Identifying patient‐ and family‐centered outcomes relevant to inpatient versus at‐home management of neutropenia in children with acute myeloid leukemia

Szymczak, Julia E.; Getz, Kelly; Madding, Rachel; Fisher, Brian T.; Raetz, Elizabeth A.; Hijiya, Nobuko; Gramatges, Maria M.; Henry, Meret; Mian, Amir; Arnold, Staci D.; Aftandilian, Catherine; Collier, Anderson B.; Aplenc, Richard

doi:10.1002/pbc.26927

Cited by 9 publications

(7 citation statements)

References 16 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the COG reported a higher risk of VGS infections, hypoxia and hypotension in case of early discharge, without a significant impact on mortality (Miller et al , ). Aside from the impact on traditional clinical outcomes, the COG is also currently studying a more quantitative comparison of patient‐ and family‐centred outcomes among neutropenic paediatric AML patients managed in the hospital versus at home (Szymczak et al , ).…”

Section: Discussionmentioning

confidence: 99%

Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin–Frankfürt–Münster (I‐BFM) study group

et al. 2018

View full text Add to dashboard Cite

Prevention of infections is of obvious relevance in paediatric patients with acute myeloid leukaemia (AML). However, recommendations are often non-specific and supported by low-quality evidence, resulting in divergent infection preventive regimens. Using a web-based survey, we investigated the infection prophylaxis guidelines of 22 paediatric AML study groups affiliated to the international Berlin-Frankfürt-Münster study group. In order to evaluate differences in daily practice among hospitals, representatives (n = 27) from the Nordic Society for Paediatric Haematology and Oncology-Dutch-Belgium-Hong Kong - AML study group participated in a slightly modified survey. Seven study groups (32%) advise gram-negative antibiotic prophylaxis, mainly with fluoroquinolones (n = 6). Gram-positive prophylaxis is prescribed by eight groups (36%). Over 60% of the study groups prescribe food and social restrictions, but the specific topics and strictness differ widely. According to the hospital-based survey, sites roughly comply with common study group guidelines. However, the use of any gram-negative antibiotic prophylaxis, the specific prophylactic antifungal agent and the strictness of the food and social restrictions differ substantially between the hospitals. Despite a long history of close collaboration, many differences are still present between the affiliated groups. The results of this survey provide an appropriate baseline measure to study the emergence and impact of future guidelines on infection prophylaxis in paediatric AML.

show abstract

Section: Discussionmentioning

confidence: 99%

Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin–Frankfürt–Münster (I‐BFM) study group

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Next, semistructured interviews identified outcomes important to patients and their families. 19 Patients receiving frontline chemotherapy were then prospectively invited to complete questionnaires measuring patient HRQOL and PCOs identified from the semistructured interviews. Lastly, the qualitative interviews provided depth of understanding and context for the quantitative findings.…”

Section: Methodsmentioning

confidence: 99%

“…First, standardized medical record abstraction captured primary medical outcomes for pediatric patients with AML who received outpatient or inpatient neutropenia management. Next, semistructured interviews identified outcomes important to patients and their families . Patients receiving frontline chemotherapy were then prospectively invited to complete questionnaires measuring patient HRQOL and PCOs identified from the semistructured interviews.…”

Section: Methodsmentioning

confidence: 99%

“…From November 2015 to February 2017, semistructured interviews were conducted at 9 pediatric institutions with patients and families experiencing either management strategy. Details about data collection and analysis have been previously reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline . In addition to identifying PCOs for prospective assessment, interviews captured patient and family perceptions about the lived experience of neutropenia, including their satisfaction with their management strategy, impact on family life, and beliefs about risks and benefits of each approach.…”

Section: Methodsmentioning

confidence: 99%

“…23 Based on expert recommendations on the use of established assessments, PedsQL and COST were administered at baseline and follow-up, whereas SDSC-DIMS and PIP-D were administered at follow-up only. SDSC-DIMS, PIP-D, and COST assessments were incorporated based on themes identified from analysis of the qualitative interviews 19 and were implemented as the amended protocol was approved by the institutional review boards of participating sites. Therefore, not all assessments were administered to every participant who consented to participate.…”

Section: Prospective Questionnairesmentioning

confidence: 99%

See 2 more Smart Citations

Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia

Getz

Szymczak

et al. 2021

JAMA Netw Open

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Pediatric acute myeloid leukemia (AML) requires multiple courses of intensive chemotherapy that result in neutropenia, with significant risk for infectious complications.Supportive care guidelines recommend hospitalization until neutrophil recovery. However, there are little data to support inpatient over outpatient management. OBJECTIVETo evaluate outpatient vs inpatient neutropenia management for pediatric AML. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used qualitative and quantitative methods to compare medical outcomes, patient health-related quality of life (HRQOL), and patient and family perceptions between outpatient and inpatient neutropenia management. The study included patients from 17 US pediatric hospitals with frontline chemotherapy start dates ranging from January 2011 to July 2019, although the specific date ranges differed for the individual analyses by design and relative timing. Data were analyzed from August 2019 to February 2020. EXPOSURES Discharge to outpatient vs inpatient neutropenia management. MAIN OUTCOMES AND MEASURESThe primary outcomes of interest were course-specific bacteremia incidence, times to next course, and patient HRQOL. Course-specific mortality was a secondary medical outcome. RESULTSPrimary quantitative analyses included 554 patients (272 [49.1%] girls and 282 [50.9%] boys; mean [SD] age, 8.2 [6.1] years). Bacteremia incidence was not significantly different during outpatient vs inpatient management (67 courses [23.8%] vs 265 courses [29.0%]; adjusted rate ratio, 0.73; 95% CI, 0.56 to 1.06; P = .08). Outpatient management was not associated with delays to the next course compared with inpatient management (mean [SD] 30.7 [12.2] days vs 32.8 [9.7]days; adjusted mean difference, −2.2; 95% CI, −4.1 to −0.2, P = .03). Mortality during intensification II was higher for patients who received outpatient management compared with those who received inpatient management (3 patients [5.4%] vs 1 patient [0.5%]; P = .03), but comparable with inpatient management at other courses (eg, 0 patients vs 5 patients [1.3%] during induction I; P = .59). Among 97 patients evaluated for HRQOL, outcomes did not differ between outpatient and inpatient management (mean [SD] Pediatric Quality of Life Inventory total score, 70.1 [18.9] vs 68.7

show abstract

Household income and health‐related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research

Newman,

Li,

Huang

et al. 2024

Cancer Medicine

Self Cite

View full text Add to dashboard Cite

ObjectiveExamine the influence of household income on health‐related quality of life (HRQOL) among children with newly diagnosed acute myeloid leukemia (AML).DesignSecondary analysis of data prospectively collected from pediatric patients receiving treatment for AML at 14 hospitals across the United States.ExposureHousehold income was self‐reported on a demographic survey. The examined mediators included the acuity of presentation and treatment toxicity.OutcomeCaregiver proxy reported assessment of patient HRQOL from the Peds QL 4.0 survey.ResultChildren with AML (n = 131) and caregivers were prospectively enrolled to complete PedsQL assessments. HRQOL scores were better for patients in the lowest versus highest income category (mean ± SD: 76.0 ± 14 household income <$25,000 vs. 59.9 ± 17 income ≥$75,000; adjusted mean difference: 11.2, 95% CI: 2.2–20.2). Seven percent of enrolled patients presented with high acuity (ICU‐level care in the first 72 h), and 16% had high toxicity (any ICU‐level care); there were no identifiable differences by income, refuting mediating roles in the association between income and HRQOL. Enrolled patients were less likely to be Black/African American (9.9% vs. 22.2%), more likely to be privately insured (50.4% vs. 40.7%), and more likely to have been treated on a clinical trial (26.7% vs. 18.5%) compared to eligible unenrolled patients not enrolled. Evaluations of potential selection bias on the association between income and HRQOL suggested differences in HRQOL may be smaller than observed or even in the opposing direction.ConclusionsWhile primary analyses suggested lower household income was associated with superior HRQOL, differential participation may have biased these results. Future studies should partner with patients/families to identify strategies for equitable participation in clinical research.

show abstract

Identifying patient‐ and family‐centered outcomes relevant to inpatient versus at‐home management of neutropenia in children with acute myeloid leukemia

Cited by 9 publications

References 16 publications

Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin–Frankfürt–Münster (I‐BFM) study group

Differences in infection prophylaxis measures between paediatric acute myeloid leukaemia study groups within the international Berlin–Frankfürt–Münster (I‐BFM) study group

Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia

Household income and health‐related quality of life in children receiving treatment for acute myeloid leukemia: Potential impact of selection bias in health equity research

Contact Info

Product

Resources

About