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Background: Nutri Crackle rusk, developed using an innovative pigmented variety of black rice flour, possesses a rich nutritional profile with essential amino acids, dietary fibers, and antioxidants, offering unique health benefits beyond traditional rice varieties. Establishing healthy eating habits during childhood cancer treatment is crucial for long-term well-being. Mindful consumption, incorporating Nutri Crackle rusk instead of empty-calorie snacks, can significantly improve the quality of life of childhood cancer survivors during their survivorship period. Materials and Methods: The novel Nutri Crackle rusk using black rice flour was developed under proper hygienic conditions. Semi-trained panel and consumer panel members evaluated the organoleptic properties of the developed product. Nutrient components of the formulated Nutri Crackle rusk were examined through an organoleptic assessment. Results: The nutrient composition of the formulated Nutri Crackle rusk was analyzed using a standard procedure. Sensory evaluation indicated positive feedback, with an overall acceptability score of 8.01. Nutrient analysis revealed a well-rounded profile, emphasizing energy provision (464.285 kcal), (11.97 g protein), (11.29 g fiber), and essential micronutrients (zinc, iron, and vitamins B1 and B2). Nutri Crackle rusk is a favorable and potentially beneficial snack for this vulnerable group. Conclusion: The study signifies that the novel healthy Nutri Crackle rusk is rich in fiber, zinc, iron, protein, vitamin B1, and vitamin B2. Intake of the developed Nutri Crackle rusk could be a healthy alternative for pediatric cancer patients and cancer survivors. [ABSTRACT FROM AUTHOR]

Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting. [ABSTRACT FROM AUTHOR]

Background: Cancer treatments may affect adolescents' and young adults' reproductive systems. Although some side effects may be temporary, infertility can be lifelong. The American Society of Clinical Oncology 2018 Guideline suggests all oncology health care providers be prepared to discuss infertility as a possible late effect of a patient's treatment (Oktay et al., 2018). However, oncology providers continue to report a lack of familiarity and confidence in discussing fertility preservation options and processes. Objectives: Objectives of this literature review were to provide a clinical overview for oncology nurse practitioners discussing fertility preservation options with patients, and to address the importance of the oncology nurse practitioner's role in this field. Method: A literature review was performed using PubMed and CINAHL for publications within the last 10 years. The search terms fertility preservation and pediatric oncology, oncology nurse practitioner, and role yielded 216 articles. A total of 17 articles were identified as relevant to this review and are synthesized in the article. Results: An overview of clinical information, including fertility preservation options and related topics, was identified. However, although the literature describes the role of nurses providing direct patient care and the oncologist in fertility preservation for children and young adults with cancer, limited literature describes the nurse practitioner's role. The author applied the literature describing the role of the nurse practitioner in pediatric oncology to their role in fertility preservation for these patients. Conclusion: The nurse practitioner's ability to spend extended time with patients, an integral role in patient education, and experience with care coordination position them to be the ideal designated fertility preservation provider. [ABSTRACT FROM AUTHOR]

Background: Granulocyte-colony stimulating factors (G-CSFs) are administered to many pediatric patients undergoing myelosuppressive cancer treatment to prevent febrile neutropenia. The most common side effect of G-CSF administration is bone pain, which can be debilitating and result in treatment delays and complications. The use of loratadine to safely and effectively manage G-CSF-induced bone pain in this population is examined. Methods: A literature review was performed using PubMed to locate relevant articles. Search terms included histamine antagonists, loratadine, granulocyte-colony stimulating factor, G-CSF bone pain, pegfilgrastim, and cancer-related bone pain. Ultimately, 18 peer-reviewed articles are included in this narrative review. Results: Current treatment options to manage bone pain are largely reliant on acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, but are not always feasible or effective. More recently, loratadine has been studied for its use in treating G-CSF-induced bone pain. As a second-generation antihistamine, loratadine is non-sedating and has shown to be beneficial in treating bone pain with minimal side effects. Conclusions: There appears to be benefit in the use of loratadine to treat bone pain with minimal risk. Although loratadine has been used extensively to treat bone pain caused by G-CSF in the adult population, more research is needed specifically in the pediatric setting. Evidence also suggests that loratadine may prove beneficial in treating other types of cancer-related bone pain as well, but more research is needed before making evidence-based practice recommendations. [ABSTRACT FROM AUTHOR]

Background: Most children and adolescents with cancer experience acute pain, and many experience longer-lasting chronic pain, negatively impacting health-related quality of life and resulting in long-term morbidity. Digital apps can aid in enhancing pain assessment and management by offering children and adolescents with cancer an accessible tool to describe their pain as a multifaceted biopsychosocial construct. Pain Squad is a useable, acceptable, and psychometrically sound multidimensional cancer pain assessment app for children and adolescents with cancer. This project aimed to evaluate the capacity to implement Pain Squad into routine pediatric oncology practice. Method: Nurse champions were asked to prescribe the Pain Squad app to patients over a 6-month implementation period. After the implementation period, we conducted audiorecorded, semistructured interviews with nurse champions to investigate the facilitators and barriers related to nurses' experiences with implementing Pain Squad. Results: The facilitators and barriers to Pain Squad implementation were organized into four overarching Consolidated Framework for Implementation Research (CFIR)-related themes: (a) characteristics of the Pain Squad app; (b) clinic setting and its context; (c) nurse implementation champions; and (d) the process of implementing Pain Squad into clinical practice. Conclusions: Interviewed nurses believed Pain Squad had the potential to improve child cancer pain care, but barriers to everyday use were evident, described in relation to the internal setting, especially the lack of compatibility between app prescription and current nurse workflows. The use of CFIR to map identified implementation facilitators and barriers can formally support the recognition of factors that may boost the chances of successful uptake. [ABSTRACT FROM AUTHOR]

Background: Providing care to children with cancer is one of the most challenging areas of ethical care for nurses. Few studies have addressed nurses' perception of the barriers to giving ethical care in oncology departments. Thus, it is essential that the ethical challenges in caregiving as perceived by oncology nurses be investigated. Objective: The present study was conducted to investigate the ethical challenges as perceived by nurses in pediatric oncology units in the south of Iran. Research design: The present study is a qualitative work of research with a conventional content analysis design. Data were collected via individual semi-structured interviews. The collected data were analyzed using the qualitative content analysis method. Participants and research context: The participants were 21 nurses from pediatric oncology units in state hospitals who were selected by purposeful sampling. Sampling continued until the data were saturated. The study lasted from April to October 2022. Findings: Three main themes, promoting psychological safety in the children, respect for the dignity of the children, and expansion of support for families, and nine subthemes were extracted from the data. Ethical considerations: The study's protocol was approved by the Research Ethics Committee of the University of Medical Sciences and ethical principles were followed throughout the study. Discussion and conclusion: From the nurses' perspective, the major ethical challenges in providing ethical care in pediatric oncology units were reducing tension toward promoting the patients' psychological safety, showing respect for the identity and dignity of the children with cancer, and expanding support of the patients' families. By creating the right cultural and professional context and establishing proper protocols, healthcare policymakers and administrators can take effective steps toward eliminating the barriers to providing ethical care. [ABSTRACT FROM AUTHOR]

Background: Genomic testing is an increasingly important technology within pediatric oncology that aids in cancer diagnosis, provides prognostic information, identifies therapeutic targets, and reveals underlying cancer predisposition. However, nurses lack basic knowledge of genomics and have limited self-assurance in using genomic information in their daily practice. This single-institution project was carried out at an academic pediatric cancer hospital in the United States with the aim to explore the barriers to achieving genomics literacy for pediatric oncology nurses. Method: This project assessed barriers to genomic education and preferences for receiving genomics education among pediatric oncology nurses, nurse practitioners, and physician assistants. An electronic survey with demographic questions and 15 genetics-focused questions was developed. The final survey instrument consisted of nine sections and was pilot-tested prior to administration. Data were analyzed using a ranking strategy, and five focus groups were conducted to capture more-nuanced information. The focus group sessions lasted 40 min to 1 hour and were recorded and transcribed. Results: Over 50% of respondents were uncomfortable with or felt unprepared to answer questions from patients and/or family members about genomics. This unease ranked as the top barrier to using genomic information in clinical practice. Discussion: These results reveal that most nurses require additional education to facilitate an understanding of genomics. This project lays the foundation to guide the development of a pediatric cancer genomics curriculum, which will enable the incorporation of genomics into nursing practice. [ABSTRACT FROM AUTHOR]

Background: The Children's Oncology Group (COG) is the only National Cancer Institute–supported clinical trials organization focused exclusively on childhood and adolescent cancer research. The COG Nursing Discipline Committee has embedded the tenets of evidence-based practice (EBP) into clinical trials nursing in order to standardize the nursing care delivered to children enrolled on these trials. The COG nursing EBP initiative is aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of cancer treatment for patients enrolled on COG clinical trials from diagnosis through survivorship. A rigorous, evidence-based process designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline was developed and was implemented with the first nurse expert team beginning in 2012. Method: The standardized process included (a) selecting EBP projects and nursing expert teams (NETs), (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination of the COG EBP projects. Results: The COG Nursing EBP Subcommittee has developed 15 publications to date that include 90 authors. Eleven of these authors contributed to multiple publications. Discussion: On this 10th anniversary of the development of the EBP within the COG nursing discipline, we recognize its contributions to the professional growth of many of the discipline's members and to advances in nursing care for children enrolled in pediatric cancer clinical trials. [ABSTRACT FROM AUTHOR]

Background: Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. Method: Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. Results: All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. Conclusion: Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being. [ABSTRACT FROM AUTHOR]

Introduction: Continuous technological progress and the constantly expanding accessibility of the web have provided new opportunities for the development and implementation of web-based interventions in pediatric oncology nursing. Aim: This study aimed to investigate web-based interventions in pediatric oncology nursing. Methods: This is a systematic review of the literature from 2021 to 2023. Research articles were retrieved from PubMed and Scopus using the PRISMA method. The study includes 15 articles with quantitative, qualitative, or mixed methods studies of children and/or adolescents with cancer and/or their parents/carers and/or health professionals. Results: Results showed that legacy-building interventions, parent education interventions, symptom reporting interventions, counseling interventions, interventions to improve treatment compliance, virtual reality interventions, parent information interventions, and interventions to improve the health-related quality of life of parents of children with cancer, based eHealth and mHealth, showed positive effects on improving the treatment and care of children with cancer. The eHealth literacy and use of technology devices significantly influenced attitudes and confidence in higher quality eHealth and mHealth applications. Conclusions: Web-based interventions in pediatric oncology nursing, based on the available evidence, seem to be useful and acceptable for monitoring complications and may have an important role in relieving and preventing the psychological consequences of children undergoing treatment and improving their quality of life. However, further studies are needed to establish their effectiveness. [ABSTRACT FROM AUTHOR]

Effective communication in end‐of‐life care for pediatric cancer patients is crucial. Yet, limited research focuses on the communication experiences of pediatric oncology nurses during this period. This study aims to investigate the communication experiences and needs of these nurses with children and their families during the end‐of‐life period. A qualitative study design with photo voice methodology was followed. The research was conducted with 16 pediatric oncology nurses working in the pediatric oncology wards of a university hospital between January and May 2023. Data were collected the "Characteristic Information Form", "Semi‐Structured Interview Form", and photovoice methodology. Data were analyzed through reflexive thematic analysis. Most of the nurses are at the undergraduate level, and their working experience in pediatric oncology wards ranges from 4 months to 17 years. Seven main themes emerged: Optimistic Communication‐Interaction, Mindfulness, Active Coping, Behavioral Actions, Death Uncertainty Dilemma, Interpersonal and Environmental Factors, and Discrepancy between Ideals and Reality. The study sheds light on the importance of pediatric oncology nurses' ideals versus realities upstream approach in communicating with end‐of‐life children and their families, empowering pediatric oncology nurses on the journey to ideal end‐of‐life care. [ABSTRACT FROM AUTHOR]

Caring for a child with cancer can place a number of burdens on families, however it is unclear the extent to which health-care professionals (HCPs) and other personnel supporting families are aware of these burdens. This study sought to explore the needs and challenges encountered by families impacted by pediatric cancer in Ireland from the perspectives of both parents and the personnel who support them. Twenty-one participants, comprising seven parents (one male, six females), and 14 supportive personnel (nine hospital-based volunteers and five HCPs) took part in in-depth semi-structured interviews via Microsoft Teams (December 2020 to April 2021) to obtain a perspective of the needs, challenges, and currently available support for families. A reflexive thematic approach to analysis was employed. The need to navigate a new normal, a sense of riding the wave and reliance on others were perceived to be the primary challenges encountered by families. Participants reported a need for community service provision, connectivity across the health-care system and more accessible psychological support. High levels of overlap across themes were found for parents and supportive personnel, particularly HCPs. Results highlight the significant challenges encountered by families impacted by pediatric cancer. Themes voiced by parents were frequently echoed by HCPs, suggesting this group is attuned to broader family needs. As such, they may be capable of providing insight where parent perspectives are unavailable. While further analysis including children's voices is needed, findings highlight key areas toward which support for families should be directed. [ABSTRACT FROM AUTHOR]

The management of cancer-related symptoms with nonpharmacological treatment has been proven effective, but more studies are still required to strengthen the scientific evidence. Given the state of the evidence, one might wonder about the perceptions of pediatric oncology experts, healthcare providers and CAM providers regarding the use of supportive care in pediatric oncology. Related to this important question, Mora et al. recently published an exploratory qualitative study entitled "Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers" in the BMC Complementary Medicine and Therapies Journal. The data generated by the authors provided new insights and perspectives to the current literature. However, their findings must be put into perspective to increase the scope of the original article and to highlight that physical activity and psychosocial interventions are powerful nonpharmacological interventions to manage cancer-related symptoms. [ABSTRACT FROM AUTHOR]

We evaluated the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer. This cross-sectional study was conducted with 62 children aged 9 to 18 years old with a solid tumor who received chemotherapy for the first time, and their parents. Data were collected using a data collection form, the State-Trait Anxiety Inventory for Children, the Beck Anxiety Inventory, the Spielberger State-Trait Anxiety Inventory, and the Baxter Retching Faces Scale. Data were analyzed using Spearman's correlation and logistic regression analyses. Risk factors related to the child, treatment, and parent were examined. Child-related factors were determined as diagnosis (odds ratio [OR] = 5.5), time since diagnosis (OR = 1.9, OR = 4.7), pretreatment anxiety of the child (r = 0.439, r = 0.422), and past experience of nausea and vomiting before treatment (OR = 1.2). Treatment-related factors involved anti-emetic prophylaxis (OR = 4.9, OR = 9.2). Parent-related factors included pretreatment anxiety of the parent (r = 0.271, r = 0.287), accommodation (OR = 5.5), not eating (OR = 1.2, OR = 1.3), and bad smell (OR = 1.2), which were described amongst parents' as factors that trigger CINV. The occurrence of CINV is significantly affected by child-, treatment-, and parent-related risk factors. Pediatric nurses should create an environment for children and their parents to reduce their anxiety and provide basic knowledge and skills about the management of CINV. • The present study explores the factors affecting chemotherapy-induced nausea and vomiting (CINV) in children with cancer. • CINV risk factors were examined as child-, treatment-, and parent-related factors. • Child-related factors were diagnosis, pretreatment anxiety, and past experience of nausea and vomiting before treatment. • Treatment-related factor was antiemetic prophylaxis. • Parent-related factors were pretreatment anxiety, accommodation, and the parent's views on the factors that trigger CINV. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of child-centred and family-centred care in children's cancer nursing • To increase your awareness of the benefits and challenges of child-centred and family-centred approaches • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) A diagnosis of cancer in a child or young person and the subsequent treatment have far-reaching consequences not only for the child or young person but also for their parents or carers and wider family. Family-centred care is an established approach whereby healthcare professionals work in partnership with parents to meet the child's needs and make decisions about the child's care. Child-centred care, whereby the child or young person plays a central and active role in care and decision-making, has become more prevalent in healthcare in recent years. There is a debate about the benefits and drawbacks of the two approaches, which both lack supporting evidence. This article discusses how nurses working in children's cancer care can use a mix of child-centred and family-centred approaches to tailor their care to the individual needs of the child or young person and their family. The author also examines the challenges of family-centred care and child-centred care and discusses how these can be overcome. [ABSTRACT FROM AUTHOR]

Background: Education for parents and caregivers of children with cancer is one of the fundamental roles of nurses to avoid complications, provide quality care, promote adherence to treatment and maintain basic standards of care. This study aimed to design educational material for parents and caregivers of children with cancer in Peru on general information about childhood cancer and its care. Method: Within the framework of the WHO Global Initiative for Childhood Cancer in Peru, a multicenter working group was convened by the Peruvian Ministry of Health. A comprehensive needs assessment of parents and caregivers of children with cancer was performed through a survey in June and July 2020. The survey was conducted online (via Google Forms) and in person at nine hospitals to examine the preferred method of delivery and content of information. Results: Based on the findings from the parent needs assessment, a national nursing working group developed Spanish-language audiovisual materials (i.e., diagnosis and treatment videos for nurses to educate parents and caregivers). A total of 365 parents and caregivers were included. Most respondents (56.9%) were parents of children receiving treatment. Main topics were childhood cancer overview and side effects (85%), food and nutrition (75%), and palliative care (67%); most (70.9%) preferred information through talks and videos (64.7%). Twenty-three videos were developed with support by the Pan American Health Organization and the Ministry of Health. Discussion: Assessing the educational needs of parents and caregivers of children with cancer provides a starting point in the design of targeted strategies. [ABSTRACT FROM AUTHOR]

Background: Cancer is a significant health problem in Turkey with pediatric cancer being the fourth leading cause of death among children. Pediatric oncology has been acknowledged as a pediatric subspecialty since 1983, and 3,000 new cases of childhood cancer are expected every year. Method: We describe our country's geography, the number and distribution of pediatric oncology centers, the profile of clinical and academic nurses, and our clinical practice. We present two nurse-led research projects. Results: Although nursing practice differs according to centers, treatment and care are usually evidence-based, especially in university and public hospitals in big cities. Nurses with an undergraduate education work in pediatric oncology units; however, few nurses with graduate degrees work in clinical settings. The Turkish Oncology Nurses Association supports the development and implementation of guidelines for evidence-based nursing care. Nurses' clinical responsibilities include patient admission to the clinic, patient and family education, care coordination, patient care, symptom management, palliative, and intensive care services. Results of two recent nurse-led studies highlight challenges to meet the needs of patients and families from surrounding countries, including refugees, and opportunities for nurses to provide holistic support to parents of hospitalized children. Discussion: Increasing the number of nurses is a priority to improve pediatric oncology nursing care. Actions to advance pediatric oncology nursing include developing advanced clinical roles for nurses with graduate degrees; supporting nurses caring for children and families from outside Turkey, including language support services; and resources to conduct national and international studies related to professional and holistic care delivery. [ABSTRACT FROM AUTHOR]

The pediatric oncology unit at the Rajiv Gandhi Cancer Institute and Research Center (RGCI & RC), a nonprofit medical facility and research institute based in Delhi, India, sought to improve clinical nursing practice through nurse leadership training supported by international nursing mentorship. A nursing team leadership program with a goal to strengthen practice was designed in collaboration with the RGCI & RC nurse education department and pediatric oncology physicians on the unit. Two expert oncology nurses from the United States made multiple visits from 2017 to 2019 to support the development of the leadership program and the resulting practice changes. Specific areas of nursing addressed through these efforts included attention to education, practice, and leadership. Selected processes were improved by the following: (a) development of a pediatric oncology nursing orientation program to follow general onboarding by the nursing education department, (b) strengthening and updating standard operating procedures for nursing, and (c) development of a nursing Team Leads program. Four team leads completed training, and staff nurses are now active members in the care of patients and opining themselves when decision-making occurs during rounds. RGCI & RC nurses have written abstracts and posters accepted at national and international conferences, which further strengthens their profile in the larger pediatric oncology professional community. [ABSTRACT FROM AUTHOR]

An editorial is presented on addressing disparities in their settings and improving survival and quality of life for their patients and families. Topics include highlights research andevidence-based practice projects led by nurses andallied health professionals caring for children and adolescents; and nurses are the largest group of global healthcare professionals, and so the largest single workforce caring for children.

Background: Online healthcare information is often used by pediatric oncology nurse educators in low- and middle-income countries (LMICs) for teaching clinical nurses as part of their initial orientation or continuing education. Access to peer-reviewed nursing journals via paid subscriptions or sub-specialty nursing textbooks in these settings is rare. This project identified and evaluated websites appropriate for pediatric oncology nurse educators in LMICs for teaching staff nurses, and for clinical staff nurses engaging in self-directed learning. Method: A strategic Google search for childhood cancer websites and an appropriate scoring tool was conducted. The Currency, Relevance, Authority, Accuracy, and Purpose Test, along with a previously published scoring rubric that was further adapted by the authors for pediatric oncology were used. Pediatric content, language options, and reading levels were appraised. Results: Of 86 identified websites, 51 met the inclusion criteria for evaluation. Websites were classified as highly recommended (n = 36), recommended (n = 12), or not recommended (n = 3) based on scores (range 14–30; maximum possible score = 30). Half offered content in multiple languages. Most websites were 9–10th-grade reading level. Discussion: Childhood cancer information appropriate for clinical nurse orientation and self-directed learning by LMIC nurses is available on free websites. Some information (diagnosis, chemotherapy, psychosocial support) is repeated across websites, while some is lacking (pediatric cancer genetics and health equity disparities). Reading levels are higher than recommended for health literacy. The reviewed websites were rarely peer-reviewed, inconsistently updated, and generally self-regulated. However, 48 websites on childhood cancer were deemed appropriate pediatric oncology clinical nursing education resources. [ABSTRACT FROM AUTHOR]

Background: A recent change in local paediatric antifungal guidelines resulted in an increase in micafungin use. Micafungin is an expensive medicine costing AUD $80 per vial. The pharmacy aseptic production unit (APU) has the ability to compound doses to share vials of micafungin to minimise wastage. Aim: To determine whether aseptically compounded and individually prepared doses of micafungin would be more cost‐beneficial than nurses using whole vials prepared on the ward, and to determine which dose and numbers of doses would be most cost‐beneficial to compound. Method: A time and motion study of 20 patients determined how long it took for nurses and the pharmacy APU to prepare doses. An economic analysis of time, cost of labour, and consumables outlined the cost to make one to seven doses with doses ranging from 10 to 200 mg. Results: On average, it took the pharmacy APU 42 min and nurses 9 min to prepare a single dose. Aseptically compounding one dose, whole vials (doses of 50 mg increments), and doses near whole vials had no cost‐benefit. Aseptically compounding five doses or more had would result in a cost‐benefit. Conclusion: Depending on the dose required, cost savings could be obtained when the pharmacy APU prepared multiple doses, with a maximum saving of $350.10 for a 7‐day course. Determining baseline costs of micafungin preparation is relevant if there are future requests to compound medicines as the data could be extrapolated and applied to the new request. [ABSTRACT FROM AUTHOR]

Purpose: The intrusive thoughts of cancer diagnosis, treatments, re-experiencing, and avoidance associated with post-traumatic stress symptoms (PTSS) can negatively affect Hodgkin lymphoma (HL) survivors. This study investigates the associations between experiences and beliefs and PTSS among adolescent survivors of intermediate-risk HL treated on the Children's Oncology Group (COG) AHOD0031 study. Methods: COG AHOD0031 participants completed self-report surveys at end of therapy concerning post-treatment medical conditions, activity limitations, fatigue, future concerns, exercise, and PTSS. Results: One thousand one hundred ten of 1721 participants in AHOD0031 completed the first survey at a median of 6.7 months post-diagnosis (interquartile range: 5.3–11.5 months), and of these, 736 (66.3%) completed a second survey at a median of 12.4 (10.1–17.6) months following the first. The mean PTSS score (ranging from 0 to 20) was 5.5 (standard deviation [SD] = 5.1) on survey 1 and 4.4 (SD = 4.8) on survey 2. Increased fatigue (odds ratio [OR] = 1.14, p < 0.01), concerns for the future (OR = 1.13, p < 0.01), activity limitations (OR = 1.05, p < 0.01), and relapse history (OR = 2.18, p < 0.05) were associated with higher PTSS scores in the initial survey. Increased fatigue (OR = 1.16, p < 0.01), concerns for the future (OR = 1.14, p < 0.01), activity limitations (OR = 1.05, p < 0.05), and higher PTSS scores on the first survey (OR = 1.19, p < 0.01) were associated with higher PTSS scores in the subsequent survey. Longer time since diagnosis (OR = 0.85, p < 0.05; OR = 0.84, p < 0.05) was associated with lower PTSS scores on both surveys. Conclusions: Based on our findings, future research should examine the onset and trajectory of PTSS among HL survivors, focusing on early recognition and intervention to improve quality of life. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer. Methods: A qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes. Results: Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child. Conclusions: Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQOL) is a key concept in pediatric oncology. This systematic review aims to update the conceptual HRQOL model by Anthony et al. (Qual Life Res 23(3):771–789, 2014), covering physical, emotional, social and general HRQOL aspects, and to present a comprehensive overview of age- and disease-specific HRQOL issues in children with cancer. Methods: Medline, PsychINFO, the Cochrane Database for Systematic Reviews (CDSR), and the COSMIN database were searched (up to 31.12.2020) for publications using patient-reported outcome measures (PROMs) and qualitative studies in children with cancer (8–14-year) or their parents. Items and quotations were extracted and mapped onto the conceptual model for HRQOL in children with cancer mentioned above. Results: Of 2038 identified studies, 221 were included for data extraction. We identified 96 PROMS with 2641 items and extracted 798 quotations from 45 qualitative studies. Most items and quotations (94.8%) could be mapped onto the conceptual model. However, some adaptations were made and the model was complemented by (sub)domains for 'treatment burden', 'treatment involvement', and 'financial issues'. Physical and psychological aspects were more frequently covered than social issues. Discussion: This review provides a comprehensive overview of HRQOL issues for children with cancer. Our findings mostly support the HRQOL model by Anthony et al. (Qual Life Res 23(3):771–789, 2014), but some adaptations are suggested. This review may be considered a starting point for a refinement of our understanding of HRQOL in children with cancer. Further qualitative research will help to evaluate the comprehensiveness of the HRQOL model and the relevance of the issues it encompasses. [ABSTRACT FROM AUTHOR]

Introduction: Organ toxicity is common in childhood cancers and can cause delays in chemotherapy and worsening of prognosis. In this study, we aimed to evaluate organ toxicities, biochemical and metabolic abnormalities associated with the tumor and/or chemotherapy in the acute phase of treatment in children with cancer. Materials and Methods: The data of 305 patients with lymphoma and solid tumors who received chemotherapy between 01.01.2010 and 31.12.2015 in a tertiary healthcare facility were retrospectively evaluated. The effects of age, gender, cancer stage, chemotherapy group, surgery and radiotherapy on organ toxicity in the first 30 days of treatment were analyzed. Results: The mean age of the patients at admission was 97 months, and the male/ female ratio was 1.5. The most common diagnoses were lymphomas (27.6%), CNS and spinal canal tumors (12.5%) and neuroblastoma (11.8%). Chemotherapy was applied to all the patients, surgery to 61.3% (n=187), and radiotherapy to 13.1% (n=40). Organ toxicity was detected in 59% (n=180) of the patients. The use of alkylating agents, antimetabolites, plant products, and no surgery were risk factors for hepatotoxicity (p<0.05). The only risk factor for nephrotoxicity was antimetabolite drug use (p<0.05). The most common electrolyte disorder was hyponatremia, observed in 56.7% (n=173) of the patients. Two patients died during the study period, which were not due to organ toxicity, metabolic disease, or electrolyte disturbance. Conclusion: The rate of organ toxicity as well as biochemical, electrolyte, and metabolic abnormalities were found to be high. These high rates were thought to be related to the excessive tumor burden and organ involvement and the intensity of the combined chemotherapies applied. No associated mortality was observed despite these high rates. Early detection of these pathologies, close follow-up and immediate treatment with the multidisciplinary approach to treatment were described as the reason for the absence of mortality. [ABSTRACT FROM AUTHOR]

Copyright of Online Turkish Journal of Health Sciences (OTJHS) / Online Türk Sağlık Bilimleri Dergisi is the property of Oguz KARABAY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Neuroblastoma, the most common extra-cranial solid tumor found in children, carries a high mortality rate due to challenges with metastatic disease at diagnoses and relapse. 131I-Metaiodobenzylguanidine (I-MIBG) therapy provides targeted radiotherapy to treat neuroblastoma, but requires children to be isolated for radiation exposure, with limited access to the healthcare team while hospitalized. There is minimal research outlining the nurses' perspectives on caring for this patient population. Therefore, the aim of this study was to describe the nurses' experiences caring for children receiving 131I-MIBG therapy, focusing on nursing care, challenges, radiation exposure, and preparation. Methods: Ten nurses were recruited using purposeful sampling for this qualitative descriptive study. Semi-structured interview guides and conventional qualitative content analysis guided the data collection and analysis. Results: Nurses overwhelmingly felt isolated from their patients and a decreased sense of connection with the child. Although nurses felt prepared, they had more anxiety with the first patient experience and identified that parent engagement was essential. Overall, nurses shared they had support from written materials outlining the protocols, and members of the multidisciplinary team. More concern for radiation exposure was expressed by nurses of childbearing age and with handling bodily fluids. Discussion: Findings suggest that nurses would benefit from simulation experiences to help prepare for radiation exposure safety, strategies to engage the family in the child's care, and interacting with a child in single-room isolation. Because programs differ around the US, additional research exploring nurses' experiences is warranted to evaluate the best successes in providing 131I-MIBG therapy. [ABSTRACT FROM AUTHOR]

Background: To address the need for standardized, comprehensive chemotherapy/biotherapy education in Latin American and Caribbean (LAC) countries, the Association of Pediatric Hematology/Oncology Nurses (APHON) Pediatric Chemotherapy/Biotherapy Provider and Instructor program courses were culturally adapted, translated to Spanish, and piloted. The process of course adaptation and implementation are described. A Context, Input, Process, Product model outcomes evaluation determined: (a) differences in pass rates by test version and pilot location, (b) predictors of pass rates, (c) course appropriateness for nurses' education and practice levels, and (d) strategies for course improvements. Methods: The Spanish APHON Pediatric Chemotherapy/Biotherapy Provider program was piloted four times and the Instructor program twice with nurses from Mexico, Central America, the Caribbean, South America, and Spain. Statistical analysis identified factors associated with pass rates. Results: Of the 203 students in four Spanish APHON Provider program courses, data from 108 students (three pilots) were analyzed (one unplanned pilot excluded for missing data). Significant predictors of pass rates included: pediatric oncology frontline nurses (OR = 9.86; 95% CI [2.56, 65.23]; p =.004), nurses dedicated to an inpatient or outpatient unit (non-rotating) (OR = 6.79 [1.29, 51.98]; p =.033), and graduation from a 5-year nursing program (OR = 5.92; 95% CI [1.30, 33.15]; p =.028). Discussion: The Spanish APHON Pediatric Chemotherapy/Biotherapy program was determined appropriate for nurses' education and practice levels in LAC countries. Through the APHON Spanish language instructor network, pediatric oncology nurses in LAC countries have increased access to standardized, comprehensive chemotherapy/biotherapy education. [ABSTRACT FROM AUTHOR]

Background: An estimated 11,060 children between the ages of 1 and 14 years and 4,900 adolescents between the ages of 15 and 19 years are diagnosed with cancer in the United States. Parents with children newly diagnosed with cancer must acquire new knowledge related to the diagnosis, treatment plan, psychosocial care, and home management therapies to safely provide care following discharge. Expert consensus and review of current evidence demonstrate that utilizing a new diagnosis education checklist allows the delivery of essential information to patients and caregivers. The checklist divides educational topics into three sections: primary, secondary, and tertiary topics. This project followed the completion of an evidence-based fellowship through Children's Oncology Group focusing upon the feasibility and efficacy of implementing a standardized new diagnosis education checklist. The fellowship identified secondary topic documentation and an electronic medical record (EMR) checklist as areas of future work. Methods: This quality improvement project focused upon nursing staffs' documentation of secondary topics and the development/utilization of an EMR checklist. A pre–post survey design evaluated the outcomes of secondary topic documentation and EMR checklist implementation. Results: This nurse-led initiative created templates for primary and secondary topic checklists using Epic's SmartPhrase feature ".PHOPTED1" and ".PHOPTED2." Secondary topic completion and documentation increased 26% following implementation, and over 40% of the nursing staff indicated that they were very likely to continue to use the new templates. Discussion: Project templates are readily applicable to institutions that utilize Epic. Template examples and strategies to facilitate inpatient/outpatient checklist completion are discussed. [ABSTRACT FROM AUTHOR]

The purpose of this article is to further develop the concept of family-centered care (FCC) in childhood cancer using Rodgers' evolutionary method of concept analysis. A search of the existing literature related to the overarching concept of FCC revealed several concept analyses specific to hospitalized children and children with chronic illness; however, none of these were specific to children with cancer. Five defining attributes of FCC in childhood cancer were identified through this concept analysis: ripple effect, customized care, family functioning, collaboration, and communication. A definition of FCC in childhood cancer is offered based on identified characteristics of the concept. Findings of this concept analysis provide a starting point for on-going development of the concept of FCC in childhood cancer and may facilitate more rigorous nursing studies involving FCC in childhood cancer. [ABSTRACT FROM AUTHOR]

Background The incidence of Clostridioides difficile infection (CDI) has been rising among hospitalized children, with poor understanding of genomic variability of C. difficile isolates in this population. Methods This was a retrospective cohort study of CDI in inpatient and outpatient pediatric oncology and cell transplant patients (POTPs) in 2016 and 2017. CDI cases were identified by positive C. difficile toxin polymerase chain reaction tests. Retrieved residual stool specimens were cultured anaerobically and toxin-producing C. difficile isolates underwent whole genome sequencing (WGS) followed by core genome multilocus sequence typing. Plausible time and location epidemiologic links among the closely related strains were evaluated to identify potential transmission events. Results Among 226 CDI episodes in 157 patients, 202 stool samples were cultured and had positive cytotoxicity tests. Sequencing identified 33 different strain types in 162 (80%) isolates. Thirty-nine (28%) patients had multiple episodes of CDI, and 31 clusters of related isolates were identified, 15 (47%) of which involved exclusively multiple specimens from the same patient. For the 16 clusters involving multiple patients, epidemiologic investigation revealed only 2 (12.5%) clusters with potential transmission events. Conclusions WGS identified a highly diverse group of C. difficile isolates among POTPs with CDI. Although WGS identified clusters of closely related isolates in multiple patients, epidemiologic investigation of shared inpatient exposures identified potential transmission in only 2 clusters. Clostridioides difficile transmission was uncommon in this population. More than 70% of new CDI reinfections in POTPs are actually recurrences caused by a previous CDI strain. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware of the existence of a capability document for advanced clinical practice in paediatric haematology and oncology • To learn about the process of developing a capability document for advanced clinical practice • To clarify the difference between competence and capability in the context of advanced clinical practice Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families. [ABSTRACT FROM AUTHOR]

Objective: to describe the strategies to be used in the continuing education of nursing professionals about end-of-life palliative care in pediatric oncology. Methods: qualitative research, data collection through semi-structured interviews. Twenty-nine nursing professionals who work in the pediatric sector of an oncology reference hospital in the city of Rio de Janeiro participated in the study. Data were processed by the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software using the descending hierarchical classification method. Results: educational strategies with nursing professionals should include a psychological approach, have the presence of a multidisciplinary team, be carried out in groups, periodically, and encourage participation and interaction. Conclusion: the study results show that to promote continuing education it is necessary to use strategies that facilitate the verbalization of feelings and emotions and that go beyond technical competence. [ABSTRACT FROM AUTHOR]

Introduction: Nursing‐sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. Design/Methods: A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open‐ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert‐scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta‐inferences were derived from the integration of Rounds One and Three findings. Results: Eighty‐five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low‐ and middle‐income and high‐income countries, and at least one panelist from the Americas. Conclusion: Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. Clinical Relevance: NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge‐sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings. [ABSTRACT FROM AUTHOR]

Purpose: In pediatric care settings, family‐centered care (FCC) is an integral way to ensure family involvement in their child's care and has been known to improve health outcomes and families' psychosocial well‐being. Similarly, nursing presence is deemed beneficial in the formation of authentic nurse–patient relationships and is known to facilitate healing and improve satisfaction for the patient and their family. The objective of this article is to explore how nursing presence supports FCC by closely examining the four concepts of FCC as described by Institute for Patient‐ and Family‐Centered Care: dignity and respect, information sharing, participation, and collaboration. A case study is also presented to demonstrate how nursing presence can be applied in FCC, when caring for a pediatric oncology patient. Conclusion: Nursing presence is essential in FCC since it plays a key role in the formation of relationships, a fundamental element in the four concepts. Attributes of nursing presence can be interwoven in the FCC framework and have positive clinical, social, and emotional outcomes for the patient and family. Although literature has explored associations between FCC and nursing presence, there is need for more scientific research to justify this argument to support the improvement of quality of family nursing care and strengthen the FCC model. Practice Implications: The four concepts of FCC lay a foundation for a model of care that can be enhanced by nursing presence, potentially providing a remedy for depersonalization of healthcare by improving nurse patient relationships in pediatric care settings. Nursing presence becomes less ambiguous when enacted in a FCC framework, revealing attributes that may be cultivated in family nursing to improve therapeutic relationships among nurses and family caregivers. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with cancer often undergo aggressive treatment and receive supportive care requiring a long-term tunneled central venous catheter (TCVC). Regular flushing promotes TCVC patency when not in use (i.e., noninfusing). However, TCVC flushing guidelines and the current practice of daily flushing are not based on high-quality evidence. Few studies have compared the effect of less frequent flushing on TCVC patency. The purpose of this study was to evaluate the feasibility of a three times weekly heparin flushing intervention, as compared to daily heparin flushing, in children and adolescents and young adults (AYAs) with noninfusing TCVCs. Methods: Twenty children and AYAs were randomized to one of two groups, standard of care (SOC) (i.e., daily heparin flushing) or intervention (three times weekly heparin flushing) for 8 weeks. Feasibility data (recruitment, retention, acceptability, TCVC patency, and complications) were analyzed descriptively. Results: Twenty of 22 eligible patients were enrolled in the study (90% recruitment rate). Four participants discontinued the study early due to TCVC removal (20% attrition rate). One participant in each group had their TCVC removed due to a central line-associated bloodstream infection, one SOC group participant had their TCVC removed due to damage, and one intervention group participant had their TCVC removed due to discontinuation of treatment. No participants were withdrawn for safety concerns or because they did not find the protocol acceptable. Conclusions: It is feasible to conduct a large-scale randomized controlled trial to investigate a three times weekly heparin flushing intervention in children and AYAs with TCVCs. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Psycho-Oncologie is the property of Tech Science Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Academic Research in Nursing (JAREN) is the property of Hemsirelikte Egitim ve Arastirma Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Periconceptional folate intake is associated with the establishment of DNA methylation in offspring; however, variations in this relation by food sources compared with folic acid supplements are not described. Also, maternal folate intake is associated with decreased risk of pediatric acute lymphoblastic leukemia (ALL), but the mechanism is not known. Objectives We evaluated the relation between periconceptional folate intake by source and DNA methylation at birth in a cohort of pediatric ALL cases and controls in an epigenome-wide association study. Methods Genome-wide DNA methylation status obtained from archived neonatal blood spots from pediatric ALL cases (n  = 189) and controls (n  = 205) in the California Childhood Leukemia Study (CCLS) from 1995–2008 was compared with periconceptional folate from total, food, and supplemental sources using multivariable linear regression. Further stratification was performed by income, education, ethnicity, and total folate intake. We evaluated variable DNA methylation response to periconceptional folate by ALL case status through an interaction term. Results Two significant differentially methylated probes (DMPs) were associated with food and supplemental periconceptional folate intake in all subjects (n  = 394). The top differentially methylated region at the promoter region of DUSP22 (dual specificity phosphatase 22) demonstrated DNA hypermethylation in ALL cases but not in controls in response to total and food folate intake. We further identified 8 interaction term DMPs with variable DNA methylation response to folate intake by ALL case status. Further stratification of the cohort by education and ethnicity revealed a substantially higher number of DMPs associated with supplemental folic acid intake in Hispanic subjects with lower income and educational level. Conclusions We identified modest associations between periconceptional folate intake and DNA methylation differing by source, including variation by ALL case status. Hispanic subjects of lower income and education appear uniquely responsive to periconceptional folate supplementation. [ABSTRACT FROM AUTHOR]

Background: Nursing staff retention is an ongoing concern within pediatric hematology/oncology settings globally. Work-related stressors cause emotional burden, psychological distress, and burnout to which nurses respond by leaving their workplace. Consequently, workplace culture and functionality are negatively impacted, quality of care reduces, and potential harm to patients increases. This paper aims to identify the "most" influencing factors for intention to leave among pediatric hematology/oncology nurses. Methods: A systematic search was undertaken on 29 July 2021 across five electronic databases, Cumulative Index to Nursing and Allied Health Literature, Joanna Briggs Institute, MEDLINE, PubMed, and Web of Science, using MeSH and keywords related to pediatric hematology/oncology nurse retention. Results: The initial search yielded 283 articles. Following abstract and full-text review, nine articles met inclusion criteria. Across all studies, strong links between health service organizational factors (e.g., unit acuity and time constraints), clinician demographics (e.g., age, education, experience, and coping mechanisms), and nursing retention within pediatric hematology/oncology settings were observed. Direct patient care and long-term relationships with pediatric hematology/oncology patients were identified as the most frequent and intense stressors, while also presenting the most rewarding aspect of the nurse's work. Discussion: Clinician burnout and retention were found to be complex and multifaceted organizational and individual issues, which most importantly evolved from accumulative exposure to specialty-specific stressors. Interventions to prevent clinician burnout and improve staff retention, therefore, need to comprise individual and organizational level strategies specific to the healthcare context. [ABSTRACT FROM AUTHOR]

Background: There is a lack of self-management tools for adolescents with cancer (AWC). This study evaluated the feasibility of Teens Taking Charge Cancer, a web-based self-management program. Methods: A pilot randomized control trial (RCT) was conducted across 4 pediatric oncology clinics. AWC (12–18 years) and their caregivers were randomized to either the intervention or control group. All were asked to complete 12 website modules over 12 weeks (at their own pace) and received monthly calls from health coaches. The intervention website was based on cognitive behavioral principals, designed as an interactive self-guided online program, while the control consisted of education and included links to 12 general cancer websites. Outcome assessments occurred at enrollment and 12 weeks post-intervention. The primary outcomes included rate of accrual and retention, adherence to the protocol, acceptability and satisfaction with intervention using questionnaire and semi-structured interviews, adverse events and engagement with the intervention. Results: Eighty-one teen-caregiver dyads were enrolled with a retention rate of 33%. In the intervention group 46% (n = 18) logged in at least once over the 12-week period. A mean of 2.4 of 12 modules (SD 3.0) were completed; and no one completed the program. Thirty-three percent of caregivers in the intervention logged into the website at least once and none completed the full program. Discussion: The results from this pilot study suggest that the current design of the Teens Taking Charge Cancer RCT lacks feasiblity. Future web-based interventions for this group should include additional features to promote uptake and engagement with the program. [ABSTRACT FROM AUTHOR]

Novel effective therapies are urgently needed in recurrent osteosarcoma. GD2 is expressed in human osteosarcoma tumours and cell lines. This study evaluated the disease control rate (DCR) in patients with recurrent osteosarcoma treated with the anti-GD2 antibody dinutuximab plus cytokine therapy as compared to historical outcomes. AOST1421 was a single-arm Phase 2 study for patients with recurrent pulmonary osteosarcoma in complete surgical remission. Patients received up to five cycles of dinutuximab (70 mg/m2/cycle) with granulocyte-macrophage colony-stimulating factor (GM-CSF). Two different dinutuximab infusion schedules were studied: 35 mg/m2/day over 20 h (2 days) and 17.5 mg/m2/day over 10 h (4 days). Primary end point was DCR, defined as a proportion of patients event free at 12 months from enrolment. The historical benchmark was 12-month DCR of 20% (95% CI 10–34%). Dinutuximab would be considered effective if ≥ 16/39 patients remained event free. Secondary objectives included toxicity evaluation and pharmacokinetics. Thirty-nine eligible patients were included in the outcome analysis. Dinutuximab did not demonstrate evidence of efficacy as 11/39 patients remained event free for a DCR of 28.2% (95% CI 15–44.9%). One of 136 administered therapy cycles met criteria for unacceptable toxicity when a patient experienced sudden death of unknown cause. Other ≥ Grade 3 toxicities included pain, diarrhoea, hypoxia, and hypotension. Pharmacokinetic parameters were similar in the two schedules. The combination of dinutuximab with GM-CSF did not significantly improve DCR in recurrent osteosarcoma. Dinutuximab toxicity and pharmacokinetics in adolescent and young adult osteosarcoma patients were similar to younger patients. Other strategies for targeting GD2 in osteosarcoma are being developed. • GD2 is expressed in most osteosarcoma tumours and cell lines. • Dinutuximab with granulocyte-macrophage colony-stimulating factor (GM-CSF) in patients with recurrent osteosarcoma was evaluated. • Dinutuximab failed to improve 12-month disease control rate in these patients. • Study provides safety and PK of dinutuximab in adolescent and young adult patients. • Novel therapeutics to target GD2 are being evaluated. [ABSTRACT FROM AUTHOR]

Background: Children hospitalized for cancer treatment are known to experience high levels of anxiety. This study aimed to examine the effects of making jewelry from beads on the state and trait anxiety levels of children with cancer. Methods: This parallel group, randomized controlled trial was conducted on 62 children aged 7–18 who were being treated for cancer. The children were selected using the random sampling method. The jewelry-making sessions with the children in the intervention group were held twice a week for four weeks. Data were analysed using the chi-square test, the Student's t -test, the independent samples t -test and linear regression. Results: The state anxiety levels of the children in the intervention group decreased both in the first week and the fourth week after making jewelry. The difference in the average post-test scores between the two groups was found to be significant (p <.05). The fourth week average trait anxiety score of the children in the intervention group decreased (M = 33.2) in comparison to the average score of the control group (M = 36.5). The difference between the two groups was found to be significant (p <.001). Discussion: This study found that the activity of making jewelry from beads was effective in reducing the state and trait anxiety levels of children with cancer. [ABSTRACT FROM AUTHOR]

Background: Because routine nursing quality indicators are not suitable to evaluate pediatric oncology nursing care, this study aimed to identify a set of quality indicators for pediatric oncology nursing care in mainland China. Method: This prospective investigation utilized a modified Delphi technique and an analytic hierarchy process. A survey questionnaire was developed using a literature review and semi-structured interviews. Fifteen invited experts evaluated the importance of potential indicators through three rounds of Delphi survey by email in 2018. The importance weight of each indicator was identified through analytic hierarchy process. Results: In the Delphi survey, the average authoritative coefficient was 0.93–0.96 for each round of the inquiry. After three rounds of survey, 29 quality indicators were identified as important nursing outcomes for assessing the quality of pediatric oncology nursing care in mainland China. The importance rating mean score of indicators ranged between 4.67 and 5.00 on a 5-point scale, and the variation coefficient ranged between 0 and 0.19. Expert-assigned indicator importance weight varied between 0.0040 and 0.0870. Conclusion: This study identified an indicator system with 29 nursing-sensitive quality indicators that may represent potential indicator candidates for quality assessment of pediatric oncology nursing practice in mainland China. [ABSTRACT FROM AUTHOR]

Simple Summary: Nutritional management is an underestimated issue in treating pediatric cancer, since a systematic approach is currently lacking. In this consensus statement, a cohort of 12 experts selected from four different tertiary pediatric oncology centers formulated 21 clinical questions regarding the identification and treatment of nutritional issues in children with cancer. These questions were discussed, and practical recommendations were provided. With this paper, we aimed to give consensus-based guidance for addressing the nutritional needs of children with cancer, filling a gap in the field. Malnutrition, intended as both overnutrition and undernutrition, is a common problem in children with cancer, impacting quality of life as well as survival. In addition, nutritional imbalances during childhood can significantly affect proper growth. Nevertheless, there is currently a lack of a systematic approach to this issue in the pediatric oncology population. To fill this gap, we aimed to provide practice recommendations for the uniform management of nutritional needs in children with cancer. Twenty-one clinical questions addressing evaluation and treatment of nutritional problems in children with cancer were formulated by selected members from four Italian Association of Pediatric Hematology and Oncology (AIEOP) centers and from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer. A literature search in PubMed was performed; during two consensus meetings, all recommendations were discussed and finalized using the nominal group technique. Members representing every institution voted on each recommendation. Finally, recommendations were approved by all authors. [ABSTRACT FROM AUTHOR]

Introduction: Work-related post traumatic stress disorder (PTSD) can develop in nurses. Pediatric oncology nursing is a potentially high-risk subspecialty for PTSD secondary to the nature of the work. This study aimed to describe the prevalence of PTSD symptomology and explore relationships between nurse psychological capital, workplace social supports, and PTSD symptomology in pediatric oncology nurses. Methods: The study utilized a cross-sectional correlational survey design. Pediatric oncology nurses working in direct patient care in the United States completed a demographics questionnaire, Psychological Capital Questionnaire (PCQ), Coworker Support Scale, Supervisor Support Scale, and the Post traumatic Checklist for Diagnostic and Statistical Manual of Mental Disorders (PCL-5). Descriptive and inferential statistics, including logistic regression models, were used to analyze data. A cutoff score of ≥31 on the PCL-5 was used to determine the prevalence of PTSD symptomology. Results: The sample included 424 nurses. The prevalence of PTSD symptomology was 13.4%. Work setting (inpatient), decreased coworker and leadership social support, and psychological capital were independently associated with PTSD symptomology. After controlling for covariates, only psychological capital was associated with PTSD symptomology. For a 1 unit decrease in PCQ score, pediatric oncology nurses were 4.25 times more likely to have PTSD symptomology. Discussion: PTSD prevalence rates in pediatric oncology nurses are aligned with rates found in other nursing specialties. Nurse psychological capital may play a protective role against PTSD symptomology. Implications for Future Research: Findings support PTSD as a serious workplace concern for nurses. Workplace programs that foster nurses' psychological capabilities should be considered to protect against the development of PTSD symptomology. [ABSTRACT FROM AUTHOR]