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Association between corticosteroids and infection, sepsis, and infectious death in pediatric acute myeloid leukemia (AML): results from the Canadian infections in AML research group.

https://arctichealth.org/en/permalink/ahliterature120927
Source
Clin Infect Dis. 2012 Dec;55(12):1608-14
Publication Type
Article
Date
Dec-2012
Author
David Dix
Sonia Cellot
Victoria Price
Biljana Gillmeister
Marie-Chantal Ethier
Donna L Johnston
Victor Lewis
Bruno Michon
David Mitchell
Kent Stobart
Rochelle Yanofsky
Carol Portwine
Mariana Silva
Lynette Bowes
Shayna Zelcer
Josée Brossard
Jeffrey Traubici
Upton Allen
Joseph Beyene
Lillian Sung
Author Affiliation
Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada.
Source
Clin Infect Dis. 2012 Dec;55(12):1608-14
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenal Cortex Hormones - adverse effects - therapeutic use
Bacteremia - complications - epidemiology
Bacterial Infections - complications - epidemiology
Canada - epidemiology
Child
Child, Preschool
Female
Graft vs Host Disease - drug therapy - prevention & control
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute - epidemiology - microbiology - surgery - therapy
Male
Regression Analysis
Retrospective Studies
Abstract
Infection continues to be a major problem for children with acute myeloid leukemia (AML). Objectives were to identify factors associated with infection, sepsis, and infectious deaths in children with newly diagnosed AML.
We conducted a retrospective, population-based cohort study that included children = 18 years of age with de novo, non-M3 AML diagnosed between January 1995 and December 2004, treated at 15 Canadian centers. Patients were monitored for infection from initiation of AML treatment until recovery from the last cycle of chemotherapy, conditioning for hematopoietic stem cell transplantation, relapse, persistent disease, or death (whichever occurred first). Consistent trained research associates abstracted all information from each site.
341 patients were included. Median age was 7.1 years (interquartile range [IQR], 2.0-13.5) and 29 (8.5%) had Down syndrome. In sum, 26 (7.6%) experienced death as a first event. There were 1277 courses of chemotherapy administered in which sterile site microbiologically documented infection occurred in 313 courses (24.5%). Sepsis and infectious death occurred in 97 (7.6%) and 16 (1.3%) courses, respectively. The median days of corticosteroid administration was 2 per course (IQR, 0-6). In multiple regression analysis, duration of corticosteroid exposure was significantly associated with more microbiologically documented sterile site infection, bacteremia, fungal infection, and sepsis. The only factor significantly associated with infectious death was days of corticosteroid exposure (odds ratio, 1.05; 95% confidence interval, 1.02-1.08; P = .001).
In pediatric AML, infection, sepsis, and infectious death were associated with duration of corticosteroid exposure. Corticosteroids should be avoided when possible for this population.
PubMed ID
22955431 View in PubMed
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Caregiving demands in parents of children with cancer: psychometric validation of the Care of My Child with Cancer questionnaire.

https://arctichealth.org/en/permalink/ahliterature142255
Source
J Pediatr Nurs. 2010 Aug;25(4):258-63
Publication Type
Article
Date
Aug-2010
Author
Anne Klassen
Robert J Klaassen
David Dix
Sheila Pritchard
Rochelle Yanofsky
Lillian Sung
Author Affiliation
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. aklass@mcmaster.ca
Source
J Pediatr Nurs. 2010 Aug;25(4):258-63
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude to Health
Canada
Child
Cost of Illness
Factor Analysis, Statistical
Female
Humans
Male
Middle Aged
Needs Assessment - organization & administration
Neoplasms - nursing
Nursing Assessment - organization & administration
Nursing Evaluation Research
Parents - psychology
Psychometrics
Quality of Life
Questionnaires - standards
Time Factors
Abstract
A comprehensive evaluation of the psychometric properties of Care of My Child With Cancer (CMCC) was performed in a sample of 411 parents of children undergoing treatment of cancer at five Canadian pediatric oncology centers. Psychometric tests used to assess data quality, targeting, reliability, and construct validity demonstrated that the CMCC is a scientific sound measure. The CMCC will be helpful for assessing increasing parental responsibility for caregiving tasks associated with cancer care.
PubMed ID
20620806 View in PubMed
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Clinical and genetic analysis of unclassifiable inherited bone marrow failure syndromes.

https://arctichealth.org/en/permalink/ahliterature156346
Source
Pediatrics. 2008 Jul;122(1):e139-48
Publication Type
Article
Date
Jul-2008
Author
Juliana T Teo
Robert Klaassen
Conrad V Fernandez
Rochelle Yanofsky
John Wu
Josette Champagne
Mariana Silva
Jeffrey H Lipton
Jossee Brossard
Yvan Samson
Sharon Abish
Macgregor Steele
Kaiser Ali
Uma Athale
Lawrence Jardine
John P Hand
Elena Tsangaris
Isaac Odame
Joseph Beyene
Yigal Dror
Author Affiliation
Marrow Failure and Myelodysplasia Program, Division of Haematology, Research Institute, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
Source
Pediatrics. 2008 Jul;122(1):e139-48
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Anemia, Aplastic - epidemiology
Bone Marrow Diseases - classification - epidemiology - genetics
Canada - epidemiology
Cytogenetic Analysis
Female
Hematologic Diseases
Humans
Infant
Male
Neural Tube Defects - epidemiology
Neutropenia - epidemiology
Pancytopenia - epidemiology
Phenotype
Registries
Syndrome
Thrombocytopenia - epidemiology
Abstract
Unclassified inherited bone marrow failure syndromes are a heterogeneous group of genetic disorders that represent either new syndromes or atypical clinical courses of known inherited bone marrow failure syndromes. The relative prevalence of the unclassified inherited bone marrow failure syndromes and their characteristics and the clinical and economic challenges that they create have never been studied.
We analyzed cases of inherited bone marrow failure syndrome in the Canadian Inherited Marrow Failure Registry that were deemed unclassifiable at study entry.
From October 2001 to March 2006, 39 of the 162 patients enrolled in the Canadian Inherited Marrow Failure Registry were registered as having unclassified inherited bone marrow failure syndromes. These patients presented at a significantly older age (median: 9 months) than the patients with classified inherited bone marrow failure syndrome (median: 1 month) and had substantial variation in the clinical presentations. The hematologic phenotype, however, was similar to the classified inherited bone marrow failure syndromes and included single- or multiple-lineage cytopenia, severe aplastic anemia, myelodysplasia, and malignancy. Grouping patients according to the affected blood cell lineage(s) and to the presence of associated physical malformations was not always sufficient to characterize a condition, because affected members from several families fit into different phenotypic groups. Compared with the classified inherited bone marrow failure syndromes, the patients with unclassified inherited bone marrow failure syndromes had 3.2 more specific diagnostic tests at 4.5 times higher cost per evaluated patient to attempt to categorize their syndrome. At last follow-up, only 20% of the unclassified inherited bone marrow failure syndromes were ultimately diagnosed with a specific syndrome on the basis of the development of new clinical findings or positive genetic tests.
Unclassified inherited bone marrow failure syndromes are relatively common among the inherited bone marrow failure syndromes and present a major diagnostic and therapeutic dilemma.
PubMed ID
18595958 View in PubMed
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Clostridium difficile infection in pediatric acute myeloid leukemia: from the Canadian Infections in Acute Myeloid Leukemia Research Group.

https://arctichealth.org/en/permalink/ahliterature108811
Source
Pediatr Infect Dis J. 2013 Jun;32(6):610-3
Publication Type
Article
Date
Jun-2013
Author
Victoria Price
Carol Portwine
Shayna Zelcer
Marie-Chantal Ethier
Biljana Gillmeister
Mariana Silva
Christina Schindera
Rochelle Yanofsky
David Mitchell
Donna L Johnston
Victor Lewis
David Dix
Sonia Cellot
Bruno Michon
Lynette Bowes
Kent Stobart
Josee Brossard
Joseph Beyene
Lillian Sung
Author Affiliation
Pediatrics, IWK Health Centre, Canada.
Source
Pediatr Infect Dis J. 2013 Jun;32(6):610-3
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Canada - epidemiology
Child
Child, Preschool
Clostridium Infections - epidemiology - microbiology - mortality - pathology
Clostridium difficile - isolation & purification
Cohort Studies
Female
Humans
Immunocompromised Host
Incidence
Leukemia, Myeloid, Acute - complications
Male
Prevalence
Recurrence
Retrospective Studies
Risk factors
Sepsis - epidemiology - microbiology - mortality - pathology
Survival Analysis
Abstract
The prevalence and severity of Clostridium difficile infection (CDI) has increased over time in adult patients, but little is known about CDI in pediatric cancer. The primary objectives were to describe the incidence and characteristics of CDI in children with de novo acute myeloid leukemia (AML). The secondary objective was to describe factors associated with CDI.
We performed a multicenter, retrospective cohort study of children with de novo AML and evaluated CDI. Recurrence, sepsis and infection-related death were examined. Factors associated with CDI were also evaluated.
Forty-three CDI occurred in 37 of 341 (10.9%) patients during 42 of 1277 (3.3%) courses of chemotherapy. There were 6 children with multiple episodes of CDI. Three infections were associated with sepsis, and no children died of CDI. Only 2 children had an associated enterocolitis. Both days of broad-spectrum antibiotics (odds ratio 1.03, 95% confidence interval: 1.01 to 1.06; P = 0.003) and at least 1 microbiologically documented sterile site infection (odds ratio 10.81, 95% confidence interval: 5.88 to 19.89; P
PubMed ID
23838731 View in PubMed
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Impact of caring for a child with cancer on parents' health-related quality of life.

https://arctichealth.org/en/permalink/ahliterature154079
Source
J Clin Oncol. 2008 Dec 20;26(36):5884-9
Publication Type
Article
Date
Dec-20-2008
Author
Anne F Klassen
Robert Klaassen
David Dix
Sheila Pritchard
Rochelle Yanofsky
Maureen O'Donnell
Amie Scott
Lillian Sung
Author Affiliation
DPhil, Department of Pediatrics, McMaster University, 3A, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada. aklass@mcmaster.ca.
Source
J Clin Oncol. 2008 Dec 20;26(36):5884-9
Date
Dec-20-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Caregivers - psychology
Child
Child, Preschool
Female
Health status
Humans
Infant
Male
Neoplasms - nursing
Parents - psychology
Quality of Life
Questionnaires
Abstract
To compare the health-related quality of life (QOL) of parents of children who are undergoing treatment for cancer with that of Canadian population norms and to identify important parent and child predictors of parental QOL.
A total of 411 respondents of 513 eligible parents were recruited from five pediatric oncology centers in Canada between November 2004 and February 2007. Parents were asked to complete a questionnaire booklet that included a measure of adult QOL (SF-36), a measure of child health status (functional status IIR), and questions to assess health-promoting self-care actions (eg, sleep, diet, and exercise habits) and characteristics of the child with cancer (eg, relapse status, time since diagnosis, prognosis, treatment intensity).
Compared with population norms, parents of children with cancer reported poorer physical and psychosocial QOL in all psychosocial domains (effect sizes range, -0.71 to -1.58) and in most physical health domains (effect sizes range, -0.08 to -0.63). Parent characteristics associated with better parental QOL included better eating, exercise and sleep habits, younger age, and higher income. Child characteristics associated with better parental QOL included better child health status (functional status IIR scores), lower treatment intensity, and longer time since diagnosis.
Parents of children with cancer report poorer QOL compared with population norms. Interventions directed at parents should be included as part of the treatment plan for a child with cancer. Modifiable variables associated with poorer parental QOL, such as sleep quality and diet and exercise habits, indicate those parents most likely to experience poor QOL and may be potential areas for intervention.
PubMed ID
19029424 View in PubMed
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Impact of caring for a child with cancer on single parents compared with parents from two-parent families.

https://arctichealth.org/en/permalink/ahliterature137724
Source
Pediatr Blood Cancer. 2012 Jan;58(1):74-9
Publication Type
Article
Date
Jan-2012
Author
Anne F Klassen
David Dix
Michael Papsdorf
Robert J Klaassen
Rochelle Yanofsky
Lillian Sung
Author Affiliation
Department of Pediatrics, McMaster University, Hamilton, ON, Canada. aklass@mcmaster.ca
Source
Pediatr Blood Cancer. 2012 Jan;58(1):74-9
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adolescent
Adult
Canada
Caregivers - psychology
Child
Child, Preschool
Cross-Sectional Studies
Family
Female
Humans
Infant
Infant, Newborn
Male
Neoplasms - psychology - therapy
Parents - psychology
Prognosis
Quality of Life
Questionnaires
Sickness Impact Profile
Single Parent - psychology
Abstract
It is currently unknown how the intensive and often prolonged treatment of childhood cancer impacts on the lives of single parents. Our aims were to determine whether single parents differ from parents from two-parent families in terms of caregiver demand (the time and effort involved in caregiving), and health-related quality of life (HRQL).
Forty single parents and 275 parents from two-parent families were recruited between November 2004 and February 2007 from five pediatric oncology centers in Canada. Parents were asked to complete a questionnaire booklet composed of items and scales to measure caregiver demand and HRQL (SF-36). The booklet also measured the following constructs: background and context factors, child factors, caregiving strain, intrapsychic factors, and coping factors.
Single parents did not differ from parents from two-parent families in caregiving demand and physical and psychosocial HRQL. Compared with Canadian population norms for the SF-36, both groups reported clinically important differences (i.e., worse health) in psychosocial HRQL (effect size = -2.00), while scores for physical HRQL were within one standard deviation of population norms.
Our findings suggest that the impact of caregiving on single parents, in terms of caregiving demand and HRQL is similar to that of parents from two-parent families.
PubMed ID
21254372 View in PubMed
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A national study of the provision of oncofertility services to female patients in Canada.

https://arctichealth.org/en/permalink/ahliterature256621
Source
J Obstet Gynaecol Can. 2012 Sep;34(9):849-58
Publication Type
Article
Date
Sep-2012
Author
Samantha Yee
William Buckett
Sharon Campbell
Rochelle Yanofsky
Ronald D Barr
Author Affiliation
Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Toronto ON, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto ON.
Source
J Obstet Gynaecol Can. 2012 Sep;34(9):849-58
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Canada
Costs and Cost Analysis
Female
Fertility Preservation - economics - statistics & numerical data
Fertilization in Vitro
Health Services Accessibility - statistics & numerical data
Humans
Neoplasms - therapy
Questionnaires
Vulnerable Populations - statistics & numerical data
Abstract
This study aimed to gain a better understanding of the fertility preservation services provided by Canadian fertility clinics to women with cancer.
We invited a total of 76 fertility clinics across Canada to complete a mailed questionnaire related to the availability, accessibility, affordability, and utilization of fertility preservation services for oncology patients.
The total response rate was 59.2%: 72.4% for IVF clinics and 51.1% for fertility centres without on-site IVF. Not all the responding IVF centres accepted oncology referrals for women. Six clinics without on-site IVF accepted cancer patients for consultation. The medical consultation fees are covered by public health insurance in all provinces. The majority of respondents expedited the referrals to schedule an initial medical appointment within three days. Despite that, the referral volume reported by respondents was markedly low for all except two facilities. With over 4000 young women of reproductive age given a diagnosis of cancer each year in Canada, the findings suggest that cancer patients are severely under-served by fertility clinics.
There is a need to develop a stronger partnership between the fields of oncology and reproductive medicine to further improve access of patients with cancer to fertility preservation services. Development of evidence-based practice guidelines covering medical, clinical, psychosocial, ethical, and legal aspects geared to the Canadian health care system would help to avoid ambiguity relating to the roles and responsibilities in the provision of fertility preservation services. Such processes would ensure optimization of services so that all young cancer patients would receive the best care in protecting their fertility.
Notes
Comment In: J Obstet Gynaecol Can. 2013 Jan;35(1):2123343792
PubMed ID
22971454 View in PubMed
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Pandemic (H1N1) 2009 influenza in Canadian pediatric cancer and hematopoietic stem cell transplant patients.

https://arctichealth.org/en/permalink/ahliterature126178
Source
Influenza Other Respir Viruses. 2012 Nov;6(6):e105-13
Publication Type
Article
Date
Nov-2012
Author
Dat Tran
Michelle Science
David Dix
Carol Portwine
Shayna Zelcer
Donna L Johnston
Rochelle Yanofsky
Adam Gassas
Marie-Chantal Ethier
Lillian Sung
Author Affiliation
Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.
Source
Influenza Other Respir Viruses. 2012 Nov;6(6):e105-13
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Antiviral Agents - administration & dosage
Canada - epidemiology
Child
Child, Preschool
Female
Hematopoietic Stem Cell Transplantation
Hospitals, Pediatric
Humans
Infant
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - drug therapy - epidemiology - pathology - virology
Male
Neoplasms - complications - therapy
Oseltamivir - administration & dosage
Retrospective Studies
Time Factors
Treatment Outcome
Virus Shedding
Abstract
The impact of pandemic H1N1 influenza (pH1N1) virus in pediatric cancer is uncertain. The objectives of this study were to characterize the clinical course of pH1N1 and identify factors associated with severe outcomes.
We conducted a Canadian multicenter retrospective review of children with cancer and stem cell transplant (SCT) recipients who were diagnosed with laboratory-confirmed pH1N1 infection between May 1, 2009 and January 31, 2010.
We identified 100 (19 in wave 1 and 81 in wave 2) cases of pH1N1 infection. Median age was 8.7 years. 71% had a hematologic malignancy, and 20% received SCT. Median duration of fever and illness was 2 and 12.5 days, respectively. 51 (51.5%) were hospitalized for a median of 5 days, with no deaths and only 1 requiring admission to the intensive care unit. Radiologically confirmed pneumonia was diagnosed in 10 (10%). Interruption of chemotherapy or conditioning occurred in 43 patients. In multivariable analyses, age 5 days) correlated with shortened duration of viral shedding (P=0.041).
pH1N1 infection in pediatric cancer and SCT patients infrequently caused complications but commonly interrupted cancer treatment. Persistent shedding of virus after illness resolution was common. Further research is needed to verify this finding as it could have implications for treatment guidelines and infection control practices.
PubMed ID
22417068 View in PubMed
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Predictors and outcomes of viridans group streptococcal infections in pediatric acute myeloid leukemia: from the Canadian infections in AML research group.

https://arctichealth.org/en/permalink/ahliterature256562
Source
Pediatr Infect Dis J. 2014 Feb;33(2):126-9
Publication Type
Article
Date
Feb-2014
Author
Victor Lewis
Rochelle Yanofsky
David Mitchell
David Dix
Marie-Chantal Ethier
Biljana Gillmeister
Donna Johnston
Bruno Michon
Kent Stobart
Carol Portwine
Mariana Silva
Sonia Cellot
Victoria Price
Lynette Bowes
Shayna Zelcer
Josee Brossard
Joseph Beyene
Lillian Sung
Author Affiliation
From the *Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Alberta; †Hematology/Oncology, Cancer Care Manitoba, Winnipeg, Manitoba; ‡Hematology/Oncology, Montreal Children's Hospital, Montréal, Quebec; §Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia; ¶Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario; ?Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario; **Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, ††Stollery Children's Hospital, University of Alberta Hospital, Edmonton, Alberta; ‡‡Hematology/Oncology, McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario; §§Hematology/Oncology, Cancer Centre of Southeastern Ontario at Kingston, Kingston, Ontario; ¶¶Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec; ??Pediatrics, IWK Health Centre, Halifax, Nova Scotia; ***Hematology/Oncology, Janeway Child Health Centre, St. John's, Newfoundland; †††Hematology/Oncology, London Health Sciences, London, Ontario; ‡‡‡Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec; ¶§§§Population Genomics Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; and ¶¶¶¶Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Source
Pediatr Infect Dis J. 2014 Feb;33(2):126-9
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - therapeutic use
Antimetabolites, Antineoplastic - therapeutic use
Bacteremia
Canada - epidemiology
Child
Child, Preschool
Cytarabine
Female
Humans
Leukemia, Myeloid, Acute - drug therapy - epidemiology - microbiology
Male
Retrospective Studies
Streptococcal Infections - complications - drug therapy - epidemiology
Treatment Outcome
Viridans Streptococci - isolation & purification
Abstract
Viridans group streptococci (VGS) cause significant morbidity in children treated for acute myeloid leukemia (AML). Our goals were to determine the occurrence and impact of these infections in children treated for AML and to understand the factors that increase the risk of VGS infections and viridans streptococcal shock syndrome (VSSS) in this population.
We conducted a retrospective, population-based cohort study that included children =18 years of age with de novo AML treated at 15 Canadian centers. We evaluated factors related to VGS infection and VSSS.
Among 341 children with AML, VGS occurred in 78 (22.9%) children over the entire course of therapy and 16 had recurrent episodes. VGS infection occurred in 97 of 1277 courses of chemotherapy (7.6%). VSSS occurred in 19.6% of these episodes and included 11 patients who required intensive care services with 2 VGS infections resulting in death. In multiple regression analysis, factors independently related to VGS included treatment on a Medical Research Council-based protocol (odds ratio (OR) 2.87, 95% confidence interval (CI) 1.53-5.39; P = 0.001), cytarabine dose per gram/m² (OR 1.04, 95% CI 1.01-1.07; P = 0.002) and prolonged neutropenia (OR 1.58, 95% CI: 0.97-2.56; P = 0.06). None of the evaluated factors were predictive of VSSS.
VGS infections occur in 7.6% of chemotherapy courses and remain an important cause of morbidity and even mortality in children being treated for AML. Interventions to reduce VGS need to be identified.
PubMed ID
24064558 View in PubMed
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9 records – page 1 of 1.