Browsing by Subject "Precursor Cell Lymphoblastic Leukemia-Lymphoma"
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Item Culturally Informed Motivational Interviewing to Improve Oral Chemotherapy Adherence for Pediatric Acute Lymphoblastic Leukemia Patients and Their Caregivers: A Feasibility, Acceptability, and Preliminary Efficacy Trial(2019-07-24) El Behadli Gonzalez, Ana Fey; Faith, Melissa A.; Stewart, Sunita M.; Winick, Naomi; Germann, Julie; Acosta, DailynBACKGROUND: Curative therapy for childhood acute lymphoblastic leukemia (ALL) mandates a two-to-three-year maintenance chemotherapy phase wherein patients must take daily oral 6-mercaptopurine (6-MP). 6-MP regimen adherence is challenging and failure to take medication has been associated with an increase in relapse risk. Accordingly, interventions that enhance 6-MP adherence during ALL maintenance chemotherapy may result in decreased morbidity and mortality for pediatric ALL patients. This study investigated the feasibility and acceptability of brief, English- and Spanish-delivered, culturally informed MI sessions during routine outpatient ALL maintenance therapy appointments. Additionally, this study preliminarily explored MI efficacy, compared to an education-only control, for improving caregiver-reported 6-MP adherence, patients' TGN blood serum levels, and caregiver-perceived 6-MP adherence barriers. METHOD: Participants included 121 caregivers (Age M(SD) = 36.66(8.02), 80.7% mothers, 47.1% Hispanic, 23.1% Spanish-speaking) of pediatric ALL patients (Age M(SD) = 7.55(4.80), range = .9-24; 66.1% male; Medicaid = 54.2%; B- and T-ALL risk category: Standard = 50.9%, High/Very High = 49.1%) in maintenance ALL treatment. Eighty caregivers (66.12%) were randomized to receive MI and the remaining 42 caregivers (33.8%) were randomized to the education-only control group. For the purpose of analyses, participants were categorized based on their ethnicity and primary language as a proxy for potential cultural similarities. Cultural categories included: (1) Non-Hispanic, English-speaking caregivers (N=63, 52.07%); (2) Hispanic, English-speaking caregivers (N=30, 24.79%); and (3) Hispanic, Spanish-speaking caregivers (N=28, 23.14%). Participants completed self-report measures assessing demographics, 6-MP adherence, 6-MP knowledge, perceived medication adherence barriers, and intervention acceptability. We obtained biological data (i.e., TGN concentrations) via chart review. MI sessions were audio recorded and rated using the MITI 4.2.1. coding manual to ensure intervention fidelity. Primary analyses included Analysis of Covariance (ANCOVA). We also conducted exploratory post-hoc analyses. RESULTS: Findings confirmed primary MI feasibility and acceptability hypotheses, supporting the possibility of delivering adherence-enhancing MI as part of routine oncological care. Additionally, although methodological limitations hindered adequate assessment of MI efficacy for improving caregiver-reported 6-MP adherence and patients' TGN concentration, post-hoc analyses suggested MI was effective for reducing caregiver-perceived 6-MP adherence barriers. CONCLUSIONS: MI may represent a deliverable, cost-effective, "no-risk" approach to improving adherence and represent an easily incorporated, low cost avenue for enhancing cure. Overall, study findings have the potential to inform a larger, future MI efficacy RCT by establishing the feasibility and acceptability of MI delivery during outpatient oncology clinic visits.Item Long Term Central Venous Access in a Pediatric Leukemia Population(2015-01-26) Fu, Aurelia; Hodgman, Erica; Renkes, Rachel; Slone, Tamra; Alder, AdamBACKGROUND: Central venous access devices (CVADs) are used during the treatment of malignancies to facilitate chemotherapy administration and to reduce the pain and trauma of frequent blood sampling. Despite the importance of venous access, there is little recent data on complication rates associated with CVADs among pediatric patients. Our aim was to retrospectively analyze the complication rates among patients with acute leukemia at a single pediatric tertiary referral center. METHODS: After IRB approval, we reviewed the medical records of all patients with a diagnosis of acute lymphoblastic leukemia or acute myeloid leukemia admitted to our institution from May 2009-July 2014. Patient data, including demographics, CVAD type (subcutaneous port or tunneled catheter), peri-operative complications (<24 hours of surgery), long-term complications (>24 hours after surgery), and overall patient outcomes were collected. Chi square, t-tests and backward stepwise multivariate-regressions were used (significance p<0.05). RESULTS: There were 292 CVADs placed in 198 patients. The peri-operative complication rate was 4.8% (14 out of 292). Out of 292 CVADs, 23 did not have any long-term complications. Long-term complications included 93 line-associated infections (blood stream and/or port site infections), 6 episodes of deep vein thrombosis (DVT), and 136 instances of line malfunction without an identifiable cause. Seventy-five CVAD's were prematurely removed: 31 due to infection and 44 to malfunction. Univariate analysis identified age as a risk factor for a hematoma (p=0.02), and weight status as a risk factor for blood stream infection (p=0.02), DVT (p=0.009), line malfunction (p=0.02), and premature removal (p=0.02). The number of days from diagnosis to CVAD placement (p=0.008) and location of the subcutaneous port reservoir (p=0.01) were identified as predictors of early CVAD removal by multivariate analysis. There were no significant differences in long term complications between ports or tunneled catheters. CONCLUSION: Our rate of peri-operative complications compares to the 1.3-14% range reported in previous studies. Long term complications are high and require additional treatment, catheter replacement, or premature removal. This is costly in health, time, and money for both the patient and our institution, and should be addressed to improve patient care. Our retrospective study is the largest recent evaluation of CVAD complications within a single institution and also represents the largest Hispanic pediatric leukemia population reported upon to date.Item [News](1983-11-01) Harrell, AnnItem Study of the Effect of Age on Toxicity During Treatment of Acute Lymphoblastic Leukemia (ALL)(2016-01-19) Wu, Amy; Leonard, David; Winick, NaomiBACKGROUND: Minimizing toxicity is critical to the safety and efficacy of therapy. There are data suggesting that adolescents and young adults experience greater toxicity than younger patients during the induction and delayed intensifications (DI) phases of therapy due to use of arparaginase and steroids. However, this data have reflected the use of an older asparaginase preparation, have been based on reviews, or do not address the potential role of BMI and ethnicity in the expression of toxicities. OBJECTIVE: We wanted to determine whether age influences the likelihood of a patient with ALL to experience a higher number or maximum grade of 3-5 chemotherapy-related toxicities during the induction and DI phases. We looked at what role BMI, ethnicity, and gender play in the effect of age on toxicity. METHODS: Patients with ALL aged <1 and >22 years at diagnosis, classified and treated as having high-risk disease on or as per the Children's Oncology group protocol AALL0232 over the past 10 years, were identified though the pediatric oncology registry at Children's Health System of Texas. We conducted a retrospective chart review; the data collected included type of leukemia, age at diagnosis, ethnicity, BMI, toxicities, WBC at diagnosis, CNS status, date of treatment, allergies to chemotherapy, and leukemia cytogenetics. We graded the toxicity severity using the CTCAEv4 system. Patient characteristics were summarized by quartile of age at diagnosis. Unadjusted trends between toxicity outcomes and age were tested using the Jonckheere-Terpstra nonparametric method. Trends between toxicity outcomes and age adjusted for BMI, ethnicity, and gender were tested using Poisson regression models. Febrile neutropenia was omitted as a toxicity. RESULTS: In the induction phase of the therapy with N=158, the unadjusted trend between age at diagnosis and maximum grade of toxicity is significant (p=0.011). The unadjusted trend between age at diagnosis and number of grade 3-5 toxicities is significant (p=0.009). The multiple regression results indicate that when the relationships between age at diagnosis and toxicity are adjusted for BMI, ethnicity and gender, the relationship between age and both maximum grade and number of grade 3-5 toxicities are no longer significant. BMI and ethnicity significantly influence the number of 3-5 toxicities. The relationship between age and toxicity during the DI phase is not significant. CONCLUSIONS: Conducting a retrospective chart review of the high-risk ALL patients at Children's Health System revealed that age is not a significant risk factor for higher number and severity of chemotherapy-related toxicity when adjusted for BMI, ethnicity, and gender. This will allow for better supportive care measure and counselling of patients and their parents with respect to the risks associated with ALL therapy.Item Where There Is a Will There Is a Way: Defining the Path Between Hope, Pain and Quality of Life in Pediatric Acute Lymphoblastic Leukemia Survivors(2011-12-12) Foxwell, Aleksandra Aceska; Germann, JulieAcute Lymphoblastic Leukemia (ALL) is the most common childhood cancer, with an expected long-term survival rate of approximately 80 – 85%. Observations have lead researchers to believe that adolescent and young adult survivors of childhood ALL have an unexpectedly high frequency of lower back pain. This increase of pain is attributed to the number of lumber punctures during treatment. Various factors influence levels of pain (i.e. BMI, exercise and neuroticism) and pain has been shown to have a negative effect on quality of life. Hope, a construct that has not been widely studied in the oncology literature, may be a buffer between pain and quality of life, meaning that those with higher hope are able to cope with their pain more effectively and in turn have a better quality of life. Moreover, because survivors have had an aversive experience, they may have increased levels of hope, thus despite high pain levels have a positive quality of life. Results suggested that ALL survivors reported higher pain ratings than siblings, but lower total hope and agency. Agency and total hope were significant predictors of QoL at time 2 over and above QoL at time 1 and mediated the relationship between pain time 1 and QoL time 2 when QoL time was not a covariate. These results conclude that hope and more specifically, agency, should be further examined in pediatric oncology and merits the development and investigation of a hope intervention.