Oncology Commons^™

Exploring The Role Of Pain On Physical Activity Among Youth With Acute Lymphoblastic Leukemia Using The Biopsychosocial Model, Anna E. Van Asselt, Renee Gilbert, Meghan Tokala, Jacee Weber, Meredith L. Dreyer Gillette, Robert C. Gibler, Carolyn R. Bates, Keith August

Research Days

The Role of Pain on Physical Activity in Pediatric ALL

Keywords: Biopsychosocial model, pediatric Acute Lymphoblastic Leukemia, pain, physical activity

Introduction: Engaging in physical activity (PA) during cancer treatment benefits a child’s physical and mental well-being (McLaughlin et al., 2021). However, engaging in PA may be challenging due to treatment and disease-related pain (Uhl et al., 2020). Pediatric cancer research has primarily focused on management of procedural and chronic pain, with fewer studies examining how pain may interfere with PA during treatment (Clews et al., 2022). The current study qualitatively investigated the impact of pain on PA using a …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Research Days

Early implementation of palliative care in pediatric oncology is well established but its role in pediatric hematopoietic stem cell transplant (HSCT) patients is yet to be fully determined. Multiple organizations encourage palliative care involvement in HSCT patients. Our aim was to increase palliative care team consults for patients receiving HSCT for our targeted diagnosis. Though we did not achieve this aim, we were able to increase the palliative care team's involvement in the total cohort of patients undergoing HSCT.

A Genomics Driven Induced Pluripotent Stem Cell Model Of Infant Acute Lymphoblastic Leukemia - Early Results, Meagan Vacek, Jacqelyn Nemechek, Irina Pushel, Bradley Thornton, Molly Leyda, Priyanka Prem Kumar, Midhat Farooqi, Jay L. Vivian, Erin M. Guest, John M. Perry

Research Days

While the cure rates for pediatric ALL have improved over the decades, infants with ALL (iALL) have not benefitted from these advances and continue to have a devastating prognosis. Unfortunately progress in treatment has also been slowed by inadequate research models. With this project, we address this unmet need by investigating a novel model to understand the cellular and molecular changes that occur during iALL onset and progression.

Ebv Infection Rates In An Urban Pediatric Population With Oncologic Diagnoses, Daniel Barr, Maxim Yankelevich, Gregory Halligan, Eugenia Kim, Jason White

St. Chris Research Day

No abstract provided.

Frailty In Children And Adolescents With Acute Lymphoblastic Leukemia Or Lymphoblastic Lymphoma Receiving Maintenance Chemotherapy – A Pilot Study, Thomas R. Cochran, Joy M. Fulbright, Samantha Butrous, Brian R. Lee, Keith J. August, David A. White

Research Days

The submitted study aims to identify children with acute lymphoblastic leukemia or lymphoblastic lymphoma that meet frailty criteria early to allow for prevention of chronic health conditions that lead to increased mortality as survivors age into adulthood. Prevention and/or reversal of frailty has the potential to improve quality of life, decrease burden of disease, and extend the lifespan of the growing population of childhood cancer survivors. Given that frailty has been accepted as a tool to identify elderly and chronically sick adults highly vulnerable to adverse health outcomes, better understanding of the relevance and applicability of frailty in pediatrics may …

Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader

Rowan-Virtua Research Day

Ewing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies.

Cost-Effectiveness And Outcomes Of Utilizing Tisagenlecleucel Therapy (Car T-Cell) In Pediatric Acute Lymphoblastic Leukemia In Comparison To Standard Of Care (Soc) Therapies: A Scoping Review, Andrew Atschinow, Evangeline Attota, Warren Chan, Pooja Kasarapu, Priyal Shah, Karina Vizzoni

Rowan-Virtua Research Day

Aims

This review aims to assess the correlations between outcomes and cost of treatment methods for pediatric acute lymphoblastic leukemia patients, specifically comparing CAR T-cell therapy and Standard-of-Care (SoC) therapy. The socioeconomic background of patients will also be taken into consideration to see if there are differences in their outcomes.

Methods

Peer-reviewed publications were collected from PubMed and Web of Science. The keyword strings used were “acute lymphoblastic leukemia,” “pediatric acute lymphoblastic leukemia,” “pediatric,” “CAR T-cell therapy,” and “cost-effectiveness.” 27 citations were obtained. Titles were screened by 6 authors. Articles met the inclusion criteria including potential Quality-Adjusted Life Year (QALY) …

A Novel Therapy For Refractory Cbfa2t3::Glis2-Associated Amkl Using Stro-002 And Plerixafor, Amy Johnson Md, Mba, Alan S. Gamis, Arturo Molina, Soheil Meshinchi, Karen Lewing

Research Days

Background: CBFA2T3::GLIS2-associated AML (CBF/GLIS AML) is an aggressive form of AML often associated with AMKL and recognized by its unique RAM phenotype by flow. It has a very poor prognosis, frequently refractory to standard of care regimens, with extreme marrow localization of leukemic blasts likely mediated by high CXCR4 (CD184) expression. The CBFA2T3::GLIS2 fusion gene is the most common oncogenic transcript in pediatric AMKL and universally results in high expression of FOLR1 surface antigen. STRO-002, an antibody drug conjugate targeting FOLR1, is currently in Phase I clinical trials for adults with refractory ovarian and endometrial malignancies A summary of 17 …

Bone Marrow Transplant For Macrophage Activation Syndrome In Systemic Juvenile Idiopathic Arthritis, Shailly Gaur, Michael J. Holland, J Allyson Hays, Ibrahim A. Ahmed

Research Days

Background

The recognition of macrophage-activation-syndrome (MAS) in the setting of systemic-juvenileidiopathic-arthritis (sJIA) is complex, but a necessary distinction given emerging treatment options. With overlapping clinical manifestations including fever, end-organ involvement and lymphadenopathy, there is a focus on laboratory values to differentiate MAS from a sJIA flare. Once parameters are met, multiple treatment modalities can be considered, as monotherapy or in combination, including steroids, immunosuppression, chemotherapy, intravenous immunoglobulin, and cytokine-directed biologics. Given the long-term morbidity and mortality associated with progressive inflammation and immune dysregulation due to MAS with sJIA, it is imperative to regain control over this complication. However, these treatments …

Reducing The Risk Of Chemotherapy Exposure, Miranda Susman

Symposium of Student Scholars

Concerns about antineoplastic drugs (ANPDs), also known as chemotherapy, began in the early 1970s by the National Institute for Occupational Safety and Health. Although ANPDs are used as a standard treatment for cancer, these drugs are considered hazardous due to their adverse health effects. About eight million healthcare workers are exposed to ANPDs and therefore essential that we continue to educate on ways to reduce the risk of exposure to occupational and home health hazards. The overall purpose of this study is to determine if additional education and use of surface wipe samplings reduce the risk of exposure. A literature …

Variation In Thiopurine Metabolism In Hispanic Children, Kayeleigh Higgerson Do

Research Days

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Overall survival rate is > 90% in the United States. However, ethnic and racial disparities remain. Hispanic patients have an inferior overall survival compared to non-Hispanics. The reasons for these differences remain unclear. Mercaptopurine (6MP) is a crucial drug in ALL treatment. Variations in the TMPT and NUDT15 genes lead to altered 6MP metabolism and accumulation of toxic metabolites (6TGN or 6MMPN). Each metabolite is associated with specific dose-limiting toxicities. The accumulation of 6TGN causes myelosuppression, and increased 6MMPN causes GI toxicity. While variants in these genes have been identified …

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Primary Venous Thromboprophylaxis In Pediatric Oncology Patients, Kyra Mccarty

Research Days

Background: The Virchow’s Triad principles of venous stasis, endothelial damage, and hypercoagulability are all features of malignancy and contribute to the increased risk venous thromboembolism (VTE) seen in oncology patients. Additionally, certain chemotherapy treatments, presence of a central venous catheter and immobility are also intrinsically associated with malignancy diagnoses and exacerbate this risk. However, much debate exists over the use of thromboprophylaxis in the pediatric population, primarily due to lack of evidence regarding safety and efficacy, primarily the risk of major bleeding. Multiple retrospective studies have attempted to identify the primary risk factors for VTE in this pediatric oncology patient …

A Novel Approach To Triosephosphate Isomerase Deficiency, Kyra Mccarty

Research Days

Background: Triosephosphate isomerase deficiency (TPID) is a glycolytic pathway enzymopathy causing hemolytic anemia and neurologic dysfunction. TPID is caused by mutations in the TPI1 gene. These patients experience severe hemolytic anemia in infancy followed by progressive neurodegeneration. Diagnosis of TPID is made by measuring decreased TPI enzyme activity elevated dihydroxyacetone phosphate (DHAP) levels in the blood. The diagnosis is confirmed by molecular genetic testing. Neurological involvement typically manifests between 6 and 24 months of age, causing progressive motor dysfunction. Chronic axonal neuropathy is often present on nerve biopsy, and peripheral neuropathy is evident on electrophysiologic studies. Splenectomy and blood transfusions …

Adolescent And Young Adult Oncology Patient And Provider Perspectives In Philadelphia (Aya-4p), Christoher Terry, Md, Miriam Pomerantz, Lsw, Jodi Sandos, Lcsw, Lindsay Wilde, Md

Health Equity and Quality Improvement (HEQI) Summit

Primary Objectives

• To assess the current perspective of AYA patients regarding medical services and psychosocial support delivered to AYAs in Philadelphia
• To assess the current knowledge and perspective of healthcare providers at the SKCC about the care and services needed by AYA patients

A New Paradigm: Ecmo Therapy In Pediatric Hematology/Oncology Patients, Igor Areinamo

Research Days

Background: The use of extracorporeal membrane oxygenation (ECMO) for support of pediatric patients has significantly increased in the past years. Patients with known oncologic diseases, immunodeficiencies, or bone marrow transplants (BMT) have traditionally not been considered candidates for Extracorporeal membrane oxygenation (ECMO) due to perceived high risk for mortality. Ongoing advances have continued to push the boundaries of ECMO use and we report our recent experience with this patient population

Objectives/Goal: To evaluate survival to discharge of pediatric patients who require ECMO support and who also have an underlying hematologic or oncologic disease process. To determine specific patient characteristics that …

Changes In Family Functioning During The First Year Of Pediatric Cancer Treatment: A Mixed-Method Pilot Study, Carolyn Bates

Research Days

Background: A new diagnosis of pediatric cancer presents a sudden and tremendous stressor for families of all backgrounds and circumstances (Long & Marsland, 2011; Bemis et al., 2015). Although many families are resilient in the context of new cancer diagnosis, approximately 33% are at risk for negative outcomes due to psychosocial distress and difficulties with effective coping (Kazak et al., 2020; Pai et al., 2008), supporting the need for systematic assessment of psychosocial health as a standard of care in pediatric oncology (Kazak et al., 2015). Alongside heightened stress within the first year of diagnosis, parents may relax family rules …

A Pediatric Case Of Treatment-Related Myelodysplastic Syndrome While On Therapy For Pre-B All, Sara Mcelroy

Research Days

Background: Treatment-related myelodysplastic syndrome (t-MDS) is a known, but rare, late effect of cancer therapy, specifically radiation, alkylating agents or topoisomerase II inhibitors. When secondary to treatment with alkylating agents, t-MDS typically occurs 4 to 7 years after therapy, and common cytogenetics include chromosomes 5 and 7 abnormalities. Treatment in children with t-MDS is typically allogeneic stem cell transplant, but the prognosis remains poor.

Objectives/Goal: To describe a rare case of a pediatric patient who developed t-MDS while receiving treatment for Pre-B Cell Acute Lymphoblastic Leukemia (pre-B ALL) and to outline the treatment regimen that he received.

Methods/Design: Case Report …

Impact Of Covid-19 On Families With A Child In Cancer Treatment, Mirae J. Fornander

Research Days

Background: A new diagnosis of pediatric cancer diagnosis is a sudden and tremendous stressor to families (Long & Marsland, 2011). The COVID-19 pandemic presented an acute, universal stressor that impacted daily life around the world (Brooks et al., 2020). The impact of the COVID-19 pandemic on children with cancer and their families is not yet known.

Objectives/Goal: The current study is a pilot investigation of COVID-19 exposure and impact among a sample of families with a child being treated for cancer.

Methods/Design: Primary caregivers (N=22) of a child (M age=7.4, SD=4.6) who was diagnosed with cancer within the last 18 …

Levofloxacin Versus Ciprofloxacin Prophylaxis In Pediatric Cancer Patients At High Risk Of Infection, Chandni Dargan Md, Amy Johnson Md, Mba

Research Days

Background: Patients with cancer and those undergoing chemotherapy are at risk of developing bacterial infections due to myelosuppression. Patients undergoing the most intensive chemotherapy regimens are at a higher risk for morbidity and mortality due to profound neutropenia. Antibacterial prophylaxis is given to reduce the incidence of infection in those at highest risk. Starting March 1, 2016 our institution used ciprofloxacin for antibacterial prophylaxis however recent literature, including the COG trial ACCL0934, supports using levofloxacin in certain high risk (HR) populations due to greater efficacy in reducing neutropenic fever (NF) and bacteremia. Therefore, we switched to this April 1, 2019. …

Standardization Of Fertility Preservation Discussion Amongst Pediatric Oncology And Bone Marrow Transplant Patients: A Single Institution Experience, Chandni Dargan, Sarah E. Mc Dermott, Shelby Chesbro

Research Days

Background/Project Intent (Aim Statement): As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options prior to initiation of treatment.

Methods (include PDSA cycles): Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014- 2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or …

Increasing Palliative Care Team Involvement In Pediatric Oncology Patients, Sana Farooki

Research Days

No abstract provided.

Cd30-Positive, Ebv-Positive T-Cell Lymphoma Associated With Chronic Active Ebv Infection: Successful Treatment With Brentuximab Vedotin, Sarah E. Mc Dermott

Research Days

No abstract provided.

Needs Assessment For Palliative Care In Pediatric Oncology: An Integrative Literature Review, Tabitha Negrete

Grace Peterson Nursing Research Colloquium

Abstract

Background: Cancer is the leading cause of non-accidental death in childhood. Cancer is the primary disease for which pediatric palliative care services are utilized worldwide. Improvement in pediatric palliative care has been identified as an ongoing research priority. There are still significant gaps in current knowledge of pediatric palliative care because education has not been integrated into curriculum and clinical experiences.

Objectives: The purpose of this integrative literature review aims to provide a comprehensive review of current research about the need of nursing education on palliative care for long-term care in pediatric oncology.

Methods: This integrative literature review focused …

Complementary Art Interventions For Children Coping With Cancer: An Integrative Literature Review, Brenda Pacheco

Grace Peterson Nursing Research Colloquium

Background: Cancer can be a physically and emotionally damaging disease. While there are various conventional pediatric cancer treatments, complementary alternative medicine (CAM), specifically art interventions, may be helpful in the care of these patients.

Objective: The aims of this integrative review were; (1) determine if art interventions impact coping with cancer in a pediatric population, (2) determine if the duration of the art intervention influences the impact on coping.

Methods: Articles were found through the following databases: Cumulative Index of Nursing and Allied Health (CINAHL), PubMed, PsycInfo, and ProQuest Nursing & Allied Health. Key search terms used included cancer, neoplasms, …

Coping With Pediatric Cancer: Conversational Methods Utilized By Parents And Children When Dealing With Pediatric Cancer, Chelsi Morgan Walls

Graduate Research Symposium (2010 - 2017)

This thesis sought to analyze how parents communicate with their child regarding pediatric cancer treatments. When dealing with pediatric cancer, it is vital that parents and their child communicate about the illness in order to effectively cope with the cancer. Using Uncertainty Management Theory, along with sub-concepts of the theory (i.e., appraisals, inferences, and illusions), this thesis sought to discover which coping mechanism (i.e., affect-management or buffering) would be chosen to manage the illness. Under UMT, appraisals were assessed, resulting in positive and negative appraisal, which indicated whether the individual handled the issue with either an inference based on general …