Nutritional status and nutritional therapy in pediatric and adolescent patients submitted to autologous hematopoietic stem cell transplantation

Introduction: To assess the use of nutritional support in children and adolescents submitted to autologous hematopoietic stem cell transplantation (HSCT), and analyze changes in nutritional status at hospital discharge after HSCT. Methods: A retrospective observational study was conducted on pediatric oncology patients hospitalized for autologous HSCT between 2010 and 2017. Nutritional therapy was evaluated based on the duration of enteral tube feeding (ETF) and parenteral nutrition (PN), either alone or in combination. The length of hospital stay was measured in days. Nutritional status was assessed at admission and discharge, and classified according to World Health Organization criteria. Results: The sample consisted of 68 patients, 54.4% of whom were boys. Most participants (89.7%) had solid tumors. Nutritional therapy was required in over half (52.9%) of cases, with PN being the most common indication. There was a reduction in the percentage of overweight patients and an increase in the percentage of underweight patients at discharge relative to admission. Conclusions: The use of nutritional therapy is highly prevalent in this population, and HSCT has a negative impact on nutritional status at discharge

Writing a research protocol in pediatric oncology

Children are considered an especially vulnerable population in a clinical trial. Specific regulations of research in pediatrics are focused upon protection from potential risks. Clinical trials in oncology have become an important step to the researchers to discover new drugs, new combinations of known drugs and new methodologies. The aim of this manuscript is to help the starter researchers to elaborate pediatrics oncology protocols for clinical trials. This guide describes the relevant aspects before writing a research protocol and a template of research protocol. Moreover, it shows the importance of a well-designed research protocol and its attachments - informed consent and assent forms – in a pediatric oncology study

Descrição do Tempo de Jejum Pré-Procedimentos em um Serviço de Oncologia Pediátrica

Introduction: Shortening the duration of preoperative fasting is one of the current nutritional cares related to surgical patients. The metabolic response to surgical trauma may be enhanced by fasting. The description of the actual time of pre-procedure fasting allows us to review old paradigms. Therefore, the aim of this study was to describe the practices in relation to the pre-procedure fasting time in a Pediatric Oncology Unit. Methods: Retrospective descriptive study, consultation of medical records, including patients aged between zero and 18 years who were admitted to the Pediatric Oncology Unit, diagnosed with cancer, who started fasting for tests or elective surgical procedures between July and September of 2014. Results: A total of 30 patients, 57% female, with an average age of 9 years (± 5 years) were included. The most common diagnoses were leukemia (40%), lymphoma (13%) and osteosarcoma (13%) and neuroblastoma (13%). The most common procedures performed were: placement of totally implantable catheter, bone marrow biopsy and intrathecal chemotherapy. All patients had a preprocedure fasting time greater than or equal to 6 hours; 66% of these patients fasted for 10h or more hours, and 23% had to fast for 12 hours or more. Conclusion: No patient had their pre-procedure fasting according to current guidelines. Our expectation is that abbreviation of preoperative fasting be considered and that it reduce physical symptoms and metabolic changes

Avaliação do transtorno de estresse pós-traumático em sobreviventes de câncer infantil

Objetivo: avaliar sintomas de transtorno de estresse pós-traumático (TEPT) em sobreviventes de câncer infantil. Método: Participaram 65 sobreviventes que responderam a uma ficha de dados sociodemográficos e clínicos, Escala de Rastreio de Sintomas de Stress Pós-Traumático (SPTSS-17) e PTSD Checklist - Civilian Version (PCL-C). Resultados: A presença de sintomas de TEPT variou entre 9,2% e 18,5% nessa amostra. Com relação à sintomatologia, 41% apresentaram sintomas aumentados de revivência, 16,9% de evitação e 35,4% de excitabilidade aumentada. Não foram encontradas correlações significativas nos índices de TEPT e características sociodemográficas e clínicas da amostra. Conclusão: Os prejuízos dos sintomas de TEPT e a própria experiência traumática do câncer repercutem negativamente na vida do sobrevivente em longo prazo e podem não ser avaliados adequadamente pelos profissionais da saúde.Purpose: evaluate symptoms of post-traumatic stress disorder (PTSD) in childhood cancer survivors. Method: 65 survivors who answered to a clinical and sociodemographic questionnaire. PTSD symptoms screening scale (PTSDS-17) and PTSD checklist- Civilian version (PCL-C). Results: within the sample, PTSD symptoms presence varied between 9,2% and 18,5%. Referred to symptomatology, 41% showed symptoms of revival, 16,9% of avoidance and 35,4% of increased excitability. The PTSD, sociodemographic and clinical indexes of the sample showed no significant correlations. Conclusion: Cancer traumatic experience and PTSD symptoms harms will be of negative repercussion on survivors life in the long run and may not be adequately evaluated by health professionals

Subjective global nutritional assessment : applicability in children and adolescents with malignant tumors

Introduction: This study investigated the applicability of the Subjective Global Nutritional Assessment (SGNA) tool to evaluate the nutritional status of pediatric cancer patients. Methods: This was a multicenter, observational cohort study of infants, children, and adolescents diagnosed with malignant tumors. Participants were evaluated at the moment they were diagnosed with a malignant tumor (EV1) and at the third month of treatment (EV2). Objective data were collected and the SGNA questionnaire was applied. Correlation between the methods was performed using the Kendall test. Results: We evaluated 216 patients at EV1 and 172 patients at EV2. During EV1, 7% of patients presented with some degree of malnutrition, according to objective measures, and 35.7% according to the SGNA. During EV2, they presented 6.4% and 26.8%, respectively. The SGNA showed ability to diagnose more malnutrition than objective indicators and the agreement found between both methods was moderate and weak. We observed a significant correlation between the SGNA and the nutritional indicators (p = <0.002), thus proving its efficacy in assessing nutritional status. Conclusion: The SGNA was applicable for evaluating the nutritional status of children and adolescents diagnosed with malignant tumors, and effective in tracking malnutrition prevalence when compared to objective nutritional assessment methods

Subjective Global Nutritional Assessment: Applicability in children and adolescents with malignant tumors

Introduction: This study investigated the applicability of the Subjective Global NutritionalAssessment (SGNA) tool to evaluate the nutritional status of pediatric cancer patients.Methods: This was a multicenter, observational cohort study of infants, children,and adolescents diagnosed with malignant tumors. Participants were evaluated at themoment they were diagnosed with a malignant tumor (EV1) and at the third monthof treatment (EV2). Objective data were collected and the SGNA questionnaire wasapplied. Correlation between the methods was performed using the Kendall test.Results: We evaluated 216 patients at EV1 and 172 patients at EV2. During EV1,7% of patients presented with some degree of malnutrition, according to objectivemeasures, and 35.7% according to the SGNA. During EV2, they presented 6.4% and26.8%, respectively. The SGNA showed ability to diagnose more malnutrition thanobjective indicators and the agreement found between both methods was moderateand weak. We observed a significant correlation between the SGNA and the nutritionalindicators (p = &lt;0.002), thus proving its efficacy in assessing nutritional status.Conclusion: The SGNA was applicable for evaluating the nutritional status of childrenand adolescents diagnosed with malignant tumors, and effective in tracking malnutritionprevalence when compared to objective nutritional assessment methods

Posttraumatic Stress Disorder and Illness Perception in Young Survivors of Childhood Cancer

Objetivo: Este estudo teve como objetivo avaliar a presença de Transtorno de Estresse Pós-Traumático (TEPT) e a sua relação com a perceção da doença numa amostra de 65 jovens sobreviventes de cancro infantil, com uma média de idades de 19 anos (DP = 2,70) e que tinham terminado o tratamento, em média, há sete anos. Método: Foram aplicados instrumentos para obtenção de dados sociodemográficos e clínicos, de sintomas de TEPT – “Posttraumatic Stress Disorder Checklist – Civilian” (PCL-C) e de perceção da doença – “Revised Illness Perception Questionnaire for Healthy People” (IPQ-RH). Resultados: A presença de sintomas de TEPT variade 9,2% a 18,5% na amostra, e a perceção da doença esteve correlacionada com os sintomas deste transtorno. As subescalas Representação Emocional e Coerência da Doença (IPQ-RH), foram preditoras dos sintomas de Reexperiência (β = 0,0370; p < 0,01; β = 0,261; p < 0,05, respetivamente). A subescala Representação Emocional (IPQ-RH) também foi preditora de sintomas de Esquiva (β = 0,330; p < 0,001). Conclusão: Concluiu-se que a perceção da doença deve ser investigada para prevenir os sintomas de TEPT em sobreviventes de câncer infantil.Aim: This study assessed the presence of posttraumatic stress disorder (PTSD) symptoms and their relation to illness perception in a sample of 65 young survivors of childhood cancer, mean age of 19 years (SD = 2.70) and who had completed treatment, on average, seven years ago.  Method: The instruments used were: sociodemographic and clinical form, PTSD - Posttraumatic Stress Disorder Checklist – Civilian (PCL-C) and Illness Perception questionnaire - Revised Illness Perception Questionnaire for Healthy People (IPQ-RH). Results: The presence of PTSD symptoms ranged between 9.2% and 18.5% in this sample, and illness perception was correlated with the symptoms of this disorder. Emotional representations and Coherence (IPQ-RH) were predictive of Re-experience symptoms (ß = .0370, p < .01; ß = .261, p < .05, respectively). Emotional Representation subscale (IPQ-RH) was also predictive of Avoidance symptoms (ß = .330, p < .001). Conclusion: It was concluded that illness perception should be examined to prevent PTSD symptoms in childhood cancer survivors

Clinical and pharmacokinetic study of fractionated doses of oral etoposide in pediatric patients with advanced malignancies

The purpose of this phase I study was to evaluate the toxicity profile, dose-limiting toxicities (DLT), maximum tolerated dose (MTD), and plasma pharmacokinetics of oral etoposide, and to recommend a safe fractionated dose for phase II trials in pediatric patients with refractory solid tumors. Material/Methods: All patients had tumors no longer amenable to established forms of treatment. The initial dose of etoposide was 20 mg/m2 TID for 14 days every 21 days (dose-level I). Etoposide plasma pharmacokinetics were studied on day 1 of treatment and determined by HPLC. Results: Seventeen children were enrolled, 13 of whom were included in the pharmacokinetic study, for a total of 64 courses. Nine patients were included at dose-level I; grade 2–3 leucopenia was observed in 5. The dose was then raised to 25 mg/m2 (dose-level II) in another 8 patients; grade 3–4 leucopenia was observed in 4. This dose-level was therefore considered the MTD. The DLT was neutropenia. In patients at dose-level I and II the maximum plasma etoposide concentration was 2.97 and 8.59 μg/ml, respectively. Drug levels > 1 μg/ml were maintained for about 6.3 hours following drug administration at both dose-levels. Partial response was observed in 1 patient and 4 patients showed stable disease. Conclusions: Prolonged oral etoposide was well tolerated by our patients. Considering the MTD, and the fact that the patients included at dose-level I achieved an adequate (>1 μg/ml) plasma concentration of etoposide for a sufficient time, this dose level was recommended for phase II studies in pediatric malignancies. This work was performed at the Pediatric Oncology Service, Hospital de Clínicas de Porto Alegre; the Pediatric Hematology-Oncology Service, Hospital da Crianca Conceicao; and at the South American Office for Anticancer Drug Development (SOAD), Porto Alegre, Brazil