A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India

Introduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children. Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India. Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis. Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant. Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.

Perceptions of the Cardiologists and Oncologists: Initial Step for Establishing Cardio-Oncology Service

Background: Over the last years, there was no established cardio-oncology service in Iraq and no firm data about the incidence of cardiovascular disease (CVD) among patients with cancer. As an initial step, we decided to conduct a national cardio-oncology online survey for cardiologists, oncologists, and their residents which would help us to understand the expected prevalence, problems, and readiness for collaboration between the two specialties.Objectives: For evaluating the current national practice in the cardiology and oncology specialty fields and to identify the hidden gaps associated with the development or worsening of CVD among patients with cancer.Methods: An online survey including 19-question for cardiologists/cardiology residents (CCRs) and 30-question for oncologists/oncology residents (OORs) about cardio-oncology service was sent to them including all Iraqi cities using Google document form during December 2020.Results: The total number of responses was 164, mainly 62.2% from CCRs while 37.8% from OORs. Hypertension was the main baseline risk factor (71%). A 77.5% of CCRs prescribe cardiovascular drugs vs. 35.5% by OORs. About 76.5% of CCRs and 79% of OORs are facing difficulties in the management of patients with cancer with established CVD. CVD was the leading cause of both hospitalization (30.7%) and mortality (48.4%). About 62.8% of CCRs and 64.5% of OORs have an interest to work in cardio-oncology service.Conclusion: Based on the perception of cardiologists and oncologists, CVD is the main cause of hospitalization and mortality among patients with cancer. High interest among CCRs and OORs to work in cardio-oncology service. Positive initiatives are available to take the action plan in this emerging field.

Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

180 Background: Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization. However, research describing these patients’ care satisfaction, symptom burden, and health care use is lacking. We sought to investigate relationships among care satisfaction, physical and psychological symptom burden, and hospital length of stay (LOS) in hospitalized patients with cancer. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 4/2017. Upon admission, we assessed patients’ care satisfaction (FAMCARE items: satisfaction with care coordination and the speed with which symptoms are treated) as well as their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction, and we also examined associations of care satisfaction with patients’ symptom burden and hospital length of stay (LOS). Results: Among 1,576 participants (median age = 65.0 years [range:19-96], 46.3% female, 70.9% with incurable cancer, 58.4% admitted to a dedicated oncology service), most reported being “satisfied” or “very satisfied” with care coordination (90.1%) and the speed with which symptoms are treated (89.0%). Older age (care coordination: B < 0.01, P = 0.022, speed with which symptoms are treated: B = 0.01, P = 0.001) and admission to a dedicated oncology service (B = 0.20, P < 0.001 for each) were associated with higher care satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = -1.28, P = 0.007), ESAS-total (B = -2.73, P < 0.001), PHQ4-depression (B = -0.14, P = 0.022), and PHQ4-anxiety (B = -0.16, P = 0.008) symptoms. Higher satisfaction with the speed with which symptoms are treated was associated with lower ESAS-physical (B = -1.32, P = 0.003), ESAS-total (B = -2.46, P < 0.001), PHQ4-depression (B = -0.14, P = 0.014), and PHQ4-anxiety (B = -0.17, P = 0.004) symptoms. Greater satisfaction with care coordination (B = -0.48, P = 0.040) and the speed with which symptoms are treated (B = -0.44, P = 0.041) were both associated with shorter LOS. Conclusions: Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.

Telephone versus face-to-face neuro-oncology consultations: comparing patient satisfaction, convenience, family support and clinician attitude during the COVID-19 pandemic

Aims During the first wave of the COVID-19 pandemic, to limit the number of patients attending hospital, the neuro-oncology department selected a large number of appointments to be conducted via the telephone. This project aimed to determine how patients and clinicians perceived telephone consultations in the neuro-oncology service compared to traditional face to face appointments. Method A 20-question patient satisfaction survey combined quantitative and qualitative questions and was distributed between June and August 2020. These were distributed by email to 88 patients who attended neuro-oncology clinic in person ("face-to-face"), or by telephone. Concurrently, a 15-question survey was distributed to all clinicians conducting telephone and face-to-face consultations for the neuro-oncology service. Questions included in the clinician survey were designed to mirror the patient satisfaction questionnaire where possible. Fisher's exact test was used to determine significance, which was set at p&lt; 0.05. Results 51.1% (n=45) of patients returned the questionnaire. Of those who received telephone appointments, 89.5% (n=17) felt the consultation was convenient, 94.7% (n=18) were satisfied and 80.0% (n=16) were able to have a family member/friend present. Of those who attended face-to-face appointments, 96.0% (n=24) felt their consultation was convenient, 100% (n=25) were satisfied and 87.5% (n=21) were able to have a family member/friend present. There was no significant difference in patient convenience, satisfaction or family/friend presence (p=0.395, p=0.432 and p=0.498 respectively) between face-to-face and telephone clinics. Overall, the clinicians reported undertaking a mean of 9.5 telephone consultations per week. Only 42.8% (n=3) use telephone appointments for first-time neuro-oncology consultations, whereas 100.0% (n=7) use them for results and follow-up appointments. Only 51.7% (n=4) felt that undertaking telephone consultations is convenient and 42.8% (n=3) have experienced difficult situations with patients during telephone consultation. Conclusion This project suggests that neuro-oncology telephone consultations provide patients with the same level of satisfaction and convenience as face-to-face appointments. We have also demonstrated that using the telephone does not provide a significant barrier to having family or friends present to support the patient. We have shown that clinicians are universally utilising neuro-oncology telephone appointments for follow-up and results whereas much fewer use the telephone for performing initial consultations. Given the high-level of satisfaction demonstrated in the patient questionnaires this reflects effective patient-selection for remote consultations. The COVID-19 pandemic has forced oncology services to evolve and results of this project suggest that telephone neuro-oncology consultations are widely accepted by patients and clinicians. We therefore propose that remote consultations should continue beyond the pandemic in select cases.