Experience of treating pediatric cancer patients in a standalone day care centre
Nandini Hazarika, Amish Vora, Amit Upadhyay, Kumar Rishikesh, Sonali Chatterjee, Harleen Kaur Nayyar
Pediatric Hematology Oncology Journal
physical visit to hospital. At end of minimum two years follow up survivors will be eligible for the next phase wherein spectrum of late effects will be evaluated on this survivor cohort. C. Result 1618 survivors from 13 centers have been enrolled.The analysis is reflective for 1321 survivors. Most enrolled survivors are from Delhi hospitals. Majority are between 5-9 years (36%) followed by 0-4 years(31%), median age being 8.3 years (range 1-26years). Majority aremales(2:1). Commonest
... was acute leukemia(40%) followed by lymphoma(18%) and retinoblastoma(9%). Regional variation with type of cancers was observed. Majority belong to middle socio-economic strata(modified Kuppuswamy scale). Period of follow up ranges from 0-40 months. Majority(92%) are under follow up. Chemotherapy was the commonest treatment exposure (98%). Relapse was seen in 5.2%(n¼69) and death was seen in 2.5%(n¼33) D. Conclusion The C2S Study is the first childhood cancer survivor registry from India.The study cohort will provide useful epidemiologic data on childhood cancer survivors and serve as a platform for further studies based on disease/ treatment exposure related late effect. Long term followup will demonstrate profile of late effects that occur in childhood cancer survivors. This will culminate in forming recommendations/guidelines for long term follow up of such children in India. A. Objective Survivors of pediatric brain tumors are at high risk of developing multiple chronic and disabling health conditions, potentially impacting growth, development and quality of life. We analyzed the prevalence, spectrum and possible risk factors for early endocrine disorders in survivors of pediatric embryonal brain tumor (PEBT) patients treated at our centre. B. Design Retrospective audit of 2-year survivors of PEBT (18 years at diagnosis), viz. medulloblastoma(MB),Central nervous system Primitive neuro-ectodermal tumors(CNS PNET) and atypical teratoid/rhabdoid tumor(ATRT) treated January 2006 -December 2017 at Tata memorial hospital, Mumbai. Treatment included surgery, cranio-spinal irradiation(CSI; 35Gy in high risk MB,CNS PNET, ATRT and 23.4Gy in average risk MB with tumor boost 19.8Gy) and six cycles of adjuvant chemotherapy(cyclophosphamide-2g/ m2/cycle, cisplatin, and vincristine). Patients were followed up as per modified Children Oncology Group Long-term Follow-up(COG LTFU) guidelines by a paediatric endocrinology team specialized in management of PEBT. C. Result Of 249 pediatric CNS embryonal tumors treated between during this period, 88 were alive in remission >2years(69-MB, 15-CNS PNET,4-ATRT). Median age at diagnosis-6 years, and Male: Femalee2.6:1. At a median follow-up of 5.6 years (range 3-12.5 years), 63 patients(72%) had at least one endocrine disorder,26 (29.%) of these patients 2 hormonal deficiencies. The most common endocrine disorders were hypothyroidism(57%),growth hormone deficiency(40%), Luteinizing hormone/ follicle stimulating hormone deficiency(5%) and adrenocorticotropic hormone deficiency(3.5%). The median time to develop hypothyroidism was 2.8 years(range-5months to 8.5 years) from CSI. Growth hormone replacement therapy began after a median period of 4.2 years(range-1.5 to 11.5years) from CSI. Higher dose of CSI was associated with development of endocrine disorder (odds ratio [OR],2.71; 95% CI, 1.03 to 7.04, p-0.04). D. Conclusion The high incidence of endocrine deficits necessitates early and lifelong monitoring, with appropriate management for survivors of PEBT to achieve their full growth and development. A. Objective Though most of chemotherapies in pediatric patients are done in a day care setting but inside a hospital premise with ICU back-up facility. Here we present our experience of treating pediatric cancer patients in a standalone chemotherapy day care set-up. B. Design We have done a retrospective analysis of all pediatric patients (0-18 years) registered in our day care center from October 2017 to September 2019 in terms of diagnosis, treatment compliance, requirement of overnight hospitalization and feasibility of treating such patients in a standalone daycare setup. C. Result Total 113 patients were registered with 19 benign hematological conditions and 94 malignant diseases. Out of 94 malignant diseases, 33 (35 %) cases took treatment at the center, another 32 (34%) were for post treatment follow -up and rest 29 cases (31%) came for initial diagnosis or a second opinion but did not receive treatment in our center. Out of 33 patients who took treatment, majority were of acute Leukemias (9) and brain tumors (10) and rest includes lymphomas (4), Osteosarcoma (2), non RMS soft tissue sarcoma (3), Rhabdomyosarcoma (2) and one each of Neuroblastoma, Retinoblastoma and Germ cell tumor. Number of patients requiring hospital admission were 13 (39%), reasons being procedures requiring sedation, for 24 hours infusions, febrile neutropenia and nonhematological toxicities. Twelve patients received blood component support in the center. D. Conclusion It is feasible to treat pediatric cancer patients requiring chemotherapy in a standalone daycare center with trained staff and facility to transfer the patient to a nearby hospital with PICU support. The advantage of day care is less possibility of hospital acquired infection, easy admission and discharge process, cost effective, homely atmosphere. The disadvantage of being a small center could be refusal of treatment.