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Woodward E.,St Jamess Institute Of Oncology | Woodward E.,University of Leeds | Jessop M.,St Jamess Institute Of Oncology | Jessop M.,Queensland Childrens Cancer Center | And 3 more authors.
Annals of Oncology | Year: 2011

Background: Late effects (LEs) after cancer treatment are increasing. After childhood cancer, substantial risks include physical, psychological and social LE and vary with age. Teenagers and young adults (TYA) present with particular cancers; their risk of LE may relate to cancer site, treatment or their age itself. The LEs after TYA-onset cancers are described in relation to age at diagnosis of primary tumour. Patients and methods: Data were extracted from Medline English language articles, 1999-2009. Keywords were late effect/s, late toxicity and survivor and the frequent TYA cancer sites. Only those articles that reported the relation between LEs risks with age at diagnosis were included. Results: The majority of known LEs are described after TYA cancer. No study primarily aimed to relate TYA age to LEs. Many studies did not report LE by age. TYA-specific risks are seen in cardiac toxicity, second malignancies, pulmonary complications and psychosocial difficulties when compared with older or younger cancer survivors. Conclusions: TYA age brings specific LE risks after cancer. Prospective population-based collection of LE data after TYA cancer will inform the development of appropriate services to effectively manage LE. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Bradford N.,University of Queensland | Bradford N.,Queensland Childrens Cancer Center | Armfield N.R.,University of Queensland | Young J.,University of Queensland | And 2 more authors.
BMC Palliative Care | Year: 2013

Background: Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods. A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results: There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion: Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology. © 2013 Bradford et al; licensee BioMed Central Ltd. Source

Slater P.J.,Queensland Childrens Cancer Center
Australian Health Review | Year: 2011

The administration team in the Queensland Children's Cancer Centre at the Royal Children's Hospital, Brisbane, included a team of 16 administration staff supporting the service and the state-wide clinical network. Shortly after the creation of a new expanded service, issues became apparent in administration team morale, relationships, communication, processes, leadership, support and training. The analysis of these issues included team interviews and surveys, consultation with senior administration staff and monthly sick leave monitoring. Strategies implemented included providing information; the joint development of a team business plan and individual performance plans; a review of the team's structure, workload and business processes; engaging staff in quality improvements; and the development of relationships and leadership. As a result, the team reported being more comfortable and supported in their roles, had improved morale and worked better together with more consistent and improving business processes. They had clear purpose and expectations of their roles, displayed better customer service and had reduced sick leave. The study shows that in a high stress environment, such as a children's cancer centre, attention to the team's culture, vision and purpose, providing information and improving communication and relationships, when combined with a team's enthusiasm, will improve the team's growth, cooperation and work outcomes. What is known about the topic? Various studies have found anxiety and depression in hospital administration staff, a perceived lack of recognition and value placed in their opinions, and some level of mistreatment. These circumstances have resulted in job absenteeism, high staff turnover, poorer interactions with patients and diminished wellbeing, job satisfaction, motivation and commitment. What does this paper add? This paper details successful strategies implemented to improve the support and development of an administration team in a busy and stressful environment. It shows how they improved the team's direction, processes and relationships. What are the implications for practitioners? Administration staff in hospital settings require appropriate support to provide the best service to clinical areas. The study shows that attention to the team's culture, vision and purpose, providing information and improving communication and relationships, when combined with a team's enthusiasm, will improve the team's growth, cooperation and work outcomes. © 2011 AHHA. Source

Mitchell R.,Center for Childrens Cancer and Blood Disorders | Nivison-Smith I.,Australasian Bone Marrow Transplant Recipient Registry | Anazodo A.,Center for Childrens Cancer and Blood Disorders | Tiedemann K.,Royal Melbourne Hospital | And 7 more authors.
Biology of Blood and Marrow Transplantation | Year: 2013

We performed a retrospective analysis on the outcomes of 135 hematopoietic stem cell transplantations (HSCTs) for primary immunodeficiency disorders in Australian and New Zealand Children's Haematology Oncology Group transplantation centers between 1992 and 2008. The most common indications for HSCT were severe combined immunodeficiency, Wiskott-Aldrich syndrome, and chronic granulomatous disease. Five-year overall survival (OS) was 72% for the entire cohort. Disease-specific 5-year OS was 70% for severe combined immunodeficiency, 81% for Wiskott-Aldrich syndrome, and 69% for chronic granulomatous disease. Transplantation-related mortality (TRM) was 10% at day +100. TRM and OS were equivalent in recipients of related and unrelated donor transplants. Source of stem cells had no impact on TRM or OS with outcomes following unrelated umbilical cord blood similar to unrelated bone marrow. The presence of interstitial pneumonitis, active cytomegalovirus infection, or veno-occlusive disease were all independent variables that significantly decreased OS. This large series supports the use of HSCT as curative therapy for a range of primary immunodeficiency disorders, demonstrating excellent survival after both related and unrelated donor transplantation. © 2013. Source

Murphy A.J.,University of Queensland | White M.,University of Queensland | White M.,Queensland Childrens Cancer Center | Davies P.S.W.,University of Queensland
American Journal of Clinical Nutrition | Year: 2010

Background: Nutritional status, as represented by body composition, is an important consideration in the treatment of pediatric cancer patients because it is linked to poor outcomes. Little is known about how a child's body composition responds to cancer and treatment. Objectives: We aimed to compare the body composition of children undergoing treatment of cancer with that of healthy controls and to compare body composition between children with hematologic malignancies and children with solid tumors. Design: This cross-sectional study measured height, weight, body cell mass, fat-free mass, and fat mass in 48 children undergoing treatment of cancer and blood-related disorders and in age-matched healthy controls. Results: Patients with cancer had a significantly lower body cell mass index z score (body cell mass/height raised to the power of 2.5 for females and 3 for males) than did controls (P = 0.0001), and 45% of the patients with cancer were considered malnourished according to body cell mass. Subjects with cancer had a significantly higher percentage of body fat (P = 0.0001) and fat mass (P = 0.0001) than did controls; however, there was no significant difference in fat-free mass (P = 0.09). On the basis of percentage fat, 77% of subjects with cancer were considered obese. No difference in body composition was observed between cancer types. Conclusions: This study showed that children undergoing treatment of all types of cancer have a significantly lower body cell mass and a significantly higher fat mass than do healthy controls. Nutritional support is suggested for all children undergoing treatment of cancer. © 2010 American Society for Nutrition. Source

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