Pediatric hematology and oncology
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Pediatr Hematol Oncol · Jan 2005
Sibling self-report, parental proxies, and quality of life: the importance of multiple informants for siblings of a critically ill child.
Assessment of quality of life (QoL) has thus far been a neglected approach in describing psychological adaptation in siblings of seriously ill children. The present results concern differences and correspondences between parent- and child-reported QoL in siblings of pediatric cancer patients, at 1 month and 2 years after the diagnosis in the ill child. A total of 83 Siblings aged 7-18 participated in the study at 1 month after the diagnosis; 57 of these siblings (69%) participated in follow-up assessment 24 months later. ⋯ Physical complaints and emotional problems remain mostly unnoticed, although distressed parents are more focused on the child's physical health. These results imply that assessment of self-reported well-being is especially relevant in siblings of a critically ill child, to obtain a realistic image of siblings' QoL. Further studies on sibling QoL are needed.
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Pediatr Hematol Oncol · Oct 2004
"Do not resuscitate" orders among children with solid tumors at the end of life.
The goal of this study was to evaluate the frequency and timing of "do not resuscitate" (DNR) orders among pediatric oncology patients with progressive solid tumors. A retrospective evaluation of the medical charts of 36 patients who died in our department over the last 4 years was made. There were 21 males and 15 females with a mean age of 10 years (range, 1-22 years). ⋯ Place of death was home for 5 (14%) patients, 3 of whom had DNR orders; pediatric oncology ward for 28 (78%), 19 of whom had DNR orders); ICU for 3 (8%), none with a DNR order. Mean time from last day of anticancer treatment until death was 63 days in the group with DNR orders and 56.5 days in the group without DNR orders (p = NS). The study showed that (1) DNR orders were written in only about half the charts of patients with progressive cancer; (2) in several cases, DNR orders were given close to death; and (3) advanced discussion of DNR with parents is needed to reduce parental and medical staff stress accompanying the death of a child and optimizing management of the terminal phase of the disease.
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Pediatr Hematol Oncol · Apr 2004
Comparative Study Clinical TrialSingle-dose oral granisetron versus multidose intravenous ondansetron for moderately emetogenic cyclophosphamide-based chemotherapy in pediatric outpatients with acute lymphoblastic leukemia.
This prospective study was designed to compare the efficacy of ondansetron with granisetron in terms of complete emesis control and time spent in an ambulatory care setting in children with acute lymphoblastic leukemia (ALL) undergoing moderately emetogenic cyclophosphamide-based chemotherapy. The costs for both treatments are also examined. A total of 33 children (mean age: 7.8 +/- 4.9 year) were studied during 66 chemotherapy cycles. ⋯ Boys experienced greater rates of vomiting than did girls despite antiemetic treatment; however, no apparent reason for the gender discrepancy was noted. Both antiemetic regimens have similar antiemetic efficacy for treating the moderately emetogenic effects associated with cyclophosphamide-based chemotherapy. It is possible that the granisetron regimen may be preferable because it is simpler to administer and more cost-effective.
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Pediatr Hematol Oncol · Mar 2004
Clinical TrialInter- and intraindividual variability in ketamine dosage in repetitive invasive procedures in children with malignancies.
Midazolam/ketamine sedation has been used successfully in children undergoing painful invasive procedures. The authors prospectively assessed inter- and intra-individual variability in ketamine dosage for sedation in repetitive invasive procedures in children with malignancies. A total of 92 invasive procedures (58 lumbar punctures, 34 bone marrow biopsies; range: 2-9 procedures/patient) were performed on 25 children (median age: 12 years). ⋯ In 12% of procedures side effects were seen, which required no or only minor interventions. Due to great inter- and intraindividual differences, ketamine dosage should be titrated toward the desired level of sedation. Thus, ketamine can be adjusted to the individual's need while achieving adequate sedation.
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Pediatr Hematol Oncol · Mar 2004
Comparative Study Clinical Trial Controlled Clinical TrialMeropenem plus amikacin versus piperacillin-tazobactam plus netilmicin as empiric therapy for high-risk febrile neutropenia in children.
The aim of this study was to evaluate the efficacy and safety of meropenem plus amikacin compared with piperacillin-tazobactam plus netilmicin for initial empirical antibiotic treatment of high-risk febrile neutropenia in children with cancer. Patients with hematologic malignancy (leukemia or stage III/IV non-Hodgkin lymphoma) who presented with fever and neutropenia (ANC < 500/mm3) and patients with solid tumors who presented with fever and severe neutropenia (ANC < 100/mm3) were considered to be at high risk and eligible for this study. In this prospective study, 33 patients with 50 febrile neutropenic episodes received i.v. neropenem (20 mg/kg every 8 h) plus amikacin (15 mg/kg/d in 2 divided doses) (in 31 episodes) or piperacillin/tazobactam (100 mg/4 mg/kg every 8 h) plus netilmicin (7 mg/kg every 24 h) (in 19 episodes). ⋯ Three patients died due to infection (1 vs. 2 patients). No major adverse effects were observed in each group. Empirical therapy with meropenem plus amikacin or piperacillin/tazobactam plus netilmicin for high-risk febrile neutropenia is equally effective and safe in pediatric cancer patients.