Parent‐centered communication at time of pediatric cancer diagnosis: A systematic review

There are limited data focused on parental communication needs surrounding the time when a child is diagnosed with cancer. In this systematic review, we synthesized current literature on communication preferences of parents at the time of their child's diagnosis of cancer. We identified 16 studies that yielded 4 major themes parents recognized as important: communication style, content, logistics, and healthcare team. We further identified several concepts that inform parent‐centered communication practice. The ensuing pediatric oncology parent‐centered communication concept map is meant as a tool to expand providers’ communication experience at the time of a new cancer diagnosis.     

Initiating Childhood Cancer Treatment in Rural Rwanda: A Partnership‐Based Approach

Background. More than 85% of pediatric cancer cases and 95% of deaths occur in resource‐poor countries that use less than 5% of the world's health resources. In the developed world, approximately 81% of children with cancer can be cured. Models applicable in the most resource‐poor settings are needed to address global inequities in pediatric cancer treatment. Procedure. Between 2006 and 2011, a cohort of children received cancer therapy using a new approach in rural Rwanda. Children were managed by a team of a Rwandan generalist doctor, Rwandan nurse case manager, Rwanda‐based US‐trained pediatrician, and US‐based pediatric oncologist. Biopsies and staging studies were obtained in‐country. Pathologic diagnoses were made at US or European laboratories. Rwanda‐based clinicians and the pediatric oncologist jointly generated treatment plans by telephone and email. Results. Treatment was provided to 24 patients. Diagnoses included lymphomas (n = 10), sarcomas (n = 9), leukemias (n = 2), and other malignancies (n = 3). Standard chemotherapy regimens included CHOP, ABVD, VA, COP/COMP, and actino‐VAC. Thirteen patients were in remission at the completion of data collection. Two succumbed to treatment complications and nine had progressive disease. There were no patients who abandoned treatment. The mean overall survival was 31 months and mean disease‐free survival was 18 months. Conclusions. These data suggest that chemotherapy can be administered with curative intent to a subset of cancer patients in this setting. This approach provides a platform for pediatric cancer care models, relying on local physicians collaborating with remote specialist consultants to deliver subspecialty care in resource‐poor settings.     

Unusual childhood presentations of abdominal non‐Hodgkin's lymphoma

Non‐Hodgkin's lymphoma (NHL) is a relatively common childhood cancer that can present in a myriad of ways. It is essential that NHL is included in the differential diagnosis of children presenting with an abdominal complaint, especially those with unexplained or prolonged symptoms. We describe three acute pediatric presentations of abdominal NHL, two of which presented as acute abdomen (the first mimicking intussusception and the second appendicitis), and the third involving lower limb edema. This case series illustrates the array of presentations of abdominal NHL and the diagnostic challenges that they can provide.     

Premature physeal closure following 13‐cis‐retinoic acid and prolonged fenretinide administration in neuroblastoma

Retinoid therapy has contributed to improved outcomes in neuroblastoma. Clinical trials of fenretinide report favorable toxicity and disease stabilization in patients with high risk (HR) neuroblastoma. Skeletal effects have been described with other retinoids, but not with fenretinide to date. Two patients with HR, metastatic, refractory neuroblastoma received protracted courses of oral fenretinide for more than 5 years’ duration. Both developed premature long bone physeal closure, causing limb length discrepancies; their neuroblastoma remains in remission. The radiographic and clinical findings reported suggest these skeletal abnormalities may be a consequence of treatment with 13‐cis‐retinoic acid (13cisRA) followed by prolonged oral fenretinide exposure.