Journals
2026 EN
Kumar Kriti · Connolly Denise M. · Kellington Ellen
+6 more
ABSTRACT Background Pediatric patients with extracranial solid tumors (ST) receiving chemotherapy are at an increased risk for Pneumocystis jirovecii pneumonia (PJP). However, evidence guiding prophylaxis practices in this population is limited. A PJP‐related fatality at our institution highlighted inconsistent prescribing approaches and concerns about prophylaxis‐related toxicity, prompting the development of a quality improvement (QI) initiative to standardize PJP prophylaxis for patients with ST. Procedure Our quality improvement (QI) initiative aimed to increase PJP prophylaxis initiation rates in pediatric patients (0–18 years) with newly diagnosed extracranial ST (excluding osteosarcoma) to over 90%, without associated chemotherapy delays or significant prophylaxis‐related toxicity. The initiative was designed using the Model for Improvement with monthly Plan–Do–Study–Act cycles. Interventions included regular stakeholder engagement, education, and electronic health record (EHR)‐integrated prophylaxis prescriptions. Balancing measures, including discontinuation rates of prophylaxis, related toxicity, and chemotherapy delays, were assessed through clinician surveys and chart review. Kotter's 8‐Step Change Model secured engagement during planning and implementation of this 6‐month (April–September 2024) initiative across inpatient and outpatient settings in a tertiary oncology center. Results PJP prophylaxis was initiated in 100% ( n = 20) of eligible patients, an 88.7% relative improvement in coverage, compared to initiation rates of 53% in a historical cohort ( n = 16/30). No chemotherapy delays or discontinuations of prophylaxis due to toxicity were reported. Conclusion A universal approach to PJP prophylaxis can be safely and effectively implemented in pediatric patients with ST without significant toxicity. Our experience highlights how change management models can effectively support the implementation of QI initiatives in pediatric oncology.
Journals
2026 EN
Chapman Hutton · Ntemi Paul S. · Mahene Richard
+5 more
ABSTRACT Background Despite the excellent outcomes achieved for pediatric mature B‐cell non‐Hodgkin lymphoma (MB‐NHL) in high‐income countries, outcomes remain very poor in low‐ and middle‐income countries. High‐dose methotrexate (HD‐MTX), which is highly efficacious for the disease, is still not commonly used in low‐resource settings due to the potential for treatment‐associated toxicity. Though there have been more recent reports of successful use of HD‐MTX in resource‐limited settings, there are no reports to date regarding the methodology used to safely introduce HD‐MTX in these environments. Subsequently, at our treatment center in northern Tanzania, we endeavored to utilize implementation science methodology to elucidate generalizable methods to allow for a safe introduction of HD‐MTX in a resource‐limited setting. Procedure The Active Implementation Frameworks were utilized as a starting point to generate an initial implementation plan. Intervention fit was assessed, and resource mapping and cost analysis were completed. Key stakeholders were identified and engaged. Novel educational strategies, decision support tools, and protocol fidelity monitoring systems were developed. Results Following completion of all planning and education activities, use of a new HD‐MTX containing MB‐NHL protocol began in October of 2024. As of June 2025, 27 cycles of HD‐MTX have been given to a cumulative total of 10 patients. Few protocol deviations have occurred, and only one Grade III non‐hematologic adverse event has been reported. Conclusions The use of implementation science methodology allowed a careful introduction of the use of HD‐MTX for the treatment of pediatric MB‐NHL in a resource‐limited setting.
Journals
2026 EN
Balsamo Lyn M. · Kairalla John A. · Hibbitts Emily
+12 more
ABSTRACT Background Quality of life (QOL) is impacted in children treated for leukemia. AALL0932 randomized reduction in vincristine/dexamethasone (VCR/DEX) pulses every 4 versus 12 weeks during maintenance in the average‐risk subset of NCI standard risk B‐ALL (NCI‐SR AR B‐ALL). We longitudinally assessed physical and emotional QOL, behavioral health, and school services by randomization. Procedure NCI‐SR AR B‐ALL English‐speaking patients aged ≥4 years were evaluated at T1–T5 (∼2, 9, 18, 26 months [females treatment end], and 38 [males only] months from diagnosis) with parent‐report. The Pediatric Quality of Life Inventory‐4.0 and school services survey were administered longitudinally, and the Behavior Assessment Scale for Children‐2 at therapy end. Results Data were obtained from 420 consented and randomized participants (mean 6.0±1.6 years, 45.7% female). Impairment among randomized participants at T2 and T4, respectively, was 11.3% and 12.5% for physical, and 12.2% and 9.8% for emotional function. In longitudinal models adjusting for race/ethnicity, time, and baseline impairment, pulse frequency was not associated with impairment (physical odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.5–1.8; emotional OR = 0.9, 95% CI = 0.5–1.7). T2 impairment was associated with increased risk of post‐randomization impairment for physical (OR = 4.3, 95% CI: 1.9–9.9) and emotional (OR = 4.9, CI: 2.3–10.5) function. Approximately 73.8% reported one or more school‐based service during treatment: special education/accommodations (67.6%) and physical/occupational therapy (8.8%). Depression (20%) and anxiety (19%) did not differ by pulse frequency. Discussion Children with NCI‐SR AR B‐ALL experience diminished QOL, despite reduced frequency of VCR/DEX maintenance pulses. Impairment begins early during ALL therapy and persists; interventions should commence early and continue throughout and after therapy.
Journals
2026 EN
Ruccione Kathleen S. · Crane Stacey · Bocking Tina
+10 more
ABSTRACT In 2012, the Children's Oncology Group (COG) issued 18 recommendations for returning aggregate research results to participants. This manuscript reviews the Return of Results (ROR) Committee's progress in implementing these recommendations. A multidisciplinary review assessed implementation status, identified challenges, and incorporated relevant literature to propose updates and future research directions. Fourteen recommendations were fully or partially implemented, three were deemed infeasible, and one is planned for future action. Successful implementation was supported by infrastructure, education, and ongoing quality improvement. This experience offers a practical model for other cooperative research groups aiming to return research results beyond clinical trials.
Journals
2026 EN
Rees Matthew · Bernstein Rachel · Meredith Carly
+4 more
ABSTRACT Objective Continuity clinic is a critical component of graduate medical training, yet challenges in the clinic setting may disrupt learning opportunities. In the pediatric hematology/oncology fellowship at our institution, fellows see patients in five separate subspecialty clinics during a day of weekly continuity clinic. Feedback from fellows and faculty indicated that clinic structure and workflows negatively impacted the fellow educational experience and overall satisfaction. The aim of this initiative was to increase fellow satisfaction with education and workflow in the continuity clinic from baseline scores of 2.3 and 1.8, respectively (scale from 1 “very dissatisfied,” to 5 “very satisfied”) to a goal of 3.5. Methods A multidisciplinary team of stakeholders was formed. A baseline survey to assess fellow satisfaction was completed in June 2022, then repeated regularly during an intervention period (July 2022 to June 2023) and a follow‐up period (July 2023 to December 2023). A separate survey assessed the satisfaction of faculty and clinic staff as a balancing measure. Five key interventions (clinical mentor, clinical team roles, patient visits per day, schedule template, patient panel) were implemented and refined through iterative plan–do–study–act cycles using the Model for Improvement. Results Fellow satisfaction increased significantly for both measures, with sustained centerline (median) shift from baseline of 2.3 to 4.1 for the educational experience, and from baseline of 1.8 to 3.5 for the clinic workflow. There was no significant decrease in faculty or staff satisfaction on any survey measure during the study. Conclusion Multidisciplinary interventions led to sustained improvement in the educational experience and workflow of fellows in a subspecialty continuity clinic.
Journals
2026 EN
CâmaraCosta Hugo · Barrault Zoé · Longaud Audrey
+15 more
ABSTRACT Objective Recent studies show evidence of cognitive and psychosocial impairments and reduced quality of life (QoL) in adult survivors of childhood extracranial solid tumors and lymphomas, but limited research has addressed these issues in pediatric populations. Study Design The French RISK‐N prospective study (2014–2021) evaluated 278 survivors of extracranial solid tumors or lymphomas (47% female, mean age at diagnosis and assessment: 6.2 and 11.7 years). Patients with pre‐existing neurological conditions were excluded. Sociodemographic, disease‐related, and treatment data were collected. Cognitive performance was assessed using Wechsler Intelligence Scales for Children (WISC‐IV, WISC‐V). Psychosocial outcomes included parent and/or patient‐reported executive functions (Behavior Rating Inventory of Executive Function), behavior (Conner's Parent Rating Scale), QoL (Pediatric Quality of Life Inventory), fatigue (Multidimensional Fatigue Scale), and depression (Children's Depression Inventory). Information on schooling and educational/rehabilitative interventions was also recorded. Results Diagnoses included lymphoma (25%), nephroblastoma (19%), neuroblastoma (19%), osteosarcoma (7%), other sarcomas (18%), and other tumors (12%). Mean Full Scale Intellectual Quotient [ M (SD) = 99.44(15.62)] was as expected in the general population [ M (SD) = 100(15)], but the WISC‐IV Perceptual Reasoning Index was slightly lower [ M (SD) = 95.4(15.0), <1.5 SD 14%]. Parent‐ and self‐reports indicated greater executive dysfunction, inattention, fatigue, and reduced QoL. In multivariable regression models, poorer cognitive outcomes were associated with lower parental education and developmental/learning delays before diagnosis. Conclusions Objective cognitive deficits were uncommon among pediatric cancer survivors, contrasting with a relatively high level of subjective cognitive and psychosocial complaints, highlighting the need for systematic screening and tailored clinical interventions.
Journals
2026 EN
Belgaumi Asim F. · Khan Muhammad Ali Akbar · Sultan Iyad
+9 more
ABSTRACT Background The pediatric hematology‐oncology (PHO) workforce has substantial variability in countries across the Eastern Mediterranean (EM) and South Asian (SA) regions, with variable certification requirements to ensure competency for safe and effective practice. To date, the quality of the training provided has not been evaluated across these regions. To assess this, we conducted a survey of PHO training by comparing the programs against international standards. Methods A cross‐sectional survey was conducted between January and May 2024. The survey was based on the American Council of Graduate Medical Education (ACGME) requirements and implemented through RedCap R . Descriptive statistics were generated, and p values <0.05 were considered statistically significant. Findings Ninety‐eight institutions from 21 countries across the EM and SA regions responded to our survey. Of these, 59.1% reported PHO training programs. A core pediatric residency was present within the proximity of the fellowship program in 63.7%. Public sector institutions were more likely to have a training program than private centers. A median of two fellows [1–20] were recruited annually, with a median faculty:fellow ratio of 2. While most programs provided exposure to the entire breadth of hematologic and oncologic diseases, 17% of programs did not offer care to patients with high‐risk/advanced malignancies, identifying an experiential deficiency. Across all domains, programs were deficient in the availability of molecular and genetic diagnostics, impacting trainee learning. Accreditation oversight was provided to 87.5% programs. Only a minority of programs facilitated program directors to oversee training. Interpretation Our survey provides a baseline overview of the capabilities of training programs in the EM and SA regions. While a majority of programs fulfilled standard requirements necessary for optimal training of PHO fellows, the quality of the exposure could not be ascertained.
Journals
2026 EN
Styczewska Malgorzata · Krawczyk Malgorzata A. · Gabrych Anna
+36 more
ABSTRACT BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor, typically affecting infants. Kasabach–Merritt phenomenon (KMP) is a frequent and serious complication of KHE. The study aimed to analyze clinical manifestations, treatment strategies, and outcomes in children with KHE treated in Poland between 2007 and 2024. PROCEDURE Clinical data of 42 children with KHE treated in 15 Polish pediatric hematology/oncology and surgery centers between 2007 and 2024 were analyzed retrospectively. RESULTS KMP was present in 27/42 children (64.3%). The median age at diagnosis in children with and without KMP was 2.5 and 8 months, respectively. A male predilection was observed (61.9%), particularly in patients without KMP (13/15, 86.7%). Diagnosis of KHE required a tumor biopsy in 20 patients, including 14/15 (93.3%) of patients without KMP. Treatment strategies varied significantly between patients, institutions, and treatment periods. Systemic treatment was administered in 39 (92.9%) children, with predominating role of chemotherapy and glucocorticoids in the first period (2007–2013), and with gradually increasing importance of sirolimus in the years 2014–2018 and 2019–2024. Three children were successfully treated with surgery only. Salvage therapies ultimately controlled KHE progression/relapse in 14/17 (82.4%) patients. Only one child with metastatic, treatment‐resistant cardiac KHE died of disease progression. CONCLUSIONS Management of childhood KHE is challenging since no unified treatment recommendations exist. To optimize KHE therapy in Poland, the Section of Childhood Vascular Anomalies was established in June 2021 as part of the Polish Society of Pediatric Oncology and Hematology. Its aim is to standardize therapeutic guidelines and provide education on vascular anomalies in Poland.
Journals
2026 EN
Rogers Andrew H. · Pester Bethany D. · Fligelman Sara J.
+5 more
ABSTRACT Background Over 89,000 adolescents and young adults (AYAs) are diagnosed with cancer every year in the United States, and despite high survival rates, AYAs continue to experience the late effects of cancer and its treatments into survivorship. Pain, cited as the most distressing, impairing, and undertreated symptom during and after active treatment, is a common concern for AYAs with cancer and a challenge for oncology providers to manage. First‐line pain treatments often include prescription opioids, but there is limited evidence to support the efficacy of long‐term opioid use to manage pain among AYAs, along with increased risk of opioid‐related negative consequences. Given the relative lack of research in this area, there is an opportunity to better understand how oncology providers think about and navigate chronic pain management and mitigate risk for opioid‐related negative outcomes. Method Therefore, we conducted a semi‐structured qualitative study with 14 pediatric oncology providers, assessing current pain management practices, decision‐making, attitudes and perspectives, and challenges to providing safe and effective pain management for AYA oncology patients. Interviews were summarized using a Rapid Qualitative Analysis framework. Results Results provided support for three themes: perceptions about pain and pain management needs for AYAs with cancer; pharmacological and nonpharmacological treatments for cancer‐related pain; and education, standardization, and challenges of opioid pain management. Conclusions There are a number of existing barriers to AYA cancer‐related pain management in the oncology setting. Oncology providers are providing primary pain management for their patients, but should consider referral to pain specialists when available. Better characterization of cancer‐related pain can ideally be leveraged to identify those patients at highest risk for chronic pain and its consequences in survivorship, opening the possibility of developing tailored prevention and intervention strategies.
Journals
2026 EN
Zupanec Sue · Honeyford Lisa · Starr Allison
+7 more
ABSTRACT Background Blinatumomab has transformed the treatment of pediatric B‐acute lymphoblastic leukemia (B‐ALL). However, it presents distinct operational challenges for administration given it is delivered as a continuous infusion and has unique toxicities. The objective of this project was to develop, implement, and evaluate a standardized institutional protocol for blinatumomab administration to optimize safety, efficiency, and patient experience. Procedure This quality improvement (QI) initiative was conducted at The Hospital for Sick Children, Toronto, Canada. A multidisciplinary Blinatumomab Working Group developed harmonized standards across five domains: (1) caregiver education, (2) fever management, (3) nursing‐led assessments, (4) infusion interruption management, and (5) use of 7‐day infusion bags. Patients receiving blinatumomab for upfront therapy or for relapsed disease between July 2024 and August 2025 were included. Demographic and clinical data were extracted from the institutional data warehouse. Outcomes included rates of caregiver education completion, antibiotic use during blinatumomab initiation, and completion of nursing‐led assessments. Results Fifty‐three patients received standard of care blinatumomab. All eligible caregivers (100%) completed standardized education. The rate of empiric antibiotic use during blinatumomab initiation decreased from 68% to 22% following adoption of selective antibiotic initiation without increased readmission, or prolonged stay. Nursing assessment completion was 95% for inpatients and 81% for outpatients. Infusion interruptions were managed using a standardized, risk‐based algorithm without observed safety events. Conclusion Implementation of multidisciplinary, standardized blinatumomab administration protocols was feasible and safe. These processes improved antibiotic stewardship, empowered nursing‐led care, and reduced practice variability. This framework may inform best practices for the safe and efficient delivery of blinatumomab in other pediatric oncology centers.