ABSTRACT
PURPOSE: Children with cancer require specific therapeutic guidance. Parents prefer physical therapy close to home, while pediatric physical therapists (PPTs) working in the community may lack specific knowledge. The aim of this study is to determine the needs of parents of children with cancer and PPTs to inform the design and development of a care network, named "KinderOncoNet." METHODS: We explored the perspectives and needs of parents of children with cancer and PPTs in the community, and we investigated the added value that KinderOncoNet could offer. We used an iterative process; data collection consisted of (1) gathering information from parents of children with cancer and PPTs through a survey and (2) co-creation sessions with stakeholders. RESULTS: In total, 98 parents and 177 PPTs participated in the survey. Parents (97%) and PPTs (93%) indicated that the care network would bring added value. All but one parent stressed the importance of a local PPT being aware of both the condition and the side and late effects of oncological treatment. Moreover, 40% of PPTs thought they do not have sufficient knowledge to provide high-quality therapy and that they would embrace opportunities for education. Through the co-creation sessions, a prototype of the care network was conceptualized. CONCLUSION: KinderOncoNet can contribute to the continuity and quality of physiotherapy care for children with cancer during and after the oncological treatment. Such a network would allow for sharing knowledge, developing skills, and improving accessibility and communication in the Netherlands.
Subject(s)
Neoplasms , Physical Therapists , Humans , Child , Neoplasms/therapy , Medical Oncology , Data Collection , ParentsABSTRACT
Background: Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct). Methods: For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. Results: In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): -0.52; 95% confidence interval (ci): -0.89 to -0.14] and with methylphenidate (smd: -0.36; 95% ci: -0.56 to -0.15); modafinil (or armodafinil) and corticosteroids were not effective. Conclusions: Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
Subject(s)
Fatigue/drug therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms/complications , Central Nervous System Stimulants/therapeutic use , Erythropoietin/therapeutic use , Fatigue/etiology , Humans , Methylphenidate/therapeutic use , Severity of Illness IndexSubject(s)
Dermatomyositis/therapy , Stem Cell Transplantation , Adolescent , Chemokine CXCL10/immunology , Child , Cytokines/immunology , Dermatomyositis/immunology , Female , Galectins/immunology , Humans , Inflammation/immunology , Receptors, Tumor Necrosis Factor, Type II/immunology , Severity of Illness Index , Transplantation, Autologous , Treatment OutcomeABSTRACT
Juvenile dermatomyositis (JDM) is a chronic inflammatory disorder of unknown aetiology that affects muscle and skin. We report on two patients with severe progressive JDM who developed contractures and were wheelchair dependent despite therapy including methotrexate (MTX), steroids, immunoglobulins, cyclosporin A, and rituximab. On account of the refractory disease, autologous stem cell transplantation (ASCT) was performed using a CD3/CD19-depleted graft after immunoablative conditioning with fludarabine, cyclophosphamide, and anti-thymocyte globulin. This induced a dramatic improvement and sustained remission of the disease in both patients. We demonstrate that ASCT is a therapeutic option with low toxicity for patients with severe, refractory JDM.
Subject(s)
Dermatomyositis/surgery , Hematopoietic Stem Cell Transplantation/methods , Transplantation Conditioning/methods , Child , Dermatomyositis/diagnosis , Female , Follow-Up Studies , Graft Survival , Humans , Magnetic Resonance Imaging , Pain Measurement , Risk Assessment , Severity of Illness Index , Time Factors , Transplantation, Autologous , Treatment OutcomeABSTRACT
Occasionally breast cancer is accidentally discovered in specimens from patients undergoing reduction mammoplasty. We present the cases of two patients, both over 50 years of age. Because a reduction mammoplasty distorts the architecture of the breast, the post-operative discovering of a carcinoma renders mastectomy the only treatment option possible. We recommend the use of a pre-operative mammography for all women over 50 years of age who are scheduled for a breast reduction.
