Petrie F. Roodbol

Malnutrition in childhood cancer patients: A review on its prevalence and possible causes

PURPOSE To perform a systematic literature review for critical evaluation of prevalence and factors contributing to malnutrition in childhood cancer. METHODS A systematic search resulting in 46 suitable articles. RESULTS Due to lack of uniform criteria and adequate studies, the prevalence rates of malnutrition can only be estimated. Based on strengths and weaknesses of included references, prevalence rates are estimated to be 0-10% for leukemia, 20-50% for neuroblastoma, and 0-30% for other malignancies. Whether energy deficiency or inflammation contributed to malnutrition could not be confirmed because the occurrence of energy deficit (low energy intake, increased metabolic rate) or inflammation (related to cachexia) was not convincing. Also, a relationship between these factors and malnutrition was not studied. CONCLUSION Longitudinal studies are needed to determine which children are at risk of malnutrition, and to investigate the impact of energy deficiency and inflammation on the nutritional status and body composition of childhood cancer patients.

Changes in nutritional status in childhood cancer patients: A prospective cohort study

BACKGROUND & AIMS Under- and overnutrition are linked to adverse outcomes during and after childhood cancer treatment. Therefore, understanding the timing of weight loss and weight gain and their contributory factors is essential for improving outcomes. We aimed to determine in which period of treatment changes in nutritional status occurred and which factors contributed to these changes. METHODS A prospective cohort study of 133 newly diagnosed cancer patients with hematological, solid, and brain malignancies was performed. Anthropometric data and related factors were assessed at 0, 3, 6 and 12 months after diagnosis. RESULTS Despite initial weight loss at the beginning of treatment in patients with hematological and solid malignancies, body mass index (BMI) and fat mass (FM) increased within 3 months with 0.13 SDS (P < 0.001) and 0.05 SDS (P = 0.021) respectively. Increase continued during the following months and resulted in a doubling of the number of overnourished patients. Fat free mass (FFM), which was already low at diagnosis, remained low. During the entire study period about 17% of the patients were undernourished on the basis of low FFM. Tube feeding and diminished activity level were related to increases in BMI and %FM respectively. No relationship was found between energy intake or corticosteroids and increase in BMI or %FM. CONCLUSIONS BMI and FM increased during and after the period of intensive treatment, while FFM remained low. Improvement of nutritional status might be accomplished by increasing physical activity from the early phase of treatment.

Dispositional optimism in adolescents with cancer: Differential associations of optimism and pessimism with positive and negative aspects of well-being

OBJECTIVES Dispositional optimism is often considered to be a unidimensional construct. Recent studies suggest, however, that optimism and pessimism are separate dimensions. In this study we investigated two issues. First, the levels of optimism and pessimism in adolescents with cancer compared with healthy controls and second, the individual effects of optimism and pessimism on concurrent and longitudinal well-being. DESIGN A matched case-control design was used to examine whether adolescents with cancer and healthy adolescents differed with regard to optimism and pessimism. The second part of the study was employed in a prospective design with assessments in the patient group at 3 and 6 months post-diagnosis. METHODS Thirty-three adolescents with cancer (3 months post-diagnosis) and 66 matched controls completed a measure on dispositional optimism (i.e., optimism and pessimism). In addition, patients completed measures on positive and negative aspects of well-being at 3 and 6 months post-diagnosis. RESULTS Although adolescents with cancer were not more optimistic than their healthy peers, they were significantly less pessimistic. Zero order and semi-partial correlations showed that optimism and pessimism are related to different aspects of well-being. Specifically, we found a cohesive pattern in which optimism predicts positive aspects and pessimism negative aspects of well-being. CONCLUSIONS The high levels of overall optimism often found in patients with cancer might in fact result from low pessimism instead of high optimism. Furthermore, as our study shows that optimism and pessimism are differentially associated with aspects of well-being, it provides strong support for the bidimensionality of dispositional optimism.

Interprofessional education in primary care for the elderly: a pilot study.

BackgroundThe Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of nurses and physicians required to meet this demand.At present, the main focus of health care in the Netherlands lies on illness and treatment. However, (frail) elderly need care and support that takes their daily functioning and well-being into consideration as well. Therefore, health care professionals, especially those professionals working in primary care such as GPs and practice nurses, will be challenged to a paradigm shift in emphasis from treating illness to promoting health (healthy ageing). Interprofessional education is necessary to realise this shift in professional behaviour. Evidence indicates that interprofessional education (IPE) can play a pivotal role in enhancing the competencies of professionals in order to provide elderly care that is both effectively, integrated and well-coordinated. At present, however, IPE in primary care is rarely utilised in the Netherlands. Therefore, the aim of this pilot study was to develop an IPE program for GPs and practice nurses and to evaluate the feasibility of an IPE program for professionals with different educational backgrounds and its effect on the division of professionals’ tasks and responsibilities.MethodsTen GPs and 10 practice nurses from eight primary care practices in two provinces in the north of the Netherlands, Groningen and Drenthe (total population about 1.1 million people), participated in the pilot IPE program. A mixed methods design including quantitative and qualitative methods was used to evaluate the IPE program.ResultsDuring the program, tasks and responsibilities, in particular those related to the care plan, shifted from GP to practice nurse. The participants’ attitude toward elderly (care) changed and the triage instrument, the practical tool for prioritising preferences of the elderly and discussing their medication use, was considered to have an added value to the development of the care plan.ConclusionsThe results of this pilot study show that an interprofessional education program for professionals with different educational backgrounds (GPs and practice nurses) is feasible and has an added value to the redefining of tasks and responsibilities among GPs and practice nurses.

Children's opinions about organ donation: a first step to assent?

BACKGROUND Parents have to decide about organ donation after the death of their child. Although most parents probably would like to respect their childs intentions, parents often are not aware of their childs wishes. This requires insight into childrens opinions about donation. METHODS An internet survey that investigated whether Dutch children in the age range of 12 through 15 years had heard about organ donation, what their opinions were on donation and whether the topic had been discussed at home. Questionnaire response rate 38%. RESULTS Around 99% of 2016 responders had heard about organ donation and about the possibility of becoming a donor, 75% preferred to decide for themselves about donation, 43% had discussed organ donation more than once at home, 66% were willing to donate. The willingness to donate was positively associated with age and socio-economic status. CONCLUSION This survey indicates that these children at 12 through 15 years of age are capable and willing to think about organ donation. Thought should be given about how to raise awareness and how to enable parents and children to develop some sort of health literacy concerning the concept of organ donation. Children and their parents should be given adequate opportunities to receive appropriate information, suited to their psychological and moral developmental status.

Providing care to a child with cancer : a longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis

This study investigated the course, predictors, and impact of caregiving stress on the functioning of primary caregivers of children with cancer during the first year after a childs cancer diagnosis.

Prevalence of Psychological Problems and Associated Transplant-Related Variables at Different Time Periods After Liver Transplantation

After liver transplantation, recipients often experience psychological problems that are influenced by demographic, personal, and transplant‐related variables. However, because previous studies have mostly reported on psychological problems and their influencing factors in the first years after transplantation, less is known about their prevalence and influence in the long run. The aims of this study were to examine point‐prevalence rates of symptoms of anxiety, depression, and posttraumatic stress (PTS) at different time periods after transplantation and to examine the transplant‐related variables associated with these problems. A cross‐sectional survey was performed among 373 liver transplant recipients who received transplants between 1979 and 2009 at our center. Five clinically relevant time periods were identified: 0.5 to <2 years, 2 to <5 years, 5 to <10 years, 10 to <15 years, and ≥15 years after transplantation. The response rate was 75% (n = 281). Overall, 33.4% of the respondents experienced clinically relevant symptom levels of anxiety (28.7%), depression (16.5%), or PTS (10.0%). Symptoms of anxiety and depression were more prevalent in the first 2 years and in the long term after transplantation. PTS symptoms were more prevalent in the first 5 years after transplantation. However, the prevalence rates did not differ significantly between time periods. Viral hepatitis and the number of side effects of the immunosuppressive (IS) medication were found to be associated with all psychological problems. Alcoholic liver disease was associated with anxiety and depression in the short term after transplantation. In conclusion, a significant subset of transplant recipients experience psychological problems, both shortly after transplantation and in the long run. These problems are often associated with side effects from the IS medication. Therefore, the monitoring of psychological problems, the offering of psychological counseling, and the management of the medications side effects should be part of the routine care of transplant recipients. Liver Transpl 21:524–538, 2015.

Key factors in paediatric organ and tissue donation : an overview of literature in a chronological working model

There is a growing shortage of size‐matched organs and tissues for children. Although examples of substandard care are reported in the literature, there is no overview of the paediatric donation process. The aim of the study is to gain insight into the chain of events, practices and procedures in paediatric donation. Method; a survey of the 1990–2010 literature on paediatric organ and tissue donation and categorization into a coherent chronological working model of key events and procedures. Studies on paediatric donation are rare. Twelve empirical studies were found, without any level I or level II‐1 evidence. Seventy‐five per cent of the studies describe the situation in the United States. Literature suggests that the identification of potential donors and the way in which parental consent is requested may be substandard. We found no literature discussing best practices. Notwithstanding the importance of looking at donation care as an integrated process, most studies discuss only a few isolated topics or sub‐processes. To improve paediatric donation, more research is required on substandard factors and their interactions. A chronological working model, as presented here, starting with the identification of potential donors and ending with aftercare, could serve as a practical tool to optimize paediatric donation.

Exploring the Response Shift Phenomenon in Childhood Patients With Cancer and Its Effect on Health-Related Quality of Life

PURPOSE/OBJECTIVES To explore the response shift phenomenon in pediatric patients with cancer and to determine its effects on ratings of health-related quality of life (HRQOL). DESIGN Retrospective pre- and post-test design. SETTING Pediatric oncology department in the northern part of the Netherlands. SAMPLE 37 children newly diagnosed with cancer and 80 parents. METHODS The then-test method was used to determine response shift. HRQOL was assessed within two weeks postdiagnosis (pretest) and three months later (post-test) using both child and parent reports of PedsQL and Cantrils ladder. The post-test and then-test were administered concurrently. MAIN RESEARCH VARIABLES Overall and multidimensional HRQOL. FINDINGS Scores on Cantrils then-test were lower than the pretest in both child and parent reports, indicating response shift in the assessment of overall HRQOL. Children experienced a greater response shift than parents. No differences were found between the PedsQL then- and pretests. CONCLUSIONS Both child- and parent-report ratings of overall HRQOL were affected by response shift, resulting in an underestimation of the improvement in overall HRQOL between diagnosis and three months postdiagnosis. No response shift was demonstrated in the more specific domains of HRQOL (PedsQL). IMPLICATIONS FOR NURSING Knowledge of the response shift phenomenon helps nurses to better interpret the outcomes of HRQOL. The use of the PedsQL instrument is recommended in future studies that aim to demonstrate changes in HRQOL.

Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units

A shortage of size‐matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy‐four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty‐two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty‐three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent.