Pediatric Hematology and Oncology最新文献

{"title":"German physicians' perceptions and views on complementary medicine in pediatric oncology: a qualitative study.","authors":"Pia Klatt,&nbsp;Christin Kohrs,&nbsp;Barbara Stein,&nbsp;Markus Horneber,&nbsp;Daniela Reis,&nbsp;Jan Schildmann,&nbsp;Alfred Längler","doi":"10.1080/08880018.2022.2103218","DOIUrl":"https://doi.org/10.1080/08880018.2022.2103218","url":null,"abstract":"<p><p>Complementary and alternative medicine (CAM) use in children with cancer has a high prevalence. If (parents of) patients bring up the topic of CAM, pediatric oncologists (POs) face considerable challenges regarding knowledge and professional behavior. In this study, we explore German POs' understanding of CAM and related attitudes as well as challenges and strategies related to CAM discussions by means of semi-structured interviews analyzed according to principles of qualitative thematic analysis with parents of children with cancer. We could conduct 14 interviews prior to theoretical saturation. The interviews had a duration of 15-82 min (<i>M</i> = 30.8, <i>SD</i> = 18.2). Professional experience in pediatric oncology was between 0.5 and 26 years (<i>M</i> = 13.8, <i>SD</i> = 7.6). Main themes identified were a heterogeneous understanding and evaluation of CAM, partly influenced by personal experiences and individual views on plausibility; the perception that CAM discussions are a possible tool for supporting parents and their children and acknowledgement of limitations regarding implementation of CAM discussions; and uncertainty and different views regarding professional duties and tasks when being confronted with CAM as a PO. Our interdisciplinary interpretation of findings with experts from (pediatric) oncology, psychology, and ethics suggests that there is need for development of a consensus on the minimal professional standards regarding addressing CAM in pediatric oncology.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"352-362"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9373897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 infection and mortality in pediatric patients with hematological malignancies and solid tumors.","authors":"João Eduardo Andrade Tavares de Aguiar,&nbsp;Marcos Antônio Lima Carvalho,&nbsp;Simone Santana Viana,&nbsp;Paulo Ricardo Martins-Filho,&nbsp;Rosana Cipolotti","doi":"10.1080/08880018.2022.2120937","DOIUrl":"https://doi.org/10.1080/08880018.2022.2120937","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) has emerged as a novel cause of mortality among children and adolescents in low- and middle-income settings. 1 In Brazil, deaths from COVID-19 among children and adolescents have exceeded the annual average of deaths from neoplasia, nervous system diseases, cardiac causes, and other vaccine-preventable diseases. 2 It was shown that the overall mortality rate associated with COVID-19 for children and adolescents aged 0–19 up to January 2022 was esti-mated at ∼ 4 deaths per 100,000 children and adolescents, with higher rates registered in the North and Northeast, 3 recognized as the poorest regions in the country. In addition, studies have suggested that immunocompromised children, including those with cancer, are at an increased risk of death from COVID-19 compared to hospitalized children without comorbidities 4 or the general pediatric population. 5 Here, we reported the prevalence of SARS-CoV-2 infection among hospitalized children and adolescents aged 0–21 with cancer and the occurrence of in-hospital deaths associated with COVID-19 in this population. This cross-sectional study was performed from April 2020 to September 2021 at the pediatric oncology center of a tertiary public hospital affiliated to the Brazilian Public Health System ( Sistema Único de Saúde - SUS) in Northeast Brazil. Due to the pandemic of COVID-19, the oncology center has established as a protocol the regular testing for SARS-CoV-2 by RT-PCR of all children undergoing cancer treatment, admitted to the hospital with cancer-related complications, or even with respiratory symptoms suggestive of COVID-19.","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"429-432"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9434275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features and prognostic implications of ecotropic viral integration site 1 (<i>EVI1</i>) in childhood acute lymphoblastic leukemia.","authors":"Ming Jia,&nbsp;Bo-Fei Hu,&nbsp;Jing-Ying Zhang,&nbsp;Li-Yao Xu,&nbsp;Yong-Min Tang","doi":"10.1080/08880018.2022.2117881","DOIUrl":"https://doi.org/10.1080/08880018.2022.2117881","url":null,"abstract":"<p><p>In contrast to the extensive knowledge on EVI1 in myeloid malignancies, few data are available on the EVI1 transcript in pediatric ALL. The purpose of this study was to examine the clinical and biological significance of EVI1 and validate its prognostic significance in pediatric patients with ALL. Here, we examined the clinical and biological significance of EVI1 expression, as measured by real-time polymerase chain reaction (PCR) in 837 children with newly diagnosed ALL treated on the National Protocol of Childhood Leukemia in China (NPCLC)-ALL-2008 protocol, and aimed to explore their prognostic significance in pediatric ALL patients. The EVI1 expression was detected in 27 of 837 (3.2%) patients. No statistically significant differences in prednisone response, complete remission (CR) rates and relapse rates were found between EVI1 overexpression (EVI1⁺) group and EVI1^- group. Moreover, we found no significant difference in event-free survival (EFS) and overall survival (OS) between these two groups, also multivariate analysis did not identify EVI1⁺ as an independent prognostic factor. In the subgroup analysis, there was no difference in clinical outcome between EVI1⁺ and EVI1^- patients in standard‑risk (SR), intermediate-risk (IR) and high-risk (HR) groups. In the minimal residual disease (MRD)<10^-4 group, EVI1⁺ patients have significantly lower EFS and OS rates compared to EVI1^- patients. Further large‑scale and well‑designed prospective studies are required to confirm the results in the future.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"371-381"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9380257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of socio-behavioral measures implemented during the SARS-CoV-2 pandemic on the outcomes of febrile neutropenia episodes in pediatric cancer patients: a single center quasi-experimental pre-post study.","authors":"Charles Nathaniel Nessle,&nbsp;Tom Braun,&nbsp;Vineet Chopra,&nbsp;Sung Won Choi,&nbsp;Rajen Mody","doi":"10.1080/08880018.2022.2107746","DOIUrl":"https://doi.org/10.1080/08880018.2022.2107746","url":null,"abstract":"<p><p>During COVID-19, public health measures including masks and social distancing decreased viral upper respiratory infections (URI). Upper respiratory infections are the most common infectious etiology for low-risk pediatric febrile neutropenia (FN). This single-center, quasi-experimental, pre-post study was designed to understand the impact of public health measures on FN admissions and outcomes in the general pediatric oncology population during the COVID (March 2020-February 2021) vs. pre-COVID era (January 2018-February 2020) and their respective respiratory seasons (November-February). Episodes were risk-stratified using a tool recommended by the Children's Oncology Group. Descriptive and bivariate statistics were used to compare admission characteristics and outcomes. Comparing respiratory seasons, the Covid-era season had 60% fewer URI diagnoses (5/12), while high-risk episodes (63.6% [28/44] vs. 44.2% [23/52]) and intensive care admissions (18.2% [8/44] vs. 3.8% [2/52]) increased. Between eras, URIs were lower in the COVID-era (10.8% [16/148] vs. 19.9% [67/336]; <i>p</i> = 0.01), but admission characteristics and severe outcomes were not different. The impact of public health measures was most prominent during the respiratory season. Despite decreased incidence of URIs, the overall admission characteristics and severe outcomes were minimally impacted due to the brevity of respiratory seasons, but larger studies are warranted.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"412-421"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025165/pdf/nihms-1838142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9412168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual enzyme therapy improves adherence to chemotherapy in a patient with gaucher disease and Ewing sarcoma.","authors":"Brandon Lucari,&nbsp;Eran Tallis,&nbsp;Vernon Reid Sutton,&nbsp;Timothy Porea","doi":"10.1080/08880018.2022.2124006","DOIUrl":"https://doi.org/10.1080/08880018.2022.2124006","url":null,"abstract":"<p><p>This case reports concomitant use of enzyme and substrate reduction therapy to improve chemotherapy adherence in a pediatric patient diagnosed with Ewing sarcoma (ES) and type 1 Gaucher disease (GD). The 17-year-old female presented with 5 months of right knee pain with associated mass on exam. She was diagnosed with ES with pulmonary metastasis. The patient was treated with 17 alternating cycles of vincristine-doxorubicin-cyclophosphamide and ifosfamide and etoposide chemotherapy followed by tumor resection and radiation per standard protocol. As part of her staging work-up, bone marrow biopsy was performed, significant for Gaucher cells. After the second cycle of chemotherapy the patient began to experience severe delays averaging 30 days between cycles compared to 17.29 days observed in Children's Oncology Group data. Given her bone marrow biopsy findings and chemotherapy delays GD screening was obtained and the patient was diagnosed with GD following genetic confirmation. Due to delays in chemotherapy decreasing chance of remission, the patient was referred to Genetics for aggressive management with imiglucerase and eliglustat. After initiation of therapy the period between chemotherapy cycles decreased to 23 days on average, with a 21% increase in platelet count during therapy. The patient was able to complete ES therapy achieving remission. GD is associated with an increased risk of malignancy, as seen in our patient with ES. GD patients experience prolonged hematologic cytopenia during cancer treatment. Combining Enzyme and Substrate Reduction Therapies should be investigated as an option to improve chemotherapy adherence in GD patients.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"422-428"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9734124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presence of identical B-cell clone in both cerebrospinal fluid and tumor tissue in a patient with opsoclonus-myoclonus syndrome associated with neuroblastoma.","authors":"Kazuhiro Noguchi,&nbsp;Yasuhiro Ikawa,&nbsp;Mika Takenaka,&nbsp;Yuta Sakai,&nbsp;Toshihiro Fujiki,&nbsp;Rie Kuroda,&nbsp;Hiroko Ikeda,&nbsp;Satoko Nakada,&nbsp;Kozo Nomura,&nbsp;Seisho Sakai,&nbsp;Masaki Fukuda,&nbsp;Raita Araki,&nbsp;Yukitoshi Takahashi,&nbsp;Taizo Wada","doi":"10.1080/08880018.2022.2109784","DOIUrl":"https://doi.org/10.1080/08880018.2022.2109784","url":null,"abstract":"<p><p>Opsoclonus-myoclonus syndrome associated with neuroblastoma (OMS-NB) is a refractory paraneoplastic syndrome which often remain neurological sequelae, and detailed pathogenesis has remained elusive. We encountered a pediatric patient with OMS-NB treated by immunosuppressed therapy who showed anti-glutamate receptor δ2 antibody and increased B-cells in cerebrospinal fluid (CSF), and multiple lymphoid follicles containing abundant Bcells in tumor tissue. Unbiased B-cell receptor repertoire analysis revealed identical B-cell clone was identified as the dominant clone in both CSF and tumor tissue. These identical B-cell clone may contribute to the pathogenesis of OMS-NB. Our results could facilitate the establishment of pathogenesis-based treatment strategies for OMS-NB.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"363-370"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9748836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of iron overload with T2*MRI in children treated for hematological malignancies.","authors":"Vinay Munikoty,&nbsp;Kushaljit Singh Sodhi,&nbsp;Anmol Bhatia,&nbsp;Prateek Bhatia,&nbsp;Savita Verma Attri,&nbsp;Manoj K Rohit,&nbsp;Amita Trehan,&nbsp;Niranjan Khandelwal,&nbsp;Deepak Bansal","doi":"10.1080/08880018.2022.2098436","DOIUrl":"https://doi.org/10.1080/08880018.2022.2098436","url":null,"abstract":"<p><p>Iron overload may contribute to long-term complications in childhood cancer survivors. There are limited reports of assessment of tissue iron overload in childhood leukemia by magnetic resonance imaging (MRI). A cross-sectional, observational study in children treated for hematological malignancy was undertaken. Patients ≥6 months from the end of therapy who had received ≥5 red-cell transfusions were included. Iron overload was estimated by serum ferritin (SF) and T2*MRI. Forty-five survivors were enrolled among 431 treated for hematological malignancies. The median age at diagnosis was 7-years. A median of 8 red-cell units was transfused. The median duration from the end of treatment was 15 months. An elevated SF (>1,000 ng/ml), elevated liver iron concentration (LIC) and myocardial iron concentration (MIC) were observed in 5 (11.1%), 20 (45.4%), and 2 (4.5%) patients, respectively. All survivors with SF >1,000 ng/ml had elevated LIC. The LIC correlated with SF (<i>p</i> < 0.001). MIC lacked correlation with SF or LIC. Factors including the number of red-cell units transfused and duration from the last transfusion were associated with elevated SF (<i>p</i> = 0.001, 0.002) and elevated LIC (<i>p</i> = 0.012, 0.005) in multiple linear regression. SF >595 ng/ml predicted elevated LIC with a sensitivity of 85% and specificity of 91.6% (AUC 91.2%). A cutoff >9 units of red cell transfusions had poor sensitivity and specificity of 70% and 75% (AUC 76.6%) to predict abnormal LIC. SF >600 ng/ml is a robust tool to predict iron overload, and T2*MRI should be considered in childhood cancer survivors with SF exceeding 600 ng/ml.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"315-325"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9733642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global caregiver concerns of SARS-CoV-2 vaccination in children with cancer: a cross-sectional mixed-methods study.","authors":"Julia M Gumy,&nbsp;Allison Silverstein,&nbsp;Erica C Kaye,&nbsp;Miguela A Caniza,&nbsp;Maysam R Homsi,&nbsp;Kathy Pritchard-Jones,&nbsp;Jessica M Bate","doi":"10.1080/08880018.2022.2101724","DOIUrl":"https://doi.org/10.1080/08880018.2022.2101724","url":null,"abstract":"<p><p>The objective of this study was to understand global caregiver concerns about SARS-CoV-2 vaccination for children with cancer and to provide healthcare providers with guidance to support parental decision-making. A co-designed cross-sectional mixed-methods survey was distributed to primary caregivers of children with cancer globally between April and May 2021 via several media. Caregivers were asked to rate the importance of vaccine-related questions and the median scores were ranked. Principal Component Analysis was conducted to identify underlying dimensions of caregiver concerns by World Bank income groups. Content analysis of free-text responses was conducted and triangulated with the quantitative findings. 627 caregivers from 22 countries responded to the survey with 5.3% (<i>n</i> = 67) responses from low-and-middle-income countries (LMIC). 184 caregivers (29%) provided free-text responses. Side effects and vaccine safety were caregivers' primary concerns in all countries. Questions related to logistics were of concern for caregivers in LMIC. A small minority of caregivers (<i>n</i> = 17) did not consider the survey questions important; free-text analysis identified these parents as vaccine hesitant, some of them quoting safety and side effects as main reasons for hesitancy. Healthcare providers and other community organizations globally need to provide tailored information about vaccine safety and effectiveness in pediatric oncology settings. Importantly, continued efforts are imperative to reduce global inequities in logistical access to vaccines, particularly in LMIC.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"341-351"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward 2030: SIOP Africa adopts the Global Initiative for Childhood Cancer.","authors":"Joyce Balagadde-Kambugu,&nbsp;Alan Davidson,&nbsp;Laila Hessissen,&nbsp;Glenn Mbah Afungchwi,&nbsp;Jeannette Parkes,&nbsp;Jaques van Heerden,&nbsp;Jennifer Geel","doi":"10.1080/08880018.2022.2117883","DOIUrl":"https://doi.org/10.1080/08880018.2022.2117883","url":null,"abstract":"Implementation of the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC) has galvanized efforts to improve childhood cancer services across Africa, by providing the CureAll framework.1 The benefits to being a GICC implementing country are that attention can be focused on identifying needs by convening stakeholders to define shared objectives, increasing the capacity of a country to manage childhood cancer and developing best practices.1 Ghana, Morocco, Senegal, Zambia and Zimbabwe are currently focus countries with South Africa, Mali, Cameroon and Uganda in the early stages of implementation.2 The acronym CureAll highlights the four essential pillars of the framework: 1) adequately staffed Centers of excellence and care networks, 2) Universal health coverage (UHC) 3) context-appropriate treatment and diagnostic Regimens and roadmaps, and 4) Evaluation and monitoring. These pillars are underpinned by cross-cutting foundational enablers: Advocacy, Leveraged financing, and Linked governance.1 The initiative envisions the unification of diverse stakeholders including patients, families, multidisciplinary pediatric oncology teams and governments, to improve pediatric oncology services. In resource-limited settings, strong leadership is essential in applying available tools in innovative ways to achieve these results. Meeting the 2030 target of 60% survival, double the current estimate, can only be achieved by a unified team approach. SIOP Africa has enthusiastically embraced this framework to improve services for children with cancer and achieve its ambitious goals. Assuming a modest age-standardized ratio of 100 cancers per million children under 15 per year, and a population of 1.2 billion with 40% under the age of 15, there are at least 48 000 new cases in Africa annually.3,4 Many go undiagnosed and report low survival rates, therefore overestimate true survival. Current data only reflect outcomes of those who have accessed services.","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"197-202"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9286696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy supply chain management, safe-handling and disposal in Ethiopia: the case of Tikur Anbessa specialized hospital.","authors":"Atalay Mulu Fentie,&nbsp;Zelalem Tilahun Mekonen,&nbsp;Zelalem Gizachew,&nbsp;Mahlet Hailemariam,&nbsp;Stephen M Clark,&nbsp;Jaime Richardson,&nbsp;Benyam Muluneh","doi":"10.1080/08880018.2022.2139028","DOIUrl":"https://doi.org/10.1080/08880018.2022.2139028","url":null,"abstract":"<p><p>Optimal chemotherapy management is substandard in low and middle-income countries. We aimed to identify major gaps to design interventional strategies for improved chemotherapy management at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. This study was conducted using an observational checklist, open-ended questions, record review, and key informant interviews of department heads and focal persons at TASH. Findings were categorized into specific themes that developed. Chemotherapy represented 60.2% of the hospital medication budget. Drug utilization was quantified via monthly consumption documentation and forecasting. However, unreliable data resulted in frequent stockouts (unavailability of the item when it is needed) of chemotherapy with only 67.8% availability. Thirteen healthcare personnel (9 nurses, 2 pharmacists and 2 hospital cleaners) were interviewed: all clinical staff but neither of hospital cleaners believed that they were at risk of hazardous agents. Challenges identified included inadequate and frequent stockouts (unavailability of the item when it is needed) of personal protective equipment, lack of standardized guidelines for chemotherapy handling, admixture, and disposal, lack of designated preparation rooms, and lack of training. All nine nurses handled chemotherapy admixtures despite only two nurses previously receiving in-service training. Most of the participants had never witnessed the disposal of anticancer drugs. Prompted by the results of this study, a dialogue was initiated among members of TASH, the American Cancer Society and the University of North Carolina to implement action-oriented projects to address the gaps identified at TASH. These gaps directly and indirectly affect care and treatment outcomes of patients at a large cancer center. Collaborations with well-resourced centers are potential models for improving chemotherapy management.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"258-266"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}