A feasibility study of enhanced occupational therapy for children and young people with central nervous system tumours – outcomes for the families and for occupational therapy

A two-year feasibility study was conducted to explore harmonisation of occupation-focused practice between two UK children’s cancer centres. The Short Child Occupational Profile (SCOPE) identified occupational needs of children with brain tumours to inform goal-setting, treatment-planning and intervention. A professional decision-making log was developed to focus reflection and to enhance communication of clinical decisions. The impact of a range of personal and environmental factors on participation beyond performance components was considered, enabling the occupational therapists to incorporate the child’s strengths to overcome daily occupational challenges. Twenty-four children aged 3-14 years with central nervous system tumours received enhanced occupational therapy for six months which families perceived as being helpful in rehabilitating children to participate in life and equipping them with better coping strategies for the future. Individual occupational needs of children were highlighted using the SCOPE which helped to standardise practice. Using the SCOPE harmonised occupational therapists’ unique focus on occupation in their practice with patients with brain tumours. This both evidenced intervention outcomes and strengthened professional identity. The outcome was robust preparation for a multi-centre intervention study. Keywords Occupational therapy, children, brain tumour, harmonised practice, SCOP

Methyl-donor depletion of head and neck cancer cells in vitro establishes a less aggressive tumour cell phenotype

PURPOSE: DNA methylation plays a fundamental role in the epigenetic control of carcinogenesis and is, in part, influenced by the availability of methyl donors obtained from the diet. In this study, we developed an in-vitro model to investigate whether methyl donor depletion affects the phenotype and gene expression in head and neck squamous cell carcinoma (HNSCC) cells. METHODS: HNSCC cell lines (UD-SCC2 and UPCI-SCC72) were cultured in medium deficient in methionine, folate, and choline or methyl donor complete medium. Cell doubling-time, proliferation, migration, and apoptosis were analysed. The effects of methyl donor depletion on enzymes controlling DNA methylation and the pro-apoptotic factors death-associated protein kinase-1 (DAPK1) and p53 upregulated modulator of apoptosis (PUMA) were examined by quantitative-PCR or immunoblotting. RESULTS: HNSCC cells cultured in methyl donor deplete conditions showed significantly increased cell doubling times, reduced cell proliferation, impaired cell migration, and a dose-dependent increase in apoptosis when compared to cells cultured in complete medium. Methyl donor depletion significantly increased the gene expression of DNMT3a and TET-1, an effect that was reversed upon methyl donor repletion in UD-SCC2 cells. In addition, expression of DAPK1 and PUMA was increased in UD-SCC2 cells cultured in methyl donor deplete compared to complete medium, possibly explaining the observed increase in apoptosis in these cells. CONCLUSION: Taken together, these data show that depleting HNSCC cells of methyl donors reduces the growth and mobility of HNSCC cells, while increasing rates of apoptosis, suggesting that a methyl donor depleted diet may significantly affect the growth of established HNSCC