[Show abstract][Hide abstract] ABSTRACT: Purpose: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb-preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The purpose of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb-preservation procedure while identifying psychological differences for further evaluation. The main hypothesis was that sparing a person's limb, as opposed to amputating it, would result in a better quality of life. Patients and Methods: Eighty-two long-term survivors of lower extremity bone sarcoma were studied to make a comparison of the overall quality of life, pain assessment, and psychological evaluations in limb preservation and amputation patients. Forty-eight patients with limb preservation and thirty-four patients with amputations were enrolled in the study. Validated psychometric measures including the Quality of Life Questionnaire (QLQ), the Minnesota Multiphasic Personality Inventory, and visual analog scales were utilized. Results: The overall quality of life of patients with limb preservation was significantly higher than patients with amputation (p-value < 0.01). Significant differences were noted in the categories of material well-being, job satisfiers, and occupational relations. Conclusion: The overall quality of life of patients with limb-preservation appears to be better than for those patients with amputation based on the QLQ in patients surviving lower extremity bone sarcoma. Further analysis needs to verify the results and focus on the categories that significantly affect the overall quality of life.
[Show abstract][Hide abstract] ABSTRACT: Methadone is effective in the treatment of cancer-related pain in adults. Pediatric oncologists may be reluctant to use methadone, given the paucity of existing research and a lack of familiarity with its use. This study's purpose was to assess pediatric oncologists' experience, comfort and practice of methadone prescription, and determine interest in and appropriate venues for education on methadone. A 22-item survey was sent by electronic mail to 1912 practicing pediatric oncologists. Six hundred thirty-one pediatric oncologists (33%) responded to the survey. Seventy-two percent of respondents reported they prescribe methadone to <10% of their patients receiving opioids. Physicians practicing ≥10 years (84% vs. 76%, P=0.01), at centers that see ≥100 new patients per year (86% vs. 76%, P=0.003), or who have received prior education on methadone (89% vs. 54%, P<0.001) were more likely to have prescribed methadone. The primary reasons respondents did not utilize methadone included a lack of knowledge of methadone's pharmacodynamics (39%), effectiveness (39%), and/or dosing equivalence (34%). Perceived competence with dose equivalence, belief that methadone is effective, and working in a division where >20 patients per year died were all independently associated with having prescribed methadone to >10% of patients on opioids. Eighty-five percent of respondents would like additional education on methadone. Many pediatric oncologists lack experience and education in the use of methadone. Formal education initiatives should be implemented to enhance pediatric oncologists' comfort and expertise in methadone use.
Journal of Pediatric Hematology/Oncology 12/2012; · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Patients with advanced squamous cell carcinoma of the head and neck (SCCHN) have limited treatment options. Inhibition of histone deacetylases (HDACs) represents a novel therapeutic approach warranting additional investigation in solid tumors. METHODS: A phase II trial of single agent romidepsin, an HDAC inhibitor, was performed in 14 patients with SCCHN who provided consent for pre- and post-therapy samples of accessible tumor, blood and uninvolved oral mucosa. Romidepsin was administered at 13mg/m(2) as a 4-h intravenous infusion on days 1, 8 and 15 of 28day cycles, with response assessment by RECIST every 8weeks. RESULTS: Objective responses were not observed, although 2 heavily pretreated patients had brief clinical disease stabilization. Observed toxicities were expected, including frequent severe fatigue. Immunohistochemical analysis of 7 pre- and post-treatment tumor pairs demonstrated induction of p21(Waf1/Cip1) characteristic of HDAC inhibition, as well as decreased Ki67 staining. Exploratory microarray analyses of mucosal and tumor samples detected changes in gene expression following romidepsin treatment that were most commonly associated with regulation of transcription, cell cycle control, signal transduction, and electron transport. Treatment with romidepsin did not alter the extent of DNA methylation of candidate gene loci (including CDH1 and hMLH1) in SCCHN tumors. CONCLUSIONS: Single agent romidepsin has limited activity for the treatment of SCCHN but can effectively achieve tumor-associated HDAC inhibition. Although tolerability of romidepsin in this setting may be limiting, further evaluation of other HDAC inhibitors in combination with active therapies may be justified.
[Show abstract][Hide abstract] ABSTRACT: Limited data are available regarding the psychosocial impact of cancer on families of culturally diverse backgrounds living in medically underserved communities. The unique psychosocial needs of families of children with cancer from an ethnically diverse inner-city population is the focus of this study.
The prevalence of psychosocial needs among a multi-cultural, inner-city sample of children and adolescents with cancer and their parents was assessed using a modified version of the Psychosocial Needs Assessment Survey. All patients were recruited from the Children's Hospital at Montefiore located in Bronx, NY, a designated medically underserved community.
Seventy-eight percent of parents reported unmet informational needs. The three most commonly endorsed informational needs by parents and children were regarding dietary management of acute side effects, late effects of having cancer and secondary cancer prevention. Less educated parents reported greater unmet supportive, practical, and spiritual needs than those with more education. Fathers had greater informational and practical needs than mothers and younger parents had more practical needs than older parents. Endorsement of spiritual needs was lower for both children and parents compared with supportive, informational, or practical needs.
Given the high prevalence of reported unmet informational needs, efforts should be made to provide patients and families with education tailored to their informational needs and level of education. This population may benefit from psychoeducational interventions, including community-based informational and peer support groups. Such interventions may augment efforts to lessen health gaps experienced in this population.
Supportive Care in Cancer 09/2011; 19(9):1403-10. · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Burnout is a work-related syndrome consisting of emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment. Physicians who care for patients with life-threatening illnesses are at high risk for developing burnout. This survey evaluates the prevalence of burnout among pediatric oncologists, and assesses risk factors associated with the development of burnout.
A questionnaire was sent via email to 1,047 practicing pediatric oncologists. The survey included the 22 question Maslach Burnout Inventory (MBI), as well as questions regarding work-related and lifestyle-related factors associated with developing burnout.
Four hundred ten pediatric oncologists (40%) responded to the survey. Thirty-eight percent of pediatric oncologists had high levels of burnout on the MBI, while 72% had at least moderate levels of burnout. Women (47% vs. 32%, P < 0.004) and physicians practicing for <10 years (50% vs. 33%, P < 0.004) had significantly higher rates of burnout. Physicians who reported satisfaction with their lives outside of work were less likely to have burnout (odds ratio 0.238, 0.143-0.396, P < 0.001). The availability of a forum for debriefing, and services for physicians affected by burnout were both associated with lower rates of burnout (24% vs. 46%, P < 0.001 and 23% vs. 46%, P < 0.001). Thirty-six percent of respondents reported their institution has a forum for debriefing and 40% of respondents reported their institution has services available for physicians experiencing symptoms of burnout.
Approximately three quarters of pediatric oncologists experience burnout. Further research is needed on the effectiveness of interventions aimed at preventing and treating work-related burnout.
Pediatric Blood & Cancer 05/2011; 57(7):1168-73. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Multiple cell-signaling ligands and receptors-including vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), endothelial growth factor (EGF), v-akt murine thymoma viral oncogene homolog (AKT), platelet-derived growth factor (PDGF), mitogen-activated protein kinase (MAPK), and 70-kilodalton (kD) protein S6 kinase (p70S6 kinase)-reportedly are variably expressed in osteogenic sarcoma. Expression of these proteins may have future implications for prognostication and targeted therapy. The objective of the current study was to determine the relation between clinical outcome and the expression of these proteins.
A paraffin-embedded microarray of 48 human osteogenic sarcoma tissue specimens was stained with the antibodies against VEGF, IGF, EGF, AKT, PDGF, MAPK, and p70S6 kinase. Staining for each protein included the total protein and, when applicable, the phosphorylated version of the protein. Immunohistochemical staining was then correlated with patient survival (overall survival [OS] and event-free survival [EFS]), histologic response to chemotherapy, and serum markers.
There was a negative correlation between VEGF receptor 3 (VEGF-R3) and both OS and EFS. VEGF-B was correlated with a poor histologic response to chemotherapy. Serum markers were not correlated with any specific proteins. When using a P value of .05, multiple correlations were observed between proteins of various pathways.
The current results suggested that the VEGF pathway is a critical signaling pathway in osteogenic sarcoma. These data have identified specific proteins within these pathways toward which future investigations should be directed to further clarify their prognostic potential.
Cancer 09/2009; 115(22):5243-50. · 4.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite improved survival rates for pediatric oncology patients, childhood cancers continue to be the number one cause of non-accidental death in children. Studies show that many children receiving end-of-life care, and their families, believe that physicians can improve significantly in the delivery of palliative care. This has led to the recommendation that increased palliative care training for physicians taking care of terminally ill pediatric patients is needed.
We designed a 28-question survey and sent it via electronic mail to all 66 pediatric oncology fellowship program directors in the United States. The questionnaire assessed fellowship training programs' current practice in educating pediatric oncology fellows on palliative care.
Thirty-six pediatric oncology program directors responded to the survey for a 55% response rate. Ninety-four percent of all respondents reported that it is very important or extremely important for pediatric oncology fellows to learn about palliative care during their training. Seventy-one percent of fellowship training programs do not currently have a palliative care curriculum, and less than one-third of training programs have any evidence-based journal clubs devoted to palliative care issues. Eighty-eight percent of program directors believe their program will increase palliative care education for their fellows within 5 years.
Pediatric oncology fellowship directors believe it is very important for fellows to learn about palliative care during training; however, currently the majority of fellowship programs do not have a palliative care curriculum and lack significant formal education in end-of-life care.
Pediatric Blood & Cancer 06/2009; 53(4):647-51. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pediatric oncology patients commonly use complementary and alternative medicine (CAM), yet approximately only 50% of these patients discuss CAM with their oncologist.
The aim of this study is to assess barriers to CAM communication in pediatric oncology.
A 33-question survey was sent via electronic mail to 358 pediatric oncologists in the United States.
Ninety pediatric oncologists completed the survey. Ninety-nine percent of pediatric oncologists think it is important to know what CAM therapies their patients use. However, less than half of pediatric oncologists routinely ask their patients about CAM. This is primarily because of a lack of time and knowledge. Many physicians think some forms of CAM may improve quality of life, such as massage (74%) and yoga (57%). Over half of physicians thought that dietary supplements, herbal medicine, special diets, vitamins, and chiropractic might be harmful to patients.
Pediatric oncologists believe it is important to know which CAM therapies their patients use; however, they are not asking about them owing to lack of time and knowledge. To improve communication about CAM, increased physician education is needed. In addition, physicians should identify patients using potentially harmful CAM therapies. Furthermore, CAM research in pediatric oncology should focus on those modalities physicians believe may improve patient quality of life.
Journal of Pediatric Hematology/Oncology 04/2009; 31(3):177-82. · 0.96 Impact Factor