Emily L. Mueller

Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting ED visits and factors associated with hospital admission.

What the Affordable Care Act Means for Survivors of Pediatric Cancer

In the last 50 years, major therapeutic advances in childhood cancer care have transformed pediatric oncology. Although childhood cancer incidence rates have increased significantly from 1975 to 2006,1 overall survival rates for childhood cancer have improved dramatically from 58% in the 1970s to 83%, based on the most recent data.2 The compound impact of increasing incidence and improving survival is that, today, more than 320,000 individuals live as survivors of childhood cancer in the United States.3 Childhood cancer is not the only health challenge that many of these individuals will face in their lifetimes; a survey of the largest cohort of pediatric cancer survivors revealed that two thirds of all survivors will develop a chronic medical condition, with more than one-third experiencing a severe or life-threatening condition.4

Variation in Management of Fever and Neutropenia Among Pediatric Patients with Cancer: A Survey of Providers in Michigan

Considerable variation in the management of fever and neutropenia (FN) exists, with factors associated with treatment variation not well described. An online survey of 90 pediatric cancer providers in Michigan was performed in Spring 2014. The survey frame was pediatric patients with cancer receiving treatment, with a Port-a-cath, who were clinically stable. Criteria for “Decreased” and “Increased” risk groups were defined by respondents. Survey questions addressed FN definitions, risk groups conceptualization, routine clinical practice, and management guidelines, in the context of risk groups and distance to treating institution. Fifty providers responded (56%); the majority defined a febrile event as temperature >38.3°C and/or 2 events >38.0°C within a 24-hour period. Neutropenia was defined as current or anticipated absolute neutrophil count (ANC) <500/μL. Majority of respondents recommended “Decreased” and “Increased” patients present to a local emergency department (ED) if they live >2 hours away. Respondents were significantly more likely to have a “Decreased Risk” patient travel over 2 hours if they rated the local ED as “Poor to Fair” on ability to access Port-a-caths (P = .048). Most respondents would discharge patients who are afebrile for 24 hours, blood cultures negative for 48 hours, and neutrophil count of greater than 200/μL; 40% preferred discharge on oral antibiotics when the ANC <500/μL. Triaging for febrile pediatric patients with cancer is significantly influenced by the providers’ perceptions of local EDs. Future investigation of local hospitals’ ability to provide urgent evaluation, combined with parental perspectives, could lead to improvements in timely and effective management.

Family Refusal of Chemotherapy for Pediatric Cancer Patients: A National Survey of Oncologists.

Background: Refusal of therapy is ethically acceptable for competent adults. Practitioner opinions regarding refusal of therapy in pediatric cancer patients has not been widely studied. This is the largest survey of oncology practitioners assessing support for refusal of chemotherapy. Procedure: Pediatric oncology nurses/physicians were asked: “As their provider I would support refusal of chemotherapy by a family,” with the following options: “Never support refusal,” “Always support refusal,” or “Support for refusal would depend on cure rate, age, or both.” Variables assessed were: age (0 to 7, 8 to 13, 14 to 17 y) and cure rate (0% to 33%, 34% to 66%, 67% to 100%). Results: A total of 957 practitioners responded. Fifty-six percent, 31%, and 0.2%, respectively, stated their support of chemotherapy refusal depended on “age and cure rate,” “cure rate alone,” or “age alone.” Two percent and 11% indicated they would “always” or “never” support refusal, respectively. For a “modest” or “good” cure rate, support for refusal was <20%, whereas for a “poor” cure rate, the majority would support a family’s refusal (53% to 78% age dependent). Within each cure rate, respondents were more likely to support refusal for older patients (P<0.001). Conclusions: The majority of practitioners surveyed viewed parental refusal of chemotherapy for children with a moderate or good expected cure rate as unacceptable, but were more accepting of refusal with a poor prognosis, especially for teenagers.

Frequent Emergency Department Utilizers Among Children with Cancer

Pediatric frequent emergency department (ED) utilizers contribute a significant proportion of ED visits, but no studies specifically address children with cancer.

Characteristics of Children With Cancer Discharged or Admitted From the Emergency Department.

Emergency department (ED) utilization by children with cancer is poorly understood. Among children with cancer, we explored reasons for ED visits and factors associated with admission within U.S. childrens hospitals.

Parent-centered communication at time of pediatric cancer diagnosis: A systematic review

There are limited data focused on parental communication needs surrounding the time when a child is diagnosed with cancer. In this systematic review, we synthesized current literature on communication preferences of parents at the time of their childs diagnosis of cancer. We identified 16 studies that yielded 4 major themes parents recognized as important: communication style, content, logistics, and healthcare team. We further identified several concepts that inform parent‐centered communication practice. The ensuing pediatric oncology parent‐centered communication concept map is meant as a tool to expand providers’ communication experience at the time of a new cancer diagnosis.

A survey of mobile technology usage and desires by caregivers of children with cancer

The use of mobile health (mHealth) has grown exponentially, even by caregivers of vulnerable populations. The study objective was to understand mobile technology usage, barriers, and desires by caregivers of children with cancer.

Correction to: Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009

Background: Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described. Methods: Data were analyzed from the Kids’ Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences. Results: Pediatric cancer patients accounted for 1.5 % of pediatric hospital discharges in 2009 (n = 110,967), with 10.1 % of cancer-related discharges meeting FN criteria (n = 11,261). Two-fifths of FN discharges had a “short length of stay” (SLOS) of ≤3 days, which accounted for approximately

Making Improvements in the ED: Does ED Busyness Affect Time to Antibiotics in Febrile Pediatric Oncology Patients Presenting to the Emergency Department?

65.5 million in hospital charges. Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS. Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22–2.24) or West region (OR 1.54, 1.11–2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03–1.87) or viral infection (OR = 1.63, 1.18–2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05–2.04), Hodgkin lymphoma (OR = 2.33, 1.62–3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05–2.95) compared with patients without these diagnoses. Conclusion: FN represents a common precipitant for hospitalizations among pediatric cancer patients. SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.