Pantelis Perdikaris

Cancer in childhood: Children's and parents’ aspects for quality of life

INTRODUCTION The aim of the present study is to (a) describe the level of agreement between reports of health-related quality of life (HRQL) obtained from parents and young patients both on- and off-treatment and (b) explore the factors that may affect the level of agreement in the quality of life (QoL) between young patients and parental proxies. PATIENTS AND METHODS The study group consisted of 149 young patients (77 children and 72 adolescents) with cancer followed up by an oncology in-patient clinic of a Greek childrens hospital with one of their parents (n=298). After parental consent was obtained, data were collected using the Pediatric Quality of Life Inventory (PedsQL) and a sociodemographic data form. RESULTS The data collection showed that the best agreement was for the physical (ICC=0.82) and the school domains (ICC=0.68), whereas the worst was for the emotional (ICC=0.48) and the social domains (ICC=0.52). In the off-treatment group, the mothers age was a significant predictor of the child-proxy difference on the physical sub-scale (F=9.804, P=0.003). There was a negative relationship between the mothers age and patient proxy difference on the physical sub-scale. In the on-treatment group, the educational level of the father was found to be a significant predictor for the physical (F=4.30, P=0.041), school (F=5.51, P=0.022) and total sub-scales (F=10.41, P=0.002). Parents with basic education tended to have worse agreement with their childrens reports on the physical and school sub-scales, while parents with higher education had worse agreement with their childrens reports on the total sub-scale. CONCLUSIONS Our findings suggest that the children and adolescents with cancer reported better QoL than their parents. The predictors found to be significant need to be examined extensively by further studies.

COMPLICATIONS OF HICKMAN-BROVIAC CATHETERS IN CHILDREN WITH MALIGNANCIES

The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000–31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19–6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9–250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.

Changes in children's fatigue during the course of treatment for paediatric cancer.

BACKGROUND Fatigue is described as one of the most distressing symptoms of cancer therapy; yet it has received limited clinical attention. Children are suffering from a symptom that is under-diagnosed during their treatment. AIM The aim of this study is: (a) to assess the change in fatigue scores during cancer treatment according to childrens perspectives, and (b) to describe the possible causes of fatigue from childrens points of view. SAMPLE AND METHODS The present study is part of an ongoing prospective study. The research group consisted of 40 (n = 40) children aged 7-12 years with cancer who are being followed up in the oncology clinic of a Greek childrens hospital. After parental consent was obtained, data were collected using the Child Fatigue Scale and a sociodemographic data form. RESULTS The children with cancer reported a statistically significant increase in fatigue scores during their treatment (F = 6.846, P = 0.003). Gender was the only demographic factor associated with a significant increase in the fatigue scores (F = 4.857, P = 0.034). CONCLUSIONS Cancer treatment was found significantly to increase childrens fatigue levels. Medical procedures and the hospital environment seemed to be major causative factors of the fatigue experienced by children with cancer during their treatment.

Evaluating depression in a sample of children and adolescents with cancer in Greece

BACKGROUND Several studies have found that serious illness increases the risk of depression. One of the most common psychiatric disorders related to the diagnosis and treatment of cancer is depression. AIM The aim of the present study was to investigate the rate of depression in children with cancer compared with that in healthy children. PATIENTS AND METHODS The present study is an ongoing prospective study. The research group consisted of 80 children with cancer followed up by an oncology inpatient clinic of a Greek Childrens hospital. The control group consisted of 84 healthy children. After parental consent was obtained, data were collected using the Childrens Depression Inventory (CDI) and a socio-demographic data form. RESULTS At the time that this study was carried out, neither the research group nor the control group suffered from depression. In particular, there was no statistically significant difference between the two groups with respect to symptoms of depression (mean = 5.88 for children with cancer vs. mean = 7.23 for healthy children, U = 3013, P = 0.25). CONCLUSIONS Our findings suggest that the children in this study with malignancies did not have higher depression scores than their healthy peers, although many previous surveys confirm that children with cancer are at high risk for depression.