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Flerlage JE, Hiniker SM, Armenian S, Benya EC, Bobbey AJ, Chang V, Cooper S, Coulter DW, Cuglievan B, Hoppe BS, Isenalumhe L, Kelly K, Kersun L, Lamble AJ, Larrier NA, Magee J, Oduro K, Pacheco M, Price AP, Roberts KB, Smith CM, Sohani AR, Trovillion EM, Walling E, Xavier AC, Burns JL, Campbell M. Pediatric Hodgkin Lymphoma, Version 3.2021. J Natl Compr Canc Netw 2021; 19:733-754. [PMID: 34214968 DOI: 10.6004/jnccn.2021.0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is a highly curable form of cancer, and current treatment regimens are focused on improving treatment efficacy while decreasing the risk of late effects of treatment. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric HL provide recommendations on the workup, diagnostic evaluation, and treatment of classic HL, including principles of pathology, imaging, staging, systemic therapy, and radiation therapy. This portion of the NCCN Guidelines focuses on the management of pediatric classic HL in the upfront and relapsed/refractory settings.
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Affiliation(s)
- Jamie E Flerlage
- 1St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Ellen C Benya
- 4Ann & Robert H. Lurie Children's Hospital of Chicago/Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Adam J Bobbey
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Stacy Cooper
- 7The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Kara Kelly
- 12Roswell Park Comprehensive Cancer Center
| | - Leslie Kersun
- 13Children's Hospital of Philadelphia/Abramson Cancer Center at the University of Pennsylvania
| | - Adam J Lamble
- 14Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Jeffrey Magee
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Kwadwo Oduro
- 17Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | - Ana C Xavier
- 25O'Neal Comprehensive Cancer Center at UAB; and
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2
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Aziz-Bose R, Wertheim G, Kersun L. Active learning for fellows: The hematopathology "unknown case". Pediatr Blood Cancer 2021; 68:e28895. [PMID: 33484062 DOI: 10.1002/pbc.28895] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022]
Abstract
The pediatric hematology/oncology fellowship program at the Children's Hospital of Philadelphia set out to create a case-based learning curriculum for common hematologic malignancies that would apply principles of adult learning theory and improve fellows' retention of information in a supportive, goal-oriented learning environment. A framework we employed in developing this curriculum is that of "flow theory," which parallels many of the tenets of adult learning theory. After implementing this curriculum, which we call "the unknown case," the percentage of fellows correctly identifying a common hematopathologic diagnosis improved from 50% to 85%.
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Affiliation(s)
- Rahela Aziz-Bose
- Pediatric Hematology/Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gerald Wertheim
- Division of Hematopathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leslie Kersun
- Division of Hematology/Oncology, Pediatric Hematology/Oncology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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3
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Si S, Erickson K, Evageliou N, Silverman M, Kersun L. An Usual Presentation of Pneumocystis jirovecii Pneumonia in a Woman Treated With Immune Checkpoint Inhibitor. J Pediatr Hematol Oncol 2021; 43:e163-e164. [PMID: 32097278 DOI: 10.1097/mph.0000000000001757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/30/2020] [Indexed: 12/22/2022]
Abstract
We describe a case of Pneumocystis jirovecii pneumonia in an 18-year-old female individual with refractory primary mediastinal B-cell lymphoma treated with the immune checkpoint inhibitor pembrolizumab. She received 11 doses of pembrolizumab without immune-related adverse events (irAEs) before the diagnosis of P. jirovecii pneumonia. However, prophylactic trimethoprim/sulfamethoxazole was discontinued 6 months of postautologous stem cell transplant per standard guidelines. This case report highlights the importance of judicious infectious disease evaluation while on immune checkpoint inhibitor therapy as symptoms can often mimic irAEs. Furthermore, the benefits of immunosuppressive therapy for the treatment of presumptive irAEs must be weighed against the possible increased risk for opportunistic infections.
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Affiliation(s)
| | - Kelley Erickson
- Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Michael Silverman
- Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA
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4
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Kesselheim J, Baker JN, Kersun L, Lee-Miller C, Moerdler S, Snaman JM, Warwick A, Weng S, Zhang Z. Humanism and professionalism training for pediatric hematology-oncology fellows: Results of a multicenter randomized trial. Pediatr Blood Cancer 2020; 67:e28308. [PMID: 32729211 DOI: 10.1002/pbc.28308] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Although humanism and professionalism are central tenets to the practice of medicine, few formal curricula exist for medical trainees. Following a national needs assessment among pediatric hematology-oncology (PHO) fellows, we created a novel curriculum entitled "Humanism and Professionalism for Pediatric Hematology-Oncology" (HP-PHO). In this study, we measure outcomes of this curricular intervention. METHOD We cluster-randomized 20 PHO fellowship programs to deliver usual training in humanism and professionalism (UT) or the novel curriculum (intervention) during the 2016-2017 academic year. The primary outcome measure was the Pediatric Hematology-Oncology Self-Assessment in Humanism (PHOSAH). Secondary measures included the Maslach Burnout Inventory, Patient-Provider Orientation Scale, Empowerment at Work Scale, and a 5-point satisfaction scale. Participating fellows completed pre- and posttests at the beginning and end of the academic year, respectively, and we calculated change scores for each study instrument. RESULTS Cluster randomization yielded 59 intervention and 41 UT fellows. The nine intervention sites administered 33 of 36 modules. Change scores on the PHOSAH were not significantly different between the UT and intervention arms. However, fellows on the intervention arm gave significantly higher ratings on several items within the satisfaction scale related to physician burnout, physician depression, balancing professional duties and personal life, and humanism overall. CONCLUSIONS Exposure to the HP-PHO curriculum did not alter fellows' self-assessed humanism and professionalism skills. However, intervention fellows expressed significantly higher levels of satisfaction in their humanism training, indicating the curriculum's potential for positive impact on the fellows' perceived learning environment.
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Affiliation(s)
- Jennifer Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Justin N Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie Kersun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cathy Lee-Miller
- Department of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Scott Moerdler
- Department of Pediatrics, The Children's Hospital at Montefiore, New York City, New York
| | - Jennifer M Snaman
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Ann Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shicheng Weng
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Zilu Zhang
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
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5
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Arscott W, Cope C, Kersun L, Reilly A, Ginsberg J, Hobbie W, Tochner Z, Kurtz G, Hill-Kayser C. Proton Therapy for Management of Pediatric Hodgkin Lymphoma Involving the Mediastinum: Evaluation of Toxicity and Evolution of Therapy Over 7 Years of Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kesselheim JC, Agrawal AK, Bhatia N, Cronin A, Jubran R, Kent P, Kersun L, Rao AN, Rose M, Savelli S, Sharma M, Shereck E, Twist CJ, Wang M. Measuring pediatric hematology-oncology fellows' skills in humanism and professionalism: A novel assessment instrument. Pediatr Blood Cancer 2017; 64. [PMID: 27808467 DOI: 10.1002/pbc.26316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Educators in pediatric hematology-oncology lack rigorously developed instruments to assess fellows' skills in humanism and professionalism. PROCEDURE We developed a novel 15-item self-assessment instrument to address this gap in fellowship training. Fellows (N = 122) were asked to assess their skills in five domains: balancing competing demands of fellowship, caring for the dying patient, confronting depression and burnout, responding to challenging relationships with patients, and practicing humanistic medicine. An expert focus group predefined threshold scores on the instrument that could be used as a cutoff to identify fellows who need support. Reliability and feasibility were assessed and concurrent validity was measured using three established instruments: Maslach Burnout Inventory (MBI), Flourishing Scale (FS), and Jefferson Scale of Physician Empathy (JSPE). RESULTS For 90 participating fellows (74%), the self-assessment proved feasible to administer and had high internal consistency reliability (Cronbach's α = 0.81). It was moderately correlated with the FS and MBI (Pearson's r = 0.41 and 0.4, respectively) and weakly correlated with the JSPE (Pearson's r = 0.15). Twenty-eight fellows (31%) were identified as needing support. The self-assessment had a sensitivity of 50% (95% confidence interval [CI]: 31-69) and a specificity of 77% (95% CI: 65-87) for identifying fellows who scored poorly on at least one of the three established scales. CONCLUSIONS We developed a novel assessment instrument for use in pediatric fellowship training. The new scale proved feasible and demonstrated internal consistency reliability. Its moderate correlation with other established instruments shows that the novel assessment instrument provides unique, nonredundant information as compared to existing scales.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Anurag K Agrawal
- Children's Hospital and Research Center Oakland, Oakland, California
| | - Nita Bhatia
- Department of Psychological and Brain Sciences, University of Iowa.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Angel Cronin
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rima Jubran
- Children's Hospital of Los Angeles, Los Angeles, California
| | - Paul Kent
- Rush University Medical Center, Chicago, Illinois
| | - Leslie Kersun
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Mukta Sharma
- Children's Mercy Hospital, Kansas City, Missouri
| | - Evan Shereck
- Doernbecker Children's Hospital, Oregon Health Sciences University, Portland, Oregon
| | - Clare J Twist
- Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
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7
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Sammons JS, Ross R, Ditaranto S, Gilman M, Reilly A, Kersun L, Shanahan A, Coffin S. Mucosal Barrier Injury Central Line-Associated Bloodstream Infections: What Is the Impact of Standard Prevention Bundles? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.277] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julia Shaklee Sammons
- Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachael Ross
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Ditaranto
- Department of Medical/Medical Subspecialty Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Gilman
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anne Reilly
- Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leslie Kersun
- Department of Inpatient Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda Shanahan
- Department of Inpatient Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan Coffin
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation. STUDY DESIGN We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable. RESULTS Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic. CONCLUSION There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation.
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Affiliation(s)
- Wynne Morrison
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - James Womer
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Temple University School of Medicine, Philadelphia, PA
| | - Pamela Nathanson
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Leslie Kersun
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D Micah Hester
- Division of Medical Humanities, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Corbett Walsh
- New York University School of Medicine, New York, NY
| | - Chris Feudtner
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kesselheim JC, Atlas M, Adams D, Aygun B, Barfield R, Eisenman K, Fulbright J, Garvey K, Kersun L, Nageswara Rao A, Reilly A, Sharma M, Shereck E, Wang M, Watt T, Leavey P. Humanism and professionalism education for pediatric hematology-oncology fellows: A model for pediatric subspecialty training. Pediatr Blood Cancer 2015; 62:335-340. [PMID: 25307425 DOI: 10.1002/pbc.25253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/08/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Humanism and professionalism are virtues intrinsic to the practice of medicine, for which we lack a standard, evidence-based approach for teaching and evaluation. Pediatric hematology-oncology (PHO) fellowship training brings new and significant stressors, making it an attractive setting for innovation in humanism and professionalism training. PROCEDURE We electronically surveyed a national sample of PHO fellows to identify fellows' educational needs in humanism and professionalism. Next, we developed a case-based, faculty-facilitated discussion curriculum to teach this content within pilot fellowship programs. We assessed whether fellowships would decide to offer the curriculum, feasibility of administering the curriculum, and satisfaction of fellow and faculty participants. RESULTS Surveys were completed by 187 fellows (35%). A minority (29%) reported that their training program offers a formal curriculum in humanism and/or professionalism. A majority desires more formal teaching on balancing clinical practice and research (85%), coping with death/dying (85%), bereavement (78%), balancing work and personal life (75%), navigating challenging relationships with patients (74%), and depression/burn out (71%). These six topics were condensed into four case-based modules, which proved feasible to deliver at all pilot sites. Ten fellowship programs agreed to administer the novel curriculum. The majority (90%) of responding fellows and faculty reported the sessions touched on issues important for training, stimulated reflective communication, and were valuable. CONCLUSIONS Pediatric hematology-oncology fellows identify numerous gaps in their training related to humanism and professionalism. This curriculum offers an opportunity to systematically address these educational needs and can serve as a model for wider implementation. Pediatr Blood Cancer 2015;62:335-340. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Mark Atlas
- Cohen's Children's Medical Center, New Hyde Park, NewYork
| | - Denise Adams
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Banu Aygun
- Cohen's Children's Medical Center, New Hyde Park, NewYork
| | | | | | | | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Leslie Kersun
- Children's Hospital of Philadephia, Philadelphia, Pennsylvania
| | | | - Anne Reilly
- Division of Pediatric Hematology-Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mukta Sharma
- Division of Pediatric Hematology-Oncology, Children's Mercy Hospital, Kansas City, Missouri
| | - Evan Shereck
- Doernbecker Children's Hospital, Oregon Health Sciences University, Portland, Oregon
| | | | - Tanya Watt
- University of Texas-Southwestern Children's Medical Center, Dallas, Texas
| | - Patrick Leavey
- University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Abstract
BACKGROUND Given decreasing resident duty hours, subspecialty hospitalist models have emerged to help compensate for the restructured presence of residents. We sought to examine the impact of our pediatric oncology hospitalist model on the oncology unit staff. PROCEDURE The survey was developed after a literature review of subspecialty hospitalist models. The final surveys were designed using a 5-point Likert scale. Descriptive statistics were used to compile baseline demographic characteristics of respondents and overall responses to survey questions. RESULTS Respondents agreed that house physicians provide better continuity of care (96.8%), are more comfortable with the experience level of the physician (98.4%), and are better able to answer questions (92%). Respondents also agreed that house physicians serve as backup for system-related and patient-related questions and found security knowing an experienced provider was on the floor (87.5%). Responses to open-ended questions indicated that the house physician model has impacted fellow education. CONCLUSIONS Our oncology house physician model helps account for decreased residency duty hours. This can serve as a model for other institutions requiring subspecialty inpatient coverage, given resident work hour restrictions. Adjustments in the clinical education of hematology/oncology fellows need to be considered in the setting of competent, consistent, and experienced front-line providers.
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Affiliation(s)
- Alicia Rapson
- *Division of Oncology, The Children's Hospital of Philadelphia †Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
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Luskin M, Wertheim G, Morrissette J, Daber R, Biegel J, Wilmoth D, Kersun L, King R, Paessler M, Simon C, Aplenc R, Loren A. CLL/SLL diagnosed in an adolescent. Pediatr Blood Cancer 2014; 61:1107-10. [PMID: 24281971 DOI: 10.1002/pbc.24884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/05/2013] [Indexed: 11/11/2022]
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a disease of older adults. Pediatric CLL/SLL is vanishingly rare in the literature. We present a case of CLL/SLL diagnosed in a 17-year-old male. The pathologic findings of this case were those of classic CLL/SLL with an ATM deletion, a characteristic genetic abnormality in CLL/SLL. Management guidelines for CLL/SLL are tailored to older adults making determination of the optimal therapy for this patient a unique challenge.
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Affiliation(s)
- Marlise Luskin
- Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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de Blank P, Cole K, Kersun L, Green A, Wilkes JJ, Belasco J, Bagatell R, Bailey LC, Fisher MJ. fdg-pet in two cases of neurofibromatosis type 1 and atypical malignancies. ACTA ACUST UNITED AC 2014; 21:e345-8. [PMID: 24764718 DOI: 10.3747/co.21.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/15/2022]
Abstract
Patients with neurofibromatosis type 1 (nf1) are at increased risk for both benign and malignant tumours, and distinguishing the malignant potential of an individual tumour is a common clinical problem in these patients. Here, we review two cases of uncommon malignancies (Hodgkin lymphoma and mediastinal germ-cell tumour) in patients with nf1. Although (18)F-fluorodeoxyglucose positron-emission tomography (fdg-pet) has been used to differentiate benign neurofibromas from malignant peripheral nerve sheath tumours, fdg-pet characteristics for more rare tumours have been poorly described in children with nf1. Here, we report the role of pet imaging in clinical decision-making in each case. In nf1, fdg-pet might be useful in the clinical management of unusual tumour presentations and might help to provide information about the malignant potential of uncommon tumours.
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Affiliation(s)
- P de Blank
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Rainbow Babies and Children's Hospital, Cleveland, OH, U.S.A
| | - K Cole
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L Kersun
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - A Green
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J J Wilkes
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - J Belasco
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - R Bagatell
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - L C Bailey
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M J Fisher
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, U.S.A. ; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A
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Kazak AE, Hocking MC, Ittenbach RF, Meadows AT, Hobbie W, DeRosa BW, Leahey A, Kersun L, Reilly A. A revision of the intensity of treatment rating scale: classifying the intensity of pediatric cancer treatment. Pediatr Blood Cancer 2012; 59:96-9. [PMID: 21858914 PMCID: PMC3223269 DOI: 10.1002/pbc.23320] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/27/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND We previously developed a reliable and valid method for classifying the intensity of pediatric cancer treatment. The Intensity of Treatment Rating Scale (ITR-2.0) 1 classifies treatments into four operationally defined levels of intensity and is completed by pediatric oncology specialists based on diagnosis, stage, and treatment data from the medical record. Experience with the ITR-2.0 and recent changes in treatment protocols indicated the need for a minor revision and revalidation. METHODS Five criterion raters reviewed the prior items, independently proposing additions and/or changes in the classification of diseases/treatments. Subsequent to a group discussion of the proposed changes, a revised 43-item ITR was evaluated. Pediatric oncologists (n = 47) completed a two-part online questionnaire. Validity of the classifications was determined by the oncologists classifying each disease/treatment into one of the four levels of intensity. Inter-rater reliability was calculated by having each oncologist classify the treatments of 12 sample patients using the new version which we call the ITR-3. RESULTS Agreement between median ratings of the 43 items for the pediatric oncologists and the criterion raters was high (r = 0.88). The median of the raters was either identical (81%) with the criterion ratings or discrepant by one level. Inter-rater reliability was very high when using the ITR-3 to classify 12 sample patients, with a median agreement of 0.90 and an intraclass correlation coefficient (r(ICC) = 0.86). CONCLUSIONS With these minor modifications and updates, the ITR-3 remains a reliable and valid method for classifying pediatric oncology treatment protocols.
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Affiliation(s)
- Anne E. Kazak
- Division of Oncology, The Children’s Hospital of Philadelphia,Department of Pediatrics, University of Pennsylvania School of Medicine
| | | | - Richard F. Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center,Department of Pediatrics, the University of Cincinnati College of Medicine
| | - Anna T. Meadows
- Division of Oncology, The Children’s Hospital of Philadelphia,Department of Pediatrics, University of Pennsylvania School of Medicine
| | - Wendy Hobbie
- Division of Oncology, The Children’s Hospital of Philadelphia,University of Pennsvlvania School of Nursing
| | | | - Ann Leahey
- Division of Oncology, The Children’s Hospital of Philadelphia
| | - Leslie Kersun
- Division of Oncology, The Children’s Hospital of Philadelphia,Department of Pediatrics, University of Pennsylvania School of Medicine
| | - Anne Reilly
- Division of Oncology, The Children’s Hospital of Philadelphia,Department of Pediatrics, University of Pennsylvania School of Medicine
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Kazak AE, Barakat LP, Hwang WT, Ditaranto S, Biros D, Beele D, Kersun L, Hocking MC, Reilly A. Association of psychosocial risk screening in pediatric cancer with psychosocial services provided. Psychooncology 2011; 20:715-23. [PMID: 21480432 DOI: 10.1002/pon.1972] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE How screening for psychosocial risk in pediatric oncology may relate to the number and type of psychosocial services provided is a critical step in linking screening with treatment. We predicted that screening at diagnosis would be associated with the delivery of more psychosocial services over 8 weeks and that these services would be consistent with Universal, Targeted, or Clinical psychosocial risk level based on the Pediatric Psychosocial Preventative Health Model (PPPHM). METHODS Parents of children newly diagnosed with cancer received either the Psychosocial Assessment Tool (PAT; n = 49) or psychosocial care as usual (PAU; n = 47), based on their date of diagnosis and an alternating monthly schedule. Medical record review and surveys completed by social workers and child life specialists were used to determine psychosocial services provided to patients and their families over the first eight weeks of treatment. RESULTS As predicted, families in the PAT condition received more services than those in PAU based on social worker and child life specialist report and medical record review. Within the PAT group, families at the Targeted and Clinical levels of risk received more intensive services than those at the Universal level. CONCLUSIONS This initial report shows how psychosocial risk screening may impact psychosocial care in pediatric cancer, supporting the importance of screening as well as matching services to risk level.
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Affiliation(s)
- Anne E Kazak
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Kersun L, Gyi L, Morrison WE. Training in difficult conversations: a national survey of pediatric hematology-oncology and pediatric critical care physicians. J Palliat Med 2009; 12:525-30. [PMID: 19508138 DOI: 10.1089/jpm.2008.0251] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In pediatric oncology and critical care, physicians give difficult news, including discussions regarding palliative care and comfort measures, but there are minimal data regarding fellowship program preparation for this task. PURPOSE We surveyed graduates of pediatric hematology/oncology and critical care fellowships regarding communication training to describe teaching methods, assess which were helpful, and determine whether comfort level is related to training experiences. METHODS A 12-question Web survey was sent to physicians completing fellowship in the previous 5 years. RESULTS Of 345 fellows identified, 171 (50%) responded. Prior training included observing senior physicians (100%), being observed (78%), reading (56%), lectures (46%), role-play (20%), workshops (16%), simulation (13%), and videos (13%). Observing senior physicians was thought most helpful. More years since training (p < 0.0005) and frequent difficult conversations (p = 0.009) were predictors of current comfort. Only workshops were associated with feeling better prepared at the end of training (p = 0.019). CONCLUSIONS Training may help physicians feel prepared for difficult conversations, but ongoing experience was strongly associated with comfort level.
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Affiliation(s)
- Leslie Kersun
- The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
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Maris JM, Yanik G, Messina J, Kersun L, Goldsby RE, Huberty J, Veatch J, Brophy P, Cheng SC, Hawkins RE, Matthay KK. A phase II study of 131I-MIBG for refractory neuroblastoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8504] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. M. Maris
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - G. Yanik
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - J. Messina
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - L. Kersun
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - R. E. Goldsby
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - J. Huberty
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - J. Veatch
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - P. Brophy
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - S. C. Cheng
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - R. E. Hawkins
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
| | - K. K. Matthay
- Children’s Hosp of Philadelphia, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Univ of CA, San Francisco, San Francisco, CA
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