Evaluation of Treatment-Related Mortality Among Paediatric Cancer Deaths: a population based analysis.

BACKGROUND: Objectives were to describe the proportion of deaths due to treatment-related mortality (TRM) and to identify risk factors and probable causes of TRM among paediatric cancer deaths in a population-based cohort. METHODS: We included children with cancer ⩽18 years diagnosed and treated in Ontario who died between January 2003 and December 2012. Deaths were identified using a provincial registry, the Pediatric Oncology Group of Ontario Networked Information System. Probable causes of TRM were described. RESULTS: Among the 964 deaths identified, 821 were included. The median age at diagnosis was 6.6 years (range 0-18.8) and 51.8% had at least one relapse. Of the deaths examined, TRM occurred in 217/821 (26.4%) while 604/821 (73.6%) were due to progressive cancer. Deaths from TRM did not change over time. Using multiple regression, younger age, leukaemia diagnosis and absence of relapse were independently positively associated with TRM. The most common probable causes of TRM were respiratory, infection and haemorrhage. CONCLUSIONS: TRM was responsible for 26.4% of deaths in paediatric cancer. Underlying diagnosis, younger age and absence of relapse were associated with TRM and causes of TRM differed by diagnosis group. Future work should evaluate TRM rate and risk factors among newly diagnosed cancer patients

Exploring Prevalence and Management of Anxiety in Children and Adolescents with Cancer or Undergoing Hematopoietic Stem Cell Transplantation

Cure rates for childhood cancer are on the rise, and with these improvements, focus has expanded from treatment of disease to improvement of health-related quality of life (HRQoL) for children and adolescents with cancer. Anxiety is one symptom that can be a normal response for children and adolescents diagnosed with cancer, but if prolonged or leading to excessive distress, anxiety can negatively impact an individual’s psychosocial well-being. As focus shifts towards improvement of quality of life (QoL), researchers and clinicians require a better understanding of how anxiety is experienced and managed in this population. The overall objectives of this dissertation were to identify and describe instruments for measurement of anxiety in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation (HSCT), to estimate the burden of anxiety and to describe guideline recommendations for assessing and managing anxiety in this population. The three papers comprising this dissertation established several key findings, including: (1) identification of 4 instruments (3 multi-item, 1 single-item) for assessing anxiety that are reliable and valid among paediatric cancer or HSCT patients and thus may be used for measurement of anxiety in this population; (2) between 13.0% and 28.6% of children and adolescents meet or exceed thresholds for severe anxiety depending on the anxiety measurement instrument used, and thus careful consideration should be given to the instrument selected for measurement to ensure it accurately measures the anxiety construct of interest; and (3) guidelines used by clinicians to manage cancer provide little to no guidance on assessing or managing anxiety in this population. Overall, given the inconsistency in measurement of anxiety by available instruments, along with a lack of guidelines, further research is needed to develop and implement instruments and processes that address anxiety in this population, which may improve HRQoL. This research has also established the groundwork for a program of research focused on standardized screening and intervention practices, implementation of said practices and evaluation of intervention effectiveness for anxiety in children with cancer and children who have undergone HSCT.Ph.D

Instruments to measure anxiety in children, adolescents, and young adults with cancer: a systematic review

Purpose: The primary objective was to describe anxiety measurement instruments used in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation (HSCT) and summarize their content and psychometric properties.Methods: We conducted searches of MEDLINE, Embase, PsycINFO, HAPI, and CINAHL. We included studies that used at least one instrument to measure anxiety quantitatively in children or adolescents with cancer or undergoing HSCT. Two authors independently identified studies and abstracted study demographics and instrument characteristics.Results: Twenty-seven instruments, 14 multi-item and 13 single-item, were used between 78 studies. The most commonly used instrument was the State-Trait Anxiety Inventory in 46 studies. Three multi-item instruments (Children's Manifest Anxiety Scale-Mandarin version, PROMIS Pediatric Anxiety Short Form, and the State-Trait Anxiety Inventory) and two single-item instruments (Faces Pain Scale-Revised and 10-cm Visual Analogue Scale, both adapted for anxiety) were found to be reliable and valid in children with cancer.Conclusions: We identified 14 different multi-item and 13 different single-item anxiety measurement instruments that have been used in pediatric cancer or HSCT. Only three multi-item and two single-item instruments were identified as being reliable and valid among pediatric cancer or HSCT patients and would therefore be appropriate to measure anxiety in this population

Severity, change over time, and risk factors of anxiety in children with cancer depend on anxiety instrument used

Objective The primary objective was to describe severity of anxiety among children and adolescents receiving chemotherapy for cancer or undergoing hematopoietic stem cell transplantation (HSCT). Secondary objectives were to describe how anxiety changes over time and determine factors associated with anxiety. Methods Participants were aged 8 to 18 and either receiving chemotherapy for cancer or undergoing HSCT for any indication. Respondents self-reported three anxiety measurement instruments at chemotherapy cycle or HSCT conditioning start and 3 weeks later. Results The proportion of participants with severe anxiety ranged from 10/77 (13.0%) to 22/77 (28.6%) depending on instrument used. Change over time also varied across instruments, with significant improvement observed with PedsQL (procedural) (P = 0.037) and PROMIS (P = 0.013). Factors associated with anxiety similarly varied by instrument. Older age was associated with more anxiety on the PedsQL (worry) (P = 0.036), and higher household income was associated with less anxiety on the MASC-10 (P = 0.028). Conclusions While we found that a small proportion of patients met or exceeded thresholds for severe anxiety, we also noted that severity, change over time, and predictors of anxiety varied depending on instrument used. Future research should ensure that selected instruments measure the construct of interest and describe how anxiety is conceptualized in the study