should take precedence over others' wellbeing. We consider the question of whether cancer patients with a poor prognosis should be offered FP from an ethics perspective. We structure the paper around key arguments to which multiple ethical principles might pertain, first establishing a central argument in favour of offering fertility preservation based on respect for autonomy, before exploring counterarguments. We conclude by proposing that a defeasible assumption should be adopted in favour of offering fertility preservation to all cancer patients who might benefit from it. It is important to recognise that patients could benefit from fertility preservation in many ways, and these are not limited to having a parenting experience. The burden of proof rests on the clinician in collaboration with their multi-disciplinary team, to show that there are good grounds for withholding the offer.
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Affiliation(s)
- Georgina L Jones
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Anne-Mairead Folan
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Bob Phillips
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, UK
- Paediatric Oncology, Leeds Children’s Hospital, Leeds, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower RG, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. Regional perspectives on the coordination and delivery of paediatric end-of-life care in the UK: a qualitative study. BMC Palliat Care 2023; 22:117. [PMID: 37587514 PMCID: PMC10428585 DOI: 10.1186/s12904-023-01238-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Provision of and access to paediatric end-of-life care is inequitable, but previous research on this area has focused on perspectives of health professionals in specific settings or children with specific conditions. This qualitative study aimed to explore regional perspectives of the successes, and challenges to the equitable coordination and delivery of end-of-life care for children in the UK. The study provides an overarching perspective on the challenges of delivering and coordinating end-of-life care for children in the UK, and the impact of these on health professionals and organisations. Previous research has not highlighted the successes in the sector, such as the formal and informal coordination of care between different services and sectors. METHODS Semi-structured interviews with Chairs of the regional Palliative Care Networks across the UK. Chairs or co-Chairs (n = 19) of 15/16 Networks were interviewed between October-December 2021. Data were analysed using thematic analysis. RESULTS Three main themes were identified: one standalone theme ("Communication during end-of-life care"); and two overarching themes ("Getting end-of-life services and staff in the right place", with two themes: "Access to, and staffing of end-of-life care" and "Inconsistent and insufficient funding for end-of-life care services"; and "Linking up healthcare provision", with three sub-themes: "Coordination successes", "Role of the networks", and "Coordination challenges"). Good end-of-life care was facilitated through collaborative and network approaches to service provision, and effective communication with families. The implementation of 24/7 advice lines and the formalisation of joint-working arrangements were highlighted as a way to address the current challenges in the specialism. CONCLUSIONS Findings demonstrate how informal and formal relationships between organisations and individuals, enabled early communication with families, and collaborative working with specialist services. Formalising these could increase knowledge and awareness of end of life care, improve staff confidence, and overall improve professionals' experiences of delivering care, and families' experiences of receiving it. There are considerable positives that come from collaborative working between different organisations and sectors, and care could be improved if these approaches are funded and formalised. There needs to be consistent funding for paediatric palliative care and there is a clear need for education and training to improve staff knowledge and confidence.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK.
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Bryony Beresford
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Social Policy Research Unit, University of York, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | | | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | | | - Andrew Haynes
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, Martin House Research Centre, University of York, Heslington, YO10 5DD, York, UK
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- Cicely Saunders Institute, Kings College London, Bessemer Road, London, SE5 9PJ, UK
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20
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Bedendo A, Hinde S, Beresford B, Papworth A, Phillips B, Vasudevan C, McLorie E, Walker G, Peat G, Weatherly H, Feltbower R, Hewitt C, Haynes A, Murtagh F, Noyes J, Hackett J, Hain R, Oddie S, Subramanian G, Fraser L. Consultant-led UK paediatric palliative care services: professional configuration, services, funding. BMJ Support Palliat Care 2023:spcare-2023-004172. [PMID: 37558392 DOI: 10.1136/spcare-2023-004172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To systematically gather information on the professional team members, services provided, funding sources and population served for all consultant-led specialised paediatric palliative care (SPPC) teams in the UK. METHODS Two-part online survey. RESULTS Survey 1: All 17 medical leads from hospital-based or hospice-based SPPC teams responded to the survey (100% response rate).Only six services met the NICE guidance for minimum SPPC team.All services reported providing symptom management, specialist nursing care, end-of-life planning and care, and supporting discharges and transfers to home or hospice for the child's final days-hours. Most services also provided care coordination (n=14), bereavement support (n=13), clinical psychology (n=10) and social work-welfare support (n=9). Thirteen had one or more posts partially or fully funded by a charity.Survey 2: Nine finance leads provided detailed resource/funding information, finding a range of statutory and charity funding sources. Only one of the National Health Service (NHS)-based services fully funded by the NHS. CONCLUSIONS One-third of services met the minimum criteria of professional team as defined by NICE. Most services relied on charity funding to fund part or all of one professional post and only one NHS-based service received all its funding directly from the NHS.
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Affiliation(s)
- Andre Bedendo
- Department of Health Sciences, University of York, York, UK
| | | | | | - Andrew Papworth
- School for Business and Society, University of York, York, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Emma McLorie
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | | | - George Peat
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | | | | | | | - Andrew Haynes
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Julia Hackett
- The Paediatric Palliative Care & Medical Complexities Group, Department of Health Sciences, University of York, York, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, UK
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, UK
| | | | - Lorna Fraser
- Cicely Saunders Institute and Dept of Women's and Children's Health, King's College London, London, UK
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21
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Walker R, Phillips B, Dias S. Comparison of Bayesian methods for incorporating adult clinical trial data to improve certainty of treatment effect estimates in children. PLoS One 2023; 18:e0281791. [PMID: 37319173 PMCID: PMC10270354 DOI: 10.1371/journal.pone.0281791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
There are challenges associated with recruiting children to take part in randomised clinical trials and as a result, compared to adults, in many disease areas we are less certain about which treatments are most safe and effective. This can lead to weaker recommendations about which treatments to prescribe in practice. However, it may be possible to 'borrow strength' from adult evidence to improve our understanding of which treatments work best in children, and many different statistical methods are available to conduct these analyses. In this paper we discuss four Bayesian methods for extrapolating adult clinical trial evidence to children. Using an exemplar dataset, we compare the effect of their modelling assumptions on the estimated treatment effect and associated heterogeneity. These modelling assumptions range from adult evidence being completely generalisable to being completely unrelated to the children's evidence. We finally discuss the appropriateness of these modelling assumptions in the context of estimating treatment effect in children.
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Affiliation(s)
- Ruth Walker
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, United Kingdom
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, United Kingdom
- Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, United Kingdom
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22
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:411. [PMID: 37076189 DOI: 10.1136/archdischild-2023-325623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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23
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:323. [PMID: 36931649 DOI: 10.1136/archdischild-2023-325491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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24
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Collaço N, Gamble A, Morgan JE, Phillips B, Culliford D, Darlington AS. Experiences and support needs of parents/caregivers of children with cancer through the COVID-19 pandemic in the UK: a longitudinal study. Arch Dis Child 2023; 108:198-203. [PMID: 36450442 DOI: 10.1136/archdischild-2022-324905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To explore the experiences, information and support needs of parents/caregivers of children with cancer and how these changed as the COVID-19 pandemic evolved. DESIGN Online surveys containing closed and free-text questions on experiences, information and support needs were completed at four time points (between April 2020 and October 2021) during the COVID-19 pandemic. Descriptive statistics of closed items and content analysis of qualitative data were conducted. SETTING Online. PARTICIPANTS Parents/caregivers of children with cancer. RESULTS 335 parents/caregivers completed the survey over four time points. Findings revealed that parents'/caregivers' worry about the virus and vigilance about their child's virus symptoms decreased over time. Parents reporting the need for support on how to reduce their worries and/or family members during the virus outbreak were low, however parents reported a slight increase in need for support at T3 when schools reopened. Qualitative findings reported the following themes: (1) Psychological well-being of parents/caregivers, (2) Changing perceptions of risks/priorities, (3) Adjusting to COVID-19: Living with continued caution, (4) Healthcare and treatment provision, (5) Information seeking and needs during COVID-19. CONCLUSIONS The COVID-19 pandemic disrupted people's lives and routines in relation to access to support, finances, education and social lives, leading to psychological distress. Parents highlighted the need for timely, up-to-date and personalised information in relation to COVID-19 and their child with cancer. Further consideration of the development of technology-based health solutions may provide an efficient and safe way to connect with and support parent/caregivers.
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Affiliation(s)
- Nicole Collaço
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group, Leicester, UK
| | - Jessica Elizabeth Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
- Leeds Children's Hospital, Leeds, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Leeds Children's Hospital, Leeds, UK
| | - David Culliford
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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25
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:236. [PMID: 36717210 DOI: 10.1136/archdischild-2023-325354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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26
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Jackson TJ, Napper R, Haeusler GM, Pizer B, Bate J, Grundy RG, Samarasinghe S, Angelini P, Ball-Gamble A, Phillips B, Morgan JE. Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics. Arch Dis Child 2023; 108:192-197. [PMID: 36600323 PMCID: PMC9985710 DOI: 10.1136/archdischild-2021-323254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN). DESIGN Prospective service evaluation from 17 April 2020 to 16 April 2021. SETTING 13 specialist centres in the UK. PATIENTS 405 children presenting with FN. INTERVENTION All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group. MAIN OUTCOME MEASURES Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes. RESULTS 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died. CONCLUSIONS Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.
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Affiliation(s)
- Thomas John Jackson
- Paediatric Oncology, University College London Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rachel Napper
- Regional Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
| | - Gabrielle M Haeusler
- Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Barry Pizer
- Paediatric Oncology, Royal Liverpool Children's Hospital, Liverpool, UK
| | - Jessica Bate
- Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Richard G Grundy
- Children's Cancer Leukaemia Group Chair, University of Nottingham, Nottingham, UK
| | - Sujith Samarasinghe
- Paediatric Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Paola Angelini
- Children and Young People Unit, Royal Marsden Hospital Sutton, Sutton, UK
| | | | - Bob Phillips
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jessica Elizabeth Morgan
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
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27
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Phillips B, Buchholtz K, Burgess TL. Gastrocnemius muscle architecture in distance runners with and without Achilles tendinopathy. S Afr J Sports Med 2023; 34:v34i1a12576. [PMID: 36815930 PMCID: PMC9924548 DOI: 10.17159/2078-516x/2022/v34i1a12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Achilles tendinopathy is a common condition amongst distance runners due to the cumulative repetitive overload of the tendon. Gastrocnemius weakness and inflexibility can predispose to this condition. These predisposing functional deficits could have architectural underpinnings, but the gastrocnemius architecture of distance runners with Achilles tendinopathy has not been previously described or compared to the architecture of healthy distance runners. Objectives We aimed to investigate the differences in gastrocnemius architecture between distance runners with Achilles tendinopathy and uninjured counterparts. Methods Twenty distance runners (10 with Achilles tendinopathy; 10 uninjured) were recruited to this study. Ultrasound measurement of the gastrocnemius muscle architecture (pennation angle; fascicle length; muscle thickness; muscle belly length; muscle volume; physiological cross-sectional area) was performed. Results Gastrocnemius Medial Head (GM) fascicle length was significantly greater (p = 0.02), whilst the physiological cross-sectional area (PCSA) was significantly less (p = 0.01) in the case group. Gastrocnemius Lateral Head (GL) pennation angle (p = 0.01) and PCSA (p = 0.01) were significantly lower, whilst fascicle length was significantly greater (p = 0.01) in the case group. There were no significant between-group differences in GM and GL muscle thickness, muscle belly length, or muscle volume. Conclusion Components of gastrocnemius architecture differ significantly between distance runners with Achilles tendinopathy and uninjured controls in our study sample. This study cannot infer whether these results are secondary or predisposing to the condition. Further longitudinal investigation is required to explore these relationships further.
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Affiliation(s)
- B Phillips
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town,
South Africa
| | - K Buchholtz
- HPALS, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town,
South Africa,Department of Physiotherapy, LUNEX International University of Health, Exercise and Sport,
Luxembourg
| | - TL Burgess
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town,
South Africa,Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town,
South Africa
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28
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2023; 108:141. [PMID: 36657802 DOI: 10.1136/archdischild-2022-325256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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29
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:1131. [PMID: 36396171 DOI: 10.1136/archdischild-2022-325017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Nolan GS, Dunne JA, Lee AE, Wade RG, Kiely AL, Pritchard Jones RO, Gardiner MD, Abbassi O, Abdelaty M, Ahmed F, Ahmed R, Ali S, Allan A, Allen L, Anderson I, Bakir A, Berwick D, Sarala BBN, Bhat W, Bloom O, Bolton L, Brady N, Campbell E, Capitelli-McMahon H, Cassell O, Chalhoub X, Chalmers R, Chan J, Chu HO, Collin T, Cooper K, Curran TA, Cussons D, Daruwalla M, Dearden A, Delikonstantinou I, Dobbs T, Dunlop R, El-Muttardi N, Eleftheriadou A, Elamin SE, Eriksson S, Exton R, Fourie LR, Freethy A, Gardner E, Geh JL, Georgiou A, Georgiou M, Gilbert P, Gkorila A, Green D, Haeney J, Hamilton S, Harper F, Harrison C, Heinze Z, Hemington-Gorse S, Hever P, Hili S, Holmes W, Hughes W, Ibrahim N, Ismail A, Jallali N, James NK, Jemec B, Jica R, Kaur A, Kazzazi D, Khan M, Khan N, Khashaba H, Khera B, Khoury A, Kiely J, Kumar S, Patel PK, Kumbasar DE, Kundasamy P, Kyle D, Langridge B, Liu C, Lo M, Macdonald C, Anandan SM, Mahdi M, Mandal A, Manning A, Markeson D, Matteucci P, McClymont L, Mikhail M, Miller MC, Munro S, Musajee A, Nasrallah F, Ng L, Nicholas R, Nicola A, Nikkhah D, O'Hara N, Odili J, Oudit D, Patel A, Patel C, Patel N, Patel P, Peach H, Phillips B, Pinder R, Pinto-Lopes R, Plonczak A, Quinnen N, Rafiq S, Rahman K, Ramjeeawon A, Rinkoff S, Sainsbury D, Schumacher K, Segaren N, Shahzad F, Shariff Z, Siddiqui A, Singh P, Sludden E, Smith JRO, Song M, Stodell M, Tanos G, Taylor K, Taylor L, Thomson D, Tiernan E, Totty JP, Vaingankar N, Toh V, Wensley K, Whitehead C, Whittam A, Wiener M, Wilson A, Wong KY, Wood S, Yeoh T, Yii NW, Yim G, Young R, Zberea D, Jain A. National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. Br J Surg 2022; 109:1040-1043. [DOI: 10.1093/bjs/znac232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022]
Abstract
A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.
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Affiliation(s)
- Grant S Nolan
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Jonathan A Dunne
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Alice E Lee
- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds , Leeds , UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Ailbhe L Kiely
- Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust , Fulwood, Preston , UK
| | - Rowan O Pritchard Jones
- Department of Plastic and Reconstructive Surgery, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust , Prescot , UK
| | - Matthew D Gardiner
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham , Slough , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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- Department of Plastic and Reconstructive Surgery, Charing Cross and St Mary’s Hospitals, Imperial College Healthcare NHS Trust , London , UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , UK
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31
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:845. [PMID: 35981759 DOI: 10.1136/archdischild-2022-324685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:772. [PMID: 35853637 DOI: 10.1136/archdischild-2022-324591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Friend AJ, Phillips B. Olanzapine was an effective additional antiemetic for children and young people undergoing highly emetogenic chemotherapy. Arch Dis Child Educ Pract Ed 2022; 107:312. [PMID: 33692036 DOI: 10.1136/archdischild-2021-321775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda Jane Friend
- Paediatrics, Leeds General Infirmary, Leeds, UK .,School of Medicine, University of Leeds, Leeds, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Haeusler GM, Lehrnbecher T, Agyeman PKA, Loves R, Castagnola E, Groll AH, van de Wetering M, Aftandilian CC, Phillips B, Chirra KM, Schneider C, Dupuis LL, Sung L. Clostridioides difficile infection in paediatric patients with cancer and haematopoietic stem cell transplant recipients. Eur J Cancer 2022; 171:1-9. [PMID: 35696884 DOI: 10.1016/j.ejca.2022.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Epidemiology of Clostridioides difficile infection (CDI) in paediatric cancer patients is uncertain. The primary objective was to describe the prevalence of CDI outcomes among paediatric patients receiving cancer treatments. Secondary objectives were to describe clinical features of CDI, propose a definition of severe CDI and to determine risk factors for CDI clinical outcomes. METHODS A multi-centre retrospective cohort study that included paediatric patients (1-18 years of age) receiving cancer treatments with CDI. Severe CDI definition was achieved by consensus. Univariable and multivariable regression was conducted to evaluate risk factors for CDI outcomes. RESULTS There were 627 eligible patients who experienced 721 CDI episodes. The prevalence of clinical cure was 82.9%, recurrence was 9.6%, global cure was 75.0% and repeated new CDI episode was 12.8%. The proposed definition of severe CDI was the presence of colitis, pneumatosis intestinalis, pseudomembranous colitis, ileus or surgery for CDI, occurring in 70 (9.7%) episodes. In univariable regression, initial oral metronidazole or initial oral vancomycin were not significantly associated with failure to achieve clinical cure or CDI recurrence. In multiple regression, oral metronidazole was significantly associated with higher odds (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.0-2.7) and oral vancomycin was significantly associated with lower odds (OR 0.4, 95% CI 0.2-0.8) of repeated new episodes. CONCLUSION The prevalence of clinical cure was 82.9% and recurrence was 9.6% in pediatric patients receiving cancer treatments. Severe CDI, as per our proposed definition, occurred in 9.7% episodes. Initial oral vancomycin was significantly associated with a reduction in repeated new CDI episodes.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious Diseases, Royal Children's Hospital, Melbourne, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Paediatric Integrated Cancer Service, Victoria, Australia
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Phillip K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robyn Loves
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Pediatrics, Istituto Giannina Gaslini, Genova, Italy
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany
| | | | - Catherine C Aftandilian
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Bob Phillips
- Leeds Children's Hospital, Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom; Centre for Reviews and Dissemination, University of York, Yorkshire, United Kingdom
| | - Krishna M Chirra
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Christine Schneider
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lee L Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada; Department of Pharmacy, The Hospital for Sick Children, And Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lillian Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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Hardy E, Hatt J, Doleman B, Smart T, Phillips B, Lund J. O101 Increased contractile activity through electrical stimulation attenuates postoperative loss of muscle mass and function, even in the presence of inadequate nutrition. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Significant muscle atrophy occurs after major abdominal surgery. Lack of physical activity and protein intake may play a significant role. This study assesses the efficacy of neuromuscular electrical stimulation (NMES) in attenuating loss of muscle mass and function following open colorectal resection.
Methods
Fifteen patients were recruited, and their lower limbs randomised to control (CON) or NMES (STIM). Vastus Lateralis (VL) cross sectional area (CSA), muscle thickness (MT) and knee extensor strength (KES) were measured preoperatively and repeated on postoperative day (POD) 5. Dietary intake was recorded, and nutritional intake calculated. Fifteen minutes of NMES was applied to the quadriceps of the STIM leg twice a day on POD 1–4. All outcomes were analysed using linear mixed model approaches. The study was approved by the NHS REC (ref 20/EM/069).
Results
NMES significantly reduced the loss of CSA (mean difference (MD) 1.18, 95%CI: 0.75–1.61, p<0.001), MT (MD 0.12, 95%CI: 0.04–0.2, p=0.001) and KES (MD 4.48, 95%CI: 0.00–8.97, p=0.03). Total energy and protein intakes over POD1 - 4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount for perioperative patients. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort.
Conclusion
NMES has been demonstrated to reduce loss of muscle mass and function following major abdominal surgery and may be an important tool in aiding recovery to normal functional state.
Further studies should establish the efficacy of bilateral whole-leg NMES for improving patient centred outcomes.
Take-home message
Loss of muscle mass and function after major abdominal surgery causes significant morbidity. Neuromuscular electrical stimulation reduces this muscle loss and should be investigated further as a potential therapy.
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Affiliation(s)
- E Hardy
- Department of General Surgery, Royal Derby Hospital
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
| | - J Hatt
- Department of General Surgery, Royal Derby Hospital
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
| | - B Doleman
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
| | - T Smart
- Department of General Surgery, Royal Derby Hospital
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
| | - B Phillips
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
| | - J Lund
- Department of General Surgery, Royal Derby Hospital
- Centre of Metabolism, Ageing and Physiology, University of Nottingham
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:695. [PMID: 35714987 DOI: 10.1136/archdischild-2022-324454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Jones GL, Moss RH, Darby F, Mahmoodi N, Phillips B, Hughes J, Vogt KS, Greenfield DM, Brauten-Smith G, Gath J, Campbell T, Stark D, Velikova G, Snowden JA, Baskind E, Mascerenhas M, Yeomanson D, Skull J, Lane S, Bekker HL, Anderson RA. Cancer, Fertility and Me: Developing and Testing a Novel Fertility Preservation Patient Decision Aid to Support Women at Risk of Losing Their Fertility Because of Cancer Treatment. Front Oncol 2022; 12:896939. [PMID: 35847858 PMCID: PMC9280471 DOI: 10.3389/fonc.2022.896939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Women with a new cancer diagnosis face complex decisions about interventions aiming to preserve their fertility. Decision aids are more effective in supporting decision making than traditional information provision. We describe the development and field testing of a novel patient decision aid designed to support women to make fertility preservation treatment decisions around cancer diagnosis. Methods A prospective, mixed-method, three stage study involving: 1) co-development of the resource in collaboration with a multi-disciplinary group of key stakeholders including oncology and fertility healthcare professionals and patient partners (n=24), 2) alpha testing with a group of cancer patients who had faced a fertility preservation treatment decision in the past (n=11), and oncology and fertility healthcare professionals and stakeholders (n=14) and, 3) beta testing with women in routine care who had received a recent diagnosis of cancer and were facing a fertility preservation treatment decision (n=41) and their oncology and fertility healthcare professionals (n=3). Ten service users recruited from a closed Breast Cancer Now Facebook group and the support group Cancer and Fertility UK also provided feedback on CFM via an online survey. Results A 60-page paper prototype of the Cancer, Fertility and Me patient decision aid was initially developed. Alpha testing of the resource found that overall, it was acceptable to cancer patients, healthcare professionals and key stakeholders and it was considered a useful resource to support fertility preservation treatment decision-making. However, the healthcare professionals felt that the length of the patient decision aid, and elements of its content may be a barrier to its use. Subsequently, the prototype was reduced to 40 pages. During beta testing of the shortened version in routine care, women who received the resource described its positive impact on their ability to make fertility preservation decisions and support them at a stressful time. However, practical difficulties emerged which impacted upon its wider dissemination in clinical practice and limited some elements of the evaluation planned. Discussion Women receiving the decision aid within the cancer treatment pathway found it helped them engage with decisions about fertility preservation, and make better informed, values-based care plans with oncology and fertility teams. More work is needed to address access and implementation of this resource as part of routine oncology care pathways.
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Affiliation(s)
- Georgina L. Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Rachael H. Moss
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Frances Darby
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Neda Mahmoodi
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Bob Phillips
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Jane Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Katharina S. Vogt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Diana M. Greenfield
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - Jacqui Gath
- Independent Cancer Patients’ Voice, London, United Kingdom
| | | | - Daniel Stark
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - John A. Snowden
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Ellissa Baskind
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Daniel Yeomanson
- Haematology and Oncology, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Jonathan Skull
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Sheila Lane
- Department of Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development (LUCID), School of Medicine, University of Leeds, Leeds, United Kingdom
- Research Centre for Patient Involvement (ResCenPI) Central Region Denmark, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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Gannon T, Phillips B, Saunders D, Berner AM. Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People. Front Oncol 2022; 12:891874. [PMID: 35814480 PMCID: PMC9263369 DOI: 10.3389/fonc.2022.891874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) people experience healthcare inequalities in cancer care. Previous studies have focused on knowledge, attitudes and behaviours of healthcare professionals (HCPs) treating adults with cancer and how these contribute to inequalities. To date, no research has focused on HCPs treating LGBTQ+ children and adolescents with cancer in the UK. This is important given that this group may be at a critical time for exploring their gender identity and sexual orientation, whilst also facing a cancer diagnosis. We aimed to explore the knowledge, attitudes and behaviours of paediatric, teenage and young adult oncology HCPs treating LGBTQ+ patients in the UK. Methods We carried out semi-structured interviews with 8 HCPs in paediatric, teenage and young adult (TYA) oncology from the Royal Marsden NHS Foundation Trust. Eight questions were asked, which centred around participants' knowledge, attitudes and behaviours regarding management of LGBTQ+ patients in oncology. Interview transcripts were analysed by inductive thematic analysis. Results We identified 10 themes, including novel themes (how HCPs acquire knowledge and expectations of a 'third party' to be the expert) which may underlie previously observed trends in knowledge, attitudes and behaviours of HCPs. We highlight other themes and HCP concerns specific to care of LGBTQ+ patients in paediatrics (influence of the parental-carer dynamic, concerns around patient age and development as a barrier to disclosure) which require further research. We found evidence of the interrelatedness of HCP knowledge, attitudes and behaviours and the ability of these elements to positively influence each other. We mapped our themes across these elements to form a new suggested framework for improving HCP-patient interactions in LGBTQ+ Cancer Care. We found a need both for individual HCP education and organisational change, with creation of a culture of psychological safety to improve patient care. Conclusion Knowledge, attitudes and behaviours of HCPs are closely interdependent when providing care to young LGBTQ+ patients with cancer. The authors suggest that future efforts to improve care of these patients address this complexity by spanning the domains of our suggested framework. Whilst HCP education is essential, change must also occur at an organisational level.
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Affiliation(s)
- Tamsin Gannon
- Paediatric and Teenage and Young Adult Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom,*Correspondence: Tamsin Gannon,
| | - Bob Phillips
- Paediatric and Teenage and Young Adult (TYA) Oncology, Leeds Children’s Hospital, Leeds, United Kingdom
| | - Daniel Saunders
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alison May Berner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom,Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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Haeusler GM, Garnham AL, Li‐Wai‐Suen CSN, Clark JE, Babl FE, Allaway Z, Slavin MA, Mechinaud F, Smyth GK, Phillips B, Thursky KA, Pellegrini M, Doerflinger M. Blood transcriptomics identifies immune signatures indicative of infectious complications in childhood cancer patients with febrile neutropenia. Clin Transl Immunology 2022; 11:e1383. [PMID: 35602885 PMCID: PMC9113042 DOI: 10.1002/cti2.1383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/03/2022] [Accepted: 03/10/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Febrile neutropenia (FN) is a major cause of treatment disruption and unplanned hospitalization in childhood cancer patients. This study investigated the transcriptome of peripheral blood mononuclear cells (PBMCs) in children with cancer and FN to identify potential predictors of serious infection. Methods Whole-genome transcriptional profiling was conducted on PBMCs collected during episodes of FN in children with cancer at presentation to the hospital (Day 1; n = 73) and within 8-24 h (Day 2; n = 28) after admission. Differentially expressed genes as well as gene pathways that correlated with clinical outcomes were defined for different infectious outcomes. Results Global differences in gene expression associated with specific immune responses in children with FN and documented infection, compared to episodes without documented infection, were identified at admission. These differences resolved over the subsequent 8-24 h. Distinct gene signatures specific for bacteraemia were identified both at admission and on Day 2. Differences in gene signatures between episodes with bacteraemia and episodes with bacterial infection, viral infection and clinically defined infection were also observed. Only subtle differences in gene expression profiles between non-bloodstream bacterial and viral infections were identified. Conclusion Blood transcriptome immune profiling analysis during FN episodes may inform monitoring and aid in defining adequate treatment for different infectious aetiologies in children with cancer.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVICAustralia,NHMRC National Centre for Infections in CancerSir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,The Victorian Paediatric Integrated Cancer ServiceVictoria State GovernmentMelbourneVICAustralia,Infection Diseases UnitDepartment of General MedicineRoyal Children's HospitalMelbourneVICAustralia
| | - Alexandra L Garnham
- Walter and Eliza Hall Institute for Medical ResearchParkvilleVICAustralia,Department of Medical BiologyThe University of MelbourneMelbourneVICAustralia
| | - Connie SN Li‐Wai‐Suen
- Walter and Eliza Hall Institute for Medical ResearchParkvilleVICAustralia,Department of Medical BiologyThe University of MelbourneMelbourneVICAustralia
| | - Julia E Clark
- Queensland Children's HospitalChild Health Research CentreThe University of QueenslandBrisbaneQLDAustralia
| | - Franz E Babl
- Department of Emergency MedicineRoyal Children's HospitalMelbourneVICAustralia,Murdoch Children's Research InstitutePaediatric Research in Emergency Departments International Collaborative (PREDICT)MelbourneVICAustralia,Murdoch Children's Research InstituteMelbourneVICAustralia,Department of PaediatricsFaculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVICAustralia
| | - Zoe Allaway
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVICAustralia,NHMRC National Centre for Infections in CancerSir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia
| | - Monica A Slavin
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVICAustralia,NHMRC National Centre for Infections in CancerSir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Infection Diseases UnitDepartment of General MedicineRoyal Children's HospitalMelbourneVICAustralia,Victorian Infectious Diseases ServiceThe Peter Doherty Institute for Infection and ImmunityMelbourneVICAustralia
| | - Francoise Mechinaud
- Children's Cancer CentreThe Royal Children's HospitalMelbourneVICAustralia,Unité d'Hématologie Immunologie PédiatriqueHopital Robert DebréAPHP Nord Université de ParisParisFrance
| | - Gordon K Smyth
- Walter and Eliza Hall Institute for Medical ResearchParkvilleVICAustralia,School of Mathematics and StatisticsUniversity of MelbourneMelbourneVICAustralia
| | - Bob Phillips
- Leeds Children's HospitalLeeds General InfirmaryLeedsUK
| | - Karin A Thursky
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVICAustralia,NHMRC National Centre for Infections in CancerSir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Department of Infectious DiseasesNational Centre for Antimicrobial StewardshipUniversity of MelbourneMelbourneVICAustralia
| | - Marc Pellegrini
- NHMRC National Centre for Infections in CancerSir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia,Walter and Eliza Hall Institute for Medical ResearchParkvilleVICAustralia,Department of Medical BiologyThe University of MelbourneMelbourneVICAustralia
| | - Marcel Doerflinger
- Walter and Eliza Hall Institute for Medical ResearchParkvilleVICAustralia,Department of Medical BiologyThe University of MelbourneMelbourneVICAustralia
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Papworth A, Hackett J, Beresford B, Murtagh F, Weatherly H, Hinde S, Bedendo A, Walker G, Noyes J, Oddie S, Vasudevan C, Feltbower R, Phillips B, Hain R, Subramanian G, Haynes A, Fraser LK. End of life care for infants, children and young people (ENHANCE): Protocol for a mixed methods evaluation of current practice in the United Kingdom [version 1; peer review: 2 approved]. NIHR Open Res 2022; 2:37. [PMID: 35935675 PMCID: PMC7613236 DOI: 10.3310/nihropenres.13273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/22/2022]
Abstract
Background Although child mortality has decreased over the last few decades, around 4,500 infants and children die in the UK every year, many of whom require palliative care. There is, however, little evidence on paediatric end-of-life care services. The current National Institute for Health and Care Excellence (NICE) guidance provides recommendations about what should be offered, but these are based on low quality evidence. The ENHANCE study aims to identify and investigate the different models of existing end-of-life care provision for infants, children, and young people in the UK, including an assessment of the outcomes and experiences for children and parents, and the cost implications to families and healthcare providers. Methods This mixed methods study will use three linked workstreams and a cross-cutting health economics theme to examine end-of-life care models in three exemplar clinical settings: infant, children and young adult cancer services (PTCs), paediatric intensive care units (PICUs), and neonatal units (NNUs).Workstream 1 (WS1) will survey current practice in each setting and will result in an outline of the different models of care used. WS2 is a qualitative comparison of the experiences of staff, parents and patients across the different models identified. WS3 is a quantitative assessment of the outcomes, resource use and costs across the different models identified. Discussion Results from this study will contribute to an understanding of how end-of-life care can provide the greatest benefit for children at the end of their lives. It will also allow us to understand the likely benefits of additional funding in end-of-life care in terms of patient outcomes.
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Affiliation(s)
- Andrew Papworth
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Julia Hackett
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
- Social Policy Research Unit, University of York, Heslington, York, YO10 5DD, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Helen Weatherly
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Andre Bedendo
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | | | - Jane Noyes
- School of Health Sciences, Bangor University, Fron Heulog, Bangor, LL57 2EF, UK
| | - Sam Oddie
- Bradford Hospitals National Health Service Trust, Bradford, BD9 6RJ, UK
| | | | - Richard Feltbower
- Leeds Institute for Data Analytics, University of Leeds, Leeds, LS2 9NL, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, UK, York, YO10 5DD, UK
| | - Richard Hain
- All-Wales Paediatric Palliative Care Network, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK
- College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Gayathri Subramanian
- Manchester University National Health Service Foundation Trust, Manchester, M13 9WL, UK
| | - Andrew Haynes
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
- Martin House Research Centre, University of York, Heslington, York, YO10 5DD, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:507. [PMID: 35443981 DOI: 10.1136/archdischild-2022-324201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, Alcuin College, University of York, York, UK
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42
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:409. [PMID: 35301192 DOI: 10.1136/archdischild-2022-324029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Hassan H, Kinsey S, Phillips B. Mucositis reduction with probiotics in children with cancer: a randomised-controlled feasibility study. Arch Dis Child 2022; 107:259-264. [PMID: 34193407 DOI: 10.1136/archdischild-2020-319968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND A recent systematic review and meta-analysis identified a paucity of randomised-controlled trials (RCTs) investigating the use of probiotics to reduce or prevent mucositis and infection in children with cancer. OBJECTIVE This study evaluated the feasibility of undertaking an RCT and investigated the efficacy of probiotics for reducing or preventing mucositis and infection in children with cancers. SETTING The Paediatric Oncology and Haematology department at Leeds Teaching Hospital, UK. PATIENTS Children aged 1 year or older, receiving chemotherapies likely to cause mucositis. INTERVENTIONS Participants were randomised to receive the probiotic or placebo on day 1-14 of a chemotherapy cycle. Participants were also required to complete a patient diary for 21 days. MAIN OUTCOME MEASURES To assess whether it is feasible to recruit children diagnosed with cancer who are at risk of developing mucositis to an adequately powered RCT. RESULTS Between May and November 2019, 34 out of 39 eligible participants were approached. Ten patients were recruited (4 probiotic and 6 placebo) of which 2 participants withdrew. Seven participants partially completed the diary but only two participants completed 80% or more. Eligible participants appeared to prefer giving informal verbal feedback when in direct contact with research and healthcare professionals. CONCLUSION This study demonstrated that recruitment needs to be improved prior to undertaking an adequately powered RCT. TRIAL REGISTRATION NUMBER NCT03785938.
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Affiliation(s)
- Hadeel Hassan
- Leeds Institute of Cancer and Pathology, University of Leeds, Faculty of Medicine and Health, Leeds, UK
- Paediatric Haematology and Oncology, Leeds General Infirmary, Leeds, UK
| | - Sally Kinsey
- Leeds Institute of Cancer and Pathology, University of Leeds, Faculty of Medicine and Health, Leeds, UK
- Paediatric Haematology, Leeds General Infirmary, Leeds, West Yorkshire, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:303. [PMID: 35177420 DOI: 10.1136/archdischild-2022-323908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Morgan JE, Phillips B. PAnTher Cub: procalcitonin-guided antibiotic therapy for febrile neutropenia in children and young people with cancer - a single-arm pilot study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001339. [PMID: 36053620 PMCID: PMC8928328 DOI: 10.1136/bmjpo-2021-001339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Febrile neutropenia (FN) is a common complication of cancer treatment in children and young people, and many episodes are over-treated. Procalcitonin, may be an appropriate tool to guide the stopping of antibiotics in those at low risk of serious bacterial infection. Supportive care trials in this population have proven to be difficult to undertake. This single-arm pilot study aimed to evaluate whether a study using a procalcitonin-guided stopping-rule for antibiotics in paediatric FN is possible. METHODS Daily procalcitonin levels were performed during episodes of FN and clear guidance given for antibiotic discontinuation. Episode data and quantitative feasibility data were collected alongside interviews with professionals and ethnographic observations. Analysis was descriptive. RESULTS Of 32 patients and families approached, 28 patients consented, and 13 had febrile neutropenia. In total, 16 episodes were included in the study. All relevant FN episodes had data captured, with adequate data collection. There were no significant safety events. In 4/8 (50%) of episodes without clear microbiologically documented or clinical infection, antibiotics were reduced in duration or in spectrum. Interviews with professionals revealed the importance of the research, the value of key individuals in the study team, particular challenges of this protocol and suggestions for study improvements. CONCLUSIONS Studies to evaluate procalcitonin-guided approaches to stopping antibiotics in paediatric FN are possible.
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Affiliation(s)
- Jessica Elizabeth Morgan
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK .,Centre for Reviews and Dissemination, University of York, York, UK
| | - Bob Phillips
- Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK.,Centre for Reviews and Dissemination, University of York, York, UK
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Phillips B. Prospective cohort study of the predictive value of inflammatory biomarkers over clinical variables in children and young people with cancer presenting with fever and neutropenia. F1000Res 2022; 10:1070. [PMID: 35211295 PMCID: PMC8831847 DOI: 10.12688/f1000research.73075.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Fever during chemotherapy induced neutropenia is a common and potentially life-threatening complication of the treatment of childhood cancer. Predictions of poor outcome could be enhanced by incorporating serum biomarkers of inflammation at presentation and reassessment. Methods A prospective cohort study was conducted of children under 18 years old, being treated for cancer or a cancer-like condition, who presented with fever (≥ 38.0°C) and neutropenia (neutrophil count < 0.5*10 9/L). Clinical features were recorded, along with three experimental inflammatory biomarkers: procalcitonin (PCT), interleukin-6 (IL-6) and interleukin-8 (IL-8). Outcomes included serious medical complications (SMC): any infection related mortality, critical care and organ support, severe sepsis, septic shock, significant microbiologically defined infection, or radiologically confirmed pneumonia. Results Biomarker assessments were undertaken in 43 episodes of fever and neutropenia, from 31 patients aged between four months and 17 years old (median six years): 20 were female and 22 had acute leukaemia. Five episodes of SMC were noted. PCT, IL-6 and IL-8 had poor individual discriminatory ability (C-statistic 0.48 to 0.60) and did not add to the value of clinical risk stratification tools. Insufficient data were collected to formally assess the value of repeated assessments. Conclusions Incorporating serum biomarkers of inflammation at presentation of episodes of fever with neutropenia in childhood does not clearly improve risk stratification. The value of serial assessments requires further investigation.
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Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, Yorkshire, YO10 5DD, UK,Regional Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 9TX, UK,
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Millen GC, Arnold R, Cazier JB, Curley H, Feltbower R, Gamble A, Glaser A, Grundy RG, Kirton L, Lee LYW, McCabe MG, Palles C, Phillips B, Stiller CA, Varnai C, Kearns P. COVID-19 in children with haematological malignancies. Arch Dis Child 2022; 107:186-188. [PMID: 34301621 PMCID: PMC8785070 DOI: 10.1136/archdischild-2021-322062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with cancer are not at increased risk of severe SARS-CoV-2 infection; however, adults with haematological malignancies have increased risk of severe infections compared with non-haematological malignancies. METHODS We compared patients with haematological and non-haematological malignancies enrolled in the UK Paediatric Coronavirus Cancer Monitoring Project between 12 March 2020 and 16 February 2021. Children who received stem cell transplantation were excluded. RESULTS Only 2/62 patients with haematological malignancy had severe/critical infections, with an OR of 0.5 for patients with haematological compared with non-haematological malignancies. INTERPRETATION Children with haematological malignancies are at no greater risk of severe SARS-CoV-2 infection than those with non-haematological malignancies.
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Affiliation(s)
- Gerard Cathal Millen
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Helen Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
| | - Ashley Gamble
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Richard G Grundy
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
- School of Medicine, University of Nottingham Children's Brain Tumour Research Centre, Nottingham, UK
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Martin G McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
- Paediatric Oncology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Csilla Varnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:193. [PMID: 35058239 DOI: 10.1136/archdischild-2021-323716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
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Phillips B. Towards evidence-based medicine for paediatricians. Arch Dis Child 2022; 107:93. [PMID: 34911686 DOI: 10.1136/archdischild-2021-323569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York YO10 5DD, UK
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Martinez JPD, Robinson PD, Phillips B, Lehrnbecher T, Koenig C, Fisher B, Egan G, Dupuis LL, Ammann RA, Alexander S, Cabral S, Tomlinson G, Sung L. Conventional compared to network meta-analysis to evaluate antibiotic prophylaxis in patients with cancer and haematopoietic stem cell transplantation recipients. BMJ Evid Based Med 2021; 26:320-326. [PMID: 32868288 DOI: 10.1136/bmjebm-2020-111362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/03/2022]
Abstract
Our purpose was to compare conventional meta-analysis and network meta-analysis to evaluate the efficacy of different prophylactic systemic antibiotic classes in patients undergoing chemotherapy or haematopoietic stem cell transplant (HSCT). We included randomised trials if patients had cancer or were HSCT recipients and the intervention was systemic antibacterial prophylaxis. Three types of control groups were used: (1) placebo, no antibiotic and non-absorbable antibiotic separately; (2) placebo and no antibiotic combined; and (3) all three combined. These gave different network geometries. Strategies synthesised were fluoroquinolone, trimethoprim-sulfamethoxazole, cephalosporin and parenteral glycopeptide versus control groups. In total 113 trials met the eligibility criteria. Where treatment effects could be estimated with both conventional and network meta-analysis, values were generally similar. However, where events were sparse, network meta-analysis could be more precise. For example, trimethoprim-sulfamethoxazole versus placebo for infection-related mortality showed a relative risk ratio (RR) of 0.55, 95% CI (0.21 to 1.44) with conventional, and RR 0.43, 95% credible region (0.20 to 0.82) with network meta-analysis. Cephalosporin versus fluoroquinolone was comparable only indirectly using the network approach and yielded RR 0.59, 95% credible region (0.28 to 1.20) to reduce bacteraemia. Incoherence (difference between direct and indirect estimates raising concerns about network meta-analysis validity) was observed with network geometry where control groups were separated, but not where control groups were combined. In this situation, conventional and network meta-analysis yielded similar results in general. Network meta-analysis results could be more precise when events were rare. Some analysis could only be performed with the network approach. These results identify scenarios in which network meta-analysis may be advantageous.
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Affiliation(s)
- Juan Pablo Diaz Martinez
- Biostatistic Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Bob Phillips
- Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom and Centre for Reviews and Dissemination, Leeds Children's Hospital, Leeds, UK
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe, Universität Frankfurt am Main, Frankfurt am Main, Hessen, Germany
| | - Christa Koenig
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital University Hospital Bern, Bern, Switzerland
| | - Brian Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Grace Egan
- Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - L Lee Dupuis
- Department of Pharmacy and Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Roland A Ammann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital University Hospital Bern, Bern, Switzerland
| | - Sarah Alexander
- Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sandra Cabral
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistic Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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