Palliative care service in patients with childhood cancer from a tertiary pediatric oncology center

Importance: Pediatric palliative care (PPC) has gained great attention in western countries, however data on Hong Kong children receiving PPC are limited. There are gaps in knowledge about the PPC needs in local children with cancer. Objective: To assess the current situation of PPC service of Hong Kong children with cancer. Methods: We performed a 10-year retrospective review in a tertiary pediatric oncology unit and studied the referral pattern, clinical characteristics and services provided. results: Totally 117 children were referred to PPC Team which constituted 65% deceased children within the study period. The commonest diagnoses were central nervous system tumour (32.5%), leukaemia (25.6%) and neuroblastoma (9.4%). Ninety-one percent of children were referred after the last relapse or stopping curative treatment. The median time of referral to death was 77 days (interquartile range (IQR): 35, 182)The median number of hospital admission after referral was 2 (IQR: 1, 5), with a median of 27 days total hospital stay (IQR: 10, 60). The reasons for admission were palliative chemotherapy (16.1%), pain control (12.1%) and platelet transfusion (11.2%). For the death episode, the median duration of hospital stay was 15 days (IQR: 2, 46). Most patients received oxygen (82.0%), intravenous fluid (81.2%) and intravenous analgesic (52.1%). A total of 111 (94.9%) children died in hospital, 15 had been admitted into intensive care unit (ICU) but only 5 (4.5%) died in ICU. Interpretation: Pain control and platelet transfusion were common reasons of readmission. Death in ICU and at home was uncommon in Hong Kong situation.

Examining patterns of traditional chinese medicine use in pediatric oncology: A systematic review, meta-analysis and data-mining study

Background Traditional Chinese medicine(TCM)is becoming a popular complementary approach in pediatric oncology.However,few or no meta-analyses have focused on clinical studies of the use of TCM in pediatric oncology.Objective We explored the patterns of TCM use and its efficacy in children with cancer,using a systematic review,meta-analysis and data mining study.Search strategy We conducted a search of five English(Allied and Complementary Medicine Database,Embase,PubMed,Cochrane Central Register of Controlled Trials,and ClinicalTrials.gov)and four Chinese databases(Wanfang Data,China National Knowledge Infrastructure,Chinese Biomedical Literature Database,and VIP Chinese Science and Technology Periodicals Database)for clinical studies published before October 2021,using keywords related to“pediatric,”“cancer,”and“TCM.”Inclusion criteria We included studies which were randomized controlled trials(RCTs)or observational clinical studies,focused on patients aged<19 years old who had been diagnosed with cancer,and included at least one group of subjects receiving TCM treatment.Data extraction and analysis The methodological quality of RCTs and observational studies was assessed using the six-item Jadad scale and the Effective Public Healthcare Panacea Project Quality Assessment Tool,respectively.Meta-analysis was used to evaluate the efficacy of combining TCM with chemotherapy.Study outcomes included the treatment response rate and occurrence of cancer-related symptoms.Association rule mining(ARM)was used to investigate the associations among medicinal herbs and patient symptoms.Results The fifty-four studies included in this analysis were comprised of RCTs(63.0%)and observational studies(37.0%).Most RCTs focused on hematological malignancies(41.2%).The study outcomes included chemotherapy-induced toxicities(76.5%),infection rate(35.3%),and response,survival or relapse rate(23.5%).The methodological quality of most of the RCTs(82.4%)and observational studies(80.0%)was rated as“moderate.”In studies of leukemia patients,adding TCM to conventional treatment significantly improved the clinical response rate(odds ratio[OR]=2.55;95%confidence interval[CI]=1.49-4.36),lowered infection rate(OR=0.23;95%CI=0.13-0.40),and reduced nausea and vomiting(OR=0.13;95%CI=0.08-0.23).ARM showed that Radix Astragali,the most commonly used medicinal herb(58.0%),was associated with treating myelosuppression,gastrointestinal complications,and infection.Conclusion There is growing evidence that TCM is an effective adjuvant therapy for children with cancer.We proposed a checklist to improve the quality of TCM trials in pediatric oncology.Future work will examine the use of ARM techniques on real-world data to evaluate the efficacy of medicinal herbs and drug-herb interactions in children receiving TCM as a part of integrated cancer therapy.

Treatment of childhood cancer in China:Current status and future direction

Introduction China has a population of 1.3 billion and 16.6%of the population(212 million)is below age of 15 years according to the sixth national census in 2010.1 Chinese National Central Cancer Registry(NCCR)collected data from 219 cancer registries distributed in different parts of China.In 2010 data from NCCR reported that childhood cancer comprised approximately 0.6%of all cancers.In a recent study analyzed data from 145 cancer registries in China,the age-standardized incidence rate of childhood cancer was 87.1 per million.The top five commonest childhood cancers were leukemia(35.6 per million),central nervous system(CNS)tumor(15.0 per million),lymphoma(6.4 per million),bone cancer(4.4 per million)and kidney cancer(3.7 per million).2 The incidence is lower than western countries but similar to those reported by other low-middle income countries.The reasons for lower incidence of childhood cancer may be related to incomplete data collection.In China,there is a large floating population,221 million,who were not permanent residents in locations they worked and might not be included in the city registration.The projected number of new cases of childhood cancer in 0-14 years is 22875,and new cases of leukemia projected to be 8943 in 2015.It is important to have accurate data on incidence and survival that will help the government in policy making on health care delivery.