L’hypnose en oncologie pédiatrique Hypnosis in Pediatric Oncology

Hypnosis is a modified state of consciousness which showed its benefits to decrease different symptoms,mainly pain.During the last decade,this technique has also been proposed to adults with cancer to improve other symptoms,such as emotional distress,fatigue,or sleep difficulties.In pediatric oncology,hypnosis is also used to decrease disease-,treatment-,and procedure-related pain and anxiety.The learning of self-hypnosis and self-care techniques also improves the well-being of adults or children with cancer,their parents,and their siblings.Through several clinical cases,we will illustrate how hypnosis and self-care techniques have been implemented in the pediatric haemato-oncology department of the CHC MontLégia(Liège,Belgium)and will describe their benefits.

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.

Feasibility,efficacy,and safety of animal-assisted activities with visiting dogs in inpatient pediatric oncology

Background Childhood cancer entails a heavy burden for patients and their families.Recent advances in overall survival rates have increasingly brought long-term quality of life into focus.Animal-assisted activities(AAAs)have long been hypothesized to alleviate the burden on pediatric patients and their peers in the hospital setting.However,their use in inpatient pediatric oncology has been a sensitive issue mainly due to the fear of infections,resulting in a lack of studies.This study presents data on the feasibility,safety,and efficacy of AAAs from a single German center.Methods Between 2018 and 2022,60 patients(median age=10.3 years)diagnosed with malignancy and undergoing treatment were visited by an intervention dog(total visits=100).Patients were screened for infections as per hospital policy,with additional microbiological testing performed based on symptoms.The dog was screened for human pathogens and zoonoses.Microbial data and hospitalizations were analyzed from two months prior to the first visit until two months after the last visit.Acceptance of being in the hospital,both with and without planned animal-assisted interventions and pre-and post-intervention state stress,were measured using a validated visual analogue scale(0-10).Results Patients benefited from AAAs,showing increased acceptance of being in the hospital(median:7.25 vs.4.50,P<0.001)and decreased median state stress ratings one hour after the visit compared to one hour before the visit(1.00 vs.4.25,P<0.001).The intervention did not result in an increased number of infections or unplanned hospitalizations,and no zoonoses were detected.All microbial screening tests of the dog were negative.Conclusions AAAs with visiting dogs in inpatient pediatric oncology are feasible and safe.Although they hold promise for enhancing patients’well-being,further prospective studies are needed.

Retinoblastoma: The Situation in Burkina Faso over Ten Years

Context: In Burkina Faso, there is only one retinoblastoma treatment center located in the capital. Nowadays, the treatment of retinoblastoma has benefited from the contribution of scientific progress. Objective: The aim was to take stock of the situation of retinoblastoma in the pediatric oncology department from January 1, 2010 to December 31, 2019. Materials and Methods: This was a descriptive cross-sectional study with retrospective data collection over a 10-year period, based on records of patients admitted to pediatric oncology department of CHU-YO. Data were analysed using CS Pro version 7.2 software. Categorical variables were compared using Pearsons Chi-square test at the 5% significance level. Overall survival was estimated using the Kaplan-Meier method. Operational definitions were used for lost to follow-up, consultation and diagnosis delays. Results: We collected a total of 204 cases in 10 years, i.e. an annual average of 20.4 cases/year. The mean age at diagnosis was 37.5 months for unilateral cases and 26.4 months for bilateral cases. Male predominance was noted, with a sex ratio of 1.31. The majority of patients came from disadvantaged backgrounds (72% farming fathers and 91% housewives). Clinically, leukocoria and exophthalmos were the main presenting features. The average time to consultation was long (8.73 months) and unilateral localization was predominantly unilateral at 77%. In terms of treatment, 102 patients were eligible for curative treatment and 80 for palliative treatment. The prognosis was poor, with 41% death and numerous cases of lost to follow-up (18%). Overall survival was estimated at 32%. The factor associated with the lethality of retiniblastoma was the extension of the tumor to other organs. Conclusion: Recognition of the early clinical signs of retinoblastoma can anticipate the occurrence of this cancer. Health professionals should be encouraged to perform the Buckner test every time they come into contact with children aged 0 to 5, and the public should be encouraged to examine their childrens eyes.

Neutropenic enterocolitis in pediatric leukemia patients treated with intensive chemotherapy in Upper Egypt

Importance: In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.Objective: To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis;to assess the outcome;and to evaluate the risk factors associated with the mortality in these patients.Methods: During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.Results: Out of 88 documented episodes of intestinal complications from 77 patients;58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness (OR 4.529, 95%CI 1.062-19.317,P = 0.041);a longer duration of neutropenia (OR 1.215, 95%CI 1.030-1.434,P = 0.021);and hemodynamic instability (OR 17.023, 95%CI 4.095-70.772,P < 0.001), were found to be independently associated with worse outcome.Interpretation: In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.