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Aim: To evaluate the relationship between absolute neutrophil count and C-reactive protein (CRP) in the recovery phase of neutropenic fever among paediatric patients with cancer., Methods: A total of 102 paediatric oncology patients with 177 episodes of fever and neutropenia was studied prospectively in a two-centre setting. Antimicrobial therapy was discontinued 9 d (mean) post-initiation with a mean absolute neutrophil count of 1.8 x 10(9) l(-1) and CRP of 32 mg l(-1)., Results: The mean level of CRP below 20 mg l(-1) was reached on day 12. The level of CRP peaked on the day following the commencement of antimicrobial therapy. Throughout the episodes of fever and neutropenia higher levels of CRP were associated with a lower absolute neutrophil count. Following defervescence the pace of marrow recovery as evidenced by an increasing absolute neutrophil count to > 0.2 and > 0.5 x 10(9) l(-1) was more rapid than the normalization of serum CRP. There was a 2-3 d lag period between absolute neutrophil count exceeding the level of 200 x 10(6) l(-1) and the return of CRP to a baseline level. All episodes were treated successfully and there were no fatalities., Conclusion: Among patients recovering from neutropenia and fever the signs of marrow recovery remain the key criterion in evaluating the safety of discontinuing antimicrobial therapy, with serum CRP remaining more of an indicator of ongoing tissue repair.

Seventy pediatric patients with cancer treated at the Hospital for Children and Adolescents, University of Helsinki, Finland, died while in terminal care and 30 children of therapy-related complications during active anticancer therapy in the period 1987-92. The purpose of this study was to compare these groups and characterize the main problems of the families during the mourning process. The method of evaluation was a structured interview of every parent separately. Parents of 60/70 children after terminal care, and parents of 26/30 children who died during active anticancer therapy, were interviewed. Unexpectedly, differences were minimal between families who lost a child after terminal care and those whose child died during active anticancer therapy. Parents reported physical and/or mental problems with similar frequency (39% and 34%); average self-reported recovery times were similar (14 and 16 mo); return to work was similar in both groups, 70% returning doing so within 1 mo. However, pronounced differences were observed between the mothers and the fathers; the mothers requiring longer recovery times and returning to work later. Of the siblings, 18% in the terminal care group had problems compared with 32% in the active therapy group. These included fear, behavioral problems, problems with friends and school-related problems. In conclusion, when a child with cancer dies, the ability of the respective families to cope does not seem to differ whether the child dies after terminal care or during active anticancer therapy. The inevitable loss of the child is the major event. Most parents and siblings have the potential and ability to recover normally after the death of a child, although they will never be completely the same.

Objective: This study examined whether experience of cancer in childhood leaves a hypersensitivity to various somatic symptoms. Further, are self-reported somatic symptoms explained by medical late-effects or a worry of recurrence of the cancer?, Methods: Of the total of 44 female survivors of leukaemia, 42 were compared with 69 age-matched healthy controls. We used a questionnaire to study self reported somatic symptoms and a face-to-face interview to explore worries about recurrence of the illness. Health status and medical late effects were evaluated by a paediatric haematologist., Results: In contrast to our assumptions, young survivors of leukaemia reported fewer somatic symptoms than healthy age-matched comparison subjects (p < 0.001). Late physical sequelae were uncommon except in the survivors of allogeneic bone marrow transplantation. Of the survivors, 52% were afraid of recurrence of the illness. The presence of physical or visible impairment and worry of recurrence were unrelated to frequency of somatic symptoms., Conclusions: The results suggest that experience of childhood leukaemia and its treatment does not result in increased somatic concerns or hypochondriacal tendencies.

One hundred paediatric patients with either leukaemia (36%), solid tumours (34%) or brain tumours (30%), treated at the Children's Hospital, University of Helsinki, Finland, died during 1987-92; 70 of them died while in organized terminal care. They were treated at home (60%), in hospital (29%), and partly at both (11%). One or both parents stayed at home to take care of their child. Personnel of the oncologic ward coordinated home care. The purpose of this study was to evaluate the advantages and disadvantages of a terminal care program, with special reference to terminal care at home. Evaluation included retrospective analysis of patients' records, as well as a structured interview with the two parents separately. The quality of life of the children during the terminal period was greatly influenced by their happiness at being at home. Relief of symptoms, particularly pain, was in most instances adequate. Most parents had no complaints to make afterwards. Only some of them complained of having received too little information, too little supervision and support, and insufficient preparation for the death of the child. Thus, the system of terminal care at home proved satisfactory for the child and the whole family in many different respects. For successful home care, the parents need continuous supervision, help and support by well-trained personnel.

In a prospective, population-based study, 31 patients with pure granulocytopenia lasting longer than six months were follow-up for up to 7.3 years after diagnosis. Their ages at diagnosis were 0.3-15.5 (median 0.9) years; 17 of the patients were less than 1 year of age. The lowest granulocyte count measured was 0.00-0.60 (median 0.03) x 10(9)/l. During the granulocytopenia, 12 patients suffered from repeated infections but none was life-threatening. In 21 patients, the granulocyte count normalized spontaneously within 0.5-5.5 (median 1.1) years: the other 10 remain granulocytopenic after follow-up for 2.5-7.3 (median 3.7) years. We conclude that selective granulocytopenia, if associated with unimpaired myelopoiesis, is a benign disorder in children and does not, even if prolonged, significantly increase the risk of severe infections.

In a prospective study, 91 episodes of fever in neutropenic children with cancer were evaluated. Fifteen episodes were septicemias, verified by a positive blood culture, 62 were fevers of unknown origin, 6 were focal infections and 8 were of other etiologies (i.e. drug fevers and viral infections). Serum antibody responses to bacteria were measured in paired sera by an enzyme immunoassay method. Bacterial infection was demonstrated serologically in 20% of documented septicemias, in 35% of fevers of unknown origin and occasionally in the other groups. Tests were available and found positive in the fever of unknown origin group for Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and enterobacteria. Some had multiple etiology. In conclusion, bacterial serology is a promising method of identifying bacterial etiology in fever of otherwise unknown origin in neutropenic children with cancer.

We evaluated 91 episodes of fever in 46 profoundly neutropenic children with cancer, in a search for any symptom, sign or laboratory test that would serve to identify patients with septicemia and differentiate them from those in no immediate need of prompt antimicrobial therapy. Seventeen episodes (19%) were bacteremias, 59 (64%) were suspected septic infections, 9 (10%) were focal bacterial infections and 6 (7%) proved not to be bacterial infections. We were unable to detect any parameter, either on admission or after two days of antimicrobial therapy (except for blood culture findings), that would be helpful in differentiating bacteremia from an episode not of bacterial origin. We focused on serum levels of C reactive protein and found them unreliable on an individual level. Prompt institution of antimicrobial therapy at the occurrence of fever results in low mortality, but does not allow assignment of cases to different categories.