| 41. |
- Edwinson Månsson, Marie, et al.
(author)
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The effect of preparation for lumbar puncture on children undergoing chemotherapy
- 1993
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In: Oncology Nursing Forum. - 0190-535X. ; 20:1, s. 39-45
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Journal article (peer-reviewed)abstract
- At the University Hospital in Lund, Sweden, a preparation program was developed for children undergoing lumbar punctures (LPs) during chemotherapy for leukemia or lymphoma. Subsequently, a study was initiated to determine whether a preparation program for children prior to treatment would reduce their anxiety and improve their cooperation. This study also was undertaken to examine whether reinforcing the preparation information prior to each LP would be beneficial. The 30 children who participated in the study were divided into three groups: a control group whose members did not receive preparation and two other groups whose members were exposed to different numbers of preparation programs. The parents and the nurse in charge evaluated the children's reactions during treatment using two 6-point rating scales: an anxiety scale and a noncooperation behavior scale. Two unbiased, trained observers later viewed video recordings of the children's reactions and evaluated them using the same tools. In addition, each child rated his or her experience of pain on a 10 cm visual analogue scale. Based on these ratings, the groups were analyzed to determine if within-group differences existed from one treatment to the next and to determine if between-group differences existed at the various times of treatment. Few statistically significant differences were found, but the results indicate that the children in the most informed group exhibited sustained reductions in their perceptions of pain. This may signify that reinforcing the preparation information before each of the LPs enabled these children to cope with the pain more effectively.
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| 42. |
- Einarsson, Einar Jón, et al.
(author)
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Decreased postural control in adult survivors of childhood cancer treated with chemotherapy
- 2016
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
-
Journal article (peer-reviewed)abstract
- The objective of cancer treatment is to secure survival. However, as chemotherapeutic agents can affect the central and peripheral nervous systems, patients must undergo a process of central compensation. We explored the effectiveness of this compensation process by measuring postural behaviour in adult survivors of childhood cancer treated with chemotherapy (CTS). We recruited sixteen adults treated with chemotherapy in childhood for malignant solid (non-CNS) tumours and 25 healthy age-matched controls. Subjects performed posturography with eyes open and closed during quiet and perturbed standing. Repeated balance perturbations through calf vibrations were used to study postural adaptation. Subjects were stratified into two groups (treatment before or from 12 years of age) to determine age at treatment effects. Both quiet (p = 0.040) and perturbed standing (p ≤ 0.009) were significantly poorer in CTS compared to controls, particularly with eyes open and among those treated younger. Moreover, CTS had reduced levels of adaptation compared to controls, both with eyes closed and open. Hence, adults treated with chemotherapy for childhood cancer may suffer late effects of poorer postural control manifested as reduced contribution of vision and as reduced adaptation skills. These findings advocate development of chemotherapeutic agents that cause fewer long-term side effects when used for treating children.
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| 43. |
- Einarsson, Einar Jón, et al.
(author)
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Elevated visual dependency in young adults after chemotherapy in childhood
- 2018
-
In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:2
-
Journal article (peer-reviewed)abstract
- Chemotherapy in childhood can result in long-term neurophysiological side-effects, which could extend to visual processing, specifically the degree to which a person relies on vision to determine vertical and horizontal (visual dependency). We investigated whether adults treated with chemotherapy in childhood experience elevated visual dependency compared to controls and whether any difference is associated with the age at which subjects were treated. Visual dependency was measured in 23 subjects (mean age 25.3 years) treated in childhood with chemotherapy (CTS) for malignant, solid, non-CNS tumors. We also stratified CTS into two groups: those treated before 12 years of age and those treated from 12 years of age and older. Results were compared to 25 healthy, age-matched controls. The subjective visual horizontal (SVH) and vertical (SVV) orientations was recorded by having subjects position an illuminated rod to their perceived horizontal and vertical with and without a surrounding frame tilted clockwise and counter-clockwise 20 from vertical. There was no significant difference in rod accuracy between any CTS groups and controls without a frame. However, when assessing visual dependency using a frame, CTS in general (p = 0.006) and especially CTS treated before 12 years of age (p = 0.001) tilted the rod significantly further in the direction of the frame compared to controls. Our findings suggest that chemotherapy treatment before 12 years of age is associated with elevated visual dependency compared to controls, implying a visual bias during spatial activities. Clinicians should be aware of symptoms such as visual vertigo in adults treated with chemotherapy in childhood.
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| 44. |
- Einarsson, Einar-Jon, et al.
(author)
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Hearing impairment after platinum-based chemotherapy in childhood.
- 2011
-
In: Pediatric Blood & Cancer. - : Wiley. - 1545-5017 .- 1545-5009. ; 56:4, s. 631-637
-
Journal article (peer-reviewed)abstract
- Chemotherapy is used in the treatment of children and adolescents with malignant diseases. Some of the chemotherapeutic agents are highly toxic and may cause a number of side effects. The primary objective of this study was to evaluate the long-term effects on hearing in cancer survivors who had received platinum-based chemotherapy in childhood or adolescence.
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| 45. |
- Einarsson, Einar-Jon, et al.
(author)
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Long term hearing degeneration after platinum-based chemotherapy in childhood.
- 2010
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In: International Journal of Audiology. - : Informa UK Limited. - 1708-8186 .- 1499-2027. ; 49:10, s. 765-771
-
Journal article (peer-reviewed)abstract
- The aim of this study was to investigate long-term development of hearing in subjects who had received platinum-based chemotherapy in childhood or adolescence. Another aim was to assess the self-reported hearing loss handicap and compare it to audiometric measurements. Medical records from individuals diagnosed with childhood cancer and treated with platinum-based chemotherapy between 1985 and 2000 at the University Hospital in Lund Sweden were reviewed retrospectively. Fifteen subjects, who fulfilled the eligibility criteria set for the study, underwent a thorough audiometric evaluation. The results show that the hearing loss, in subjects with ototoxicity had increased after the end of treatment, to include also the lower frequencies. The largest deterioration in hearing thresholds, up to 55 dB HL, was found at frequencies above 2 kHz. The findings also reveal that the subjects have a considerably greater hearing loss handicap and disability than would be expected from the results of the audiometric evaluations. The conclusion of this study is that children and adolescence treated with platinum-based chemotherapy should have regular audiometric follow-up examinations, also many years after the end of treatment. Furthermore, assessments of self-reported hearing disability should be made during and after chemotherapy.
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| 46. |
- Einarsson, Einar-Jon, et al.
(author)
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Oculomotor Deficits after Chemotherapy in Childhood.
- 2016
-
In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1, s. 1-17
-
Journal article (peer-reviewed)abstract
- Advances in the diagnosis and treatment of pediatric malignancies have substantially increased the number of childhood cancer survivors. However, reports suggest that some of the chemotherapy agents used for treatment can cross the blood brain barrier which may lead to a host of neurological symptoms including oculomotor dysfunction. Whether chemotherapy at young age causes oculomotor dysfunction later in life is unknown. Oculomotor performance was assessed with traditional and novel methods in 23 adults (mean age 25.3 years, treatment age 10.2 years) treated with chemotherapy for a solid malignant tumor not affecting the central nervous system. Their results were compared to those from 25 healthy, age-matched controls (mean age 25.1 years). Correlation analysis was performed between the subjective symptoms reported by the chemotherapy treated subjects (CTS) and oculomotor performance. In CTS, the temporal control of the smooth pursuit velocity (velocity accuracy) was markedly poorer (p<0.001) and the saccades had disproportionally shorter amplitude than normal for the associated saccade peak velocity (main sequence) (p = 0.004), whereas smooth pursuit and saccade onset times were shorter (p = 0.004) in CTS compared with controls. The CTS treated before 12 years of age manifested more severe oculomotor deficits. CTS frequently reported subjective symptoms of visual disturbances (70%), unsteadiness, light-headedness and that things around them were spinning or moving (87%). Several subjective symptoms were significantly related to deficits in oculomotor performance. To conclude, chemotherapy in childhood or adolescence can result in severe oculomotor dysfunctions in adulthood. The revealed oculomotor dysfunctions were significantly related to the subjects' self-perception of visual disturbances, dizziness, light-headedness and sensing unsteadiness. Assessments of oculomotor function may, thus, offer an objective method to track and rate the level of neurological complications following chemotherapy.
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| 47. |
- Einarsson, Einar-Jon, et al.
(author)
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Severe difficulties with word recognition in noise after platinum chemotherapy in childhood, and improvements with open-fitting hearing-aids.
- 2011
-
In: International Journal of Audiology. - : Informa UK Limited. - 1708-8186 .- 1499-2027. ; 50, s. 642-651
-
Journal article (peer-reviewed)abstract
- To investigate word recognition in noise in subjects treated in childhood with chemotherapy, study benefits of open-fitting hearing-aids for word recognition, and investigate whether self-reported hearing-handicap corresponded to subjects' word recognition ability. Design: Subjects diagnosed with cancer and treated with platinum-based chemotherapy in childhood underwent audiometric evaluations. Study Sample: Fifteen subjects (eight females and seven males) fulfilled the criteria set for the study, and four of those received customized open-fitting hearing-aids. Results: Subjects with cisplatin-induced ototoxicity had severe difficulties recognizing words in noise, and scored as low as 54% below reference scores standardized for age and degree of hearing loss. Hearing-impaired subjects' self-reported hearing-handicap correlated significantly with word recognition in a quiet environment but not in noise. Word recognition in noise improved markedly (up to 46%) with hearing-aids, and the self-reported hearing-handicap and disability score were reduced by more than 50%. Conclusions: This study demonstrates the importance of testing word recognition in noise in subjects treated with platinum-based chemotherapy in childhood, and to use specific custom-made questionnaires to evaluate the experienced hearing-handicap. Open-fitting hearing-aids are a good alternative for subjects suffering from poor word recognition in noise. Sumario Objectivo: Investigar el reconocimiento de palabras en ruido en sujetos tratados en la infancia con quimioterapia, los beneficios en el estudio de la adaptación abierta de auxiliares auditivos para el reconocimiento de palabras e investigar si el impedimento auditivo auto-reportado corresponde a la capacidad de reconocimiento de palabras del sujeto. Diseño: Se evaluó audiométricamente a sujetos que había sido diagnosticados con cáncer y tratados con una quimioterapia basada en platino en la infancia. Muestra del Estudio: Quince sujetos (8 mujeres y 7 hombres) cumplieron los criterios establecidos para el estudio y cuatro de ellos recibieron auxiliares auditivos de adaptación abierta, hecha a la medida. Resultados: Los sujetos con ototoxicidad inducida por cisplatino tuvieron dificultades severas para reconocer palabras en ruido y tuvieron puntuaciones tan bajas como 54% por debajo de las de referencia, estandarizadas por edad y por grado de pérdida auditiva. Los auto-reportes de impedimento auditivo de los sujetos con hipoacusia correlacionaron significativamente con el reconocimiento de palabra en un ambiente silencioso pero no en ruido. El reconocimiento de palabras en ruido mejoró marcadamente (hasta en un 46%) con los auxiliares auditivos, y el impedimento y discapacidad auditiva auto-reportados se redujeron en más del 50%. Conclusiones: Este estudio demuestra la importancia de evaluar el reconocimiento de palabras en ruido en sujetos tratados con quimioterapias basadas en platino en la infancia, y de usar cuestionarios específicos, hechos a la medida, para evaluar la disminución auditiva experimentada. Los auxiliares auditivos de adaptación abierta son una buena alternativa para sujetos que sufren de un pobre reconocimiento de palabras en ruido
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| 48. |
- Elomaa, I, et al.
(author)
-
Chemotherapy in Ewing's sarcoma. The Scandinavian Sarcoma Group experience
- 1999
-
In: Acta Orthopaedica Scandinavica. Supplementum. - 0300-8827. ; 70:285, s. 69-73
-
Journal article (peer-reviewed)abstract
- During the past 15 years the Scandinavian Sarcoma Group has treated 140 patients with Ewing's sarcoma. Two protocols have been used. SSG IV included 52 patients between 1984 and 1990 and SSG IX, 88 patients since 1990. After 5 years of treatment, local recurrences occurred in 19% of the patients (M0 + M1) in the SSG IV group and 10% in the SSG IX group. Distant metastases developed in 57% of the M0-patients in the SSG IV group and in 33% in the SSG IX group. Tumor-related survival (overall) of M0-patients was 49% in SSG IV and 70% in SSG IX, and the metastasis-free survival rate 45% and 58%, respectively. Patients having a localized extremity tumor had a survival rate of 90% (SSG IX). In both treatment groups, good responders to chemotherapy had a better survival rate than poor ones (SSG IV, p < 0.02, GI-II vs. G II-IV and SSG IX, p < 0.003, GI-III vs. G IV). In conclusions local control and survival rates were better with SSG IX than SSG IV.
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| 49. |
- Elomaa, I, et al.
(author)
-
Five-year results in Ewing's sarcoma. The Scandinavian Sarcoma Group experience with the SSG IX protocol
- 2000
-
In: European Journal of Cancer. - 1879-0852. ; 36:7, s. 875-880
-
Journal article (peer-reviewed)abstract
- The first Scandinavian protocol for Ewing's sarcoma, SSG IV, resulted in a local control rate of 74% and 5-year metastasis-free survival (MFS) of 43%. The second protocol, SSG IX, was started in order to improve upon these results. It featured four chemotherapy cycles, each consisting of two courses of VAI (vincristine, doxorubicin, ifosfamide) alternating with one course of PAI (cisplatin, doxorubicin, ifosfamide) at 3-weekly intervals. Total treatment time was 35 weeks. Local therapy was given at week 9. Inoperable or non-radically operated patients received hyperfractionated accelerated radiotherapy 1.5 Gy twice daily between chemotherapy courses to a total dose of 42-60 Gy, depending on surgical radicality and tumour localisation. 88 patients were included (58 male, 30 female, mean age 20 years; range 5-65 years). The tumour (73 M0 and 15 M1) was located centrally in 31 patients (35%), in the extremities in 34 (39%) and other sites in 23 (26%) of cases. The median size of tumour was 10 cm (range 2-23), soft tissue was invaded in 87%. Surgery was the local therapy for 60 (68%) patients: amputation in 8 and local excision in 52. The surgical margins were wide in 35 patients, marginal in 14 and intralesional in 3. Radiotherapy was given to 17 non-radically operated patients postoperatively and to 28 patients with inoperable tumours primarily. Histological responses were evaluated in 52 patients. 9 local recurrences were observed (10%). Distant metastases developed in 24 M0 patients (33%). The estimated 5-year MFS was 58% and overall survival (OS) 70% for M0 and 27% and 28% for M1 patients, respectively. Survival was favourable in patients with non-metastatic extremity tumours (90%) and tumours operated with wide margins (90%). Patients with a total necrosis after chemotherapy had a better OS than those with a partial or poor response (P=0.003). The toxicity (World Health Organisation) was acceptable (gastrointestinal G1-2; haematological G3-4). The SSG IX protocol gave better local control and survival rates than the SSG IV. Whether this is due to a higher therapeutic efficacy of the present protocol cannot be ascertained in this comparison with a historical control.
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| 50. |
- Ferrari, S, et al.
(author)
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Neoadjuvant chemotherapy with high-dose ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: A joint study by the Italian and Scandinavian Sarcoma Groups
- 2005
-
In: Journal of Clinical Oncology. - 1527-7755. ; 23:34, s. 8845-8852
-
Journal article (peer-reviewed)abstract
- Purpose To explore the effect of high-dose ifosfamide in first-line treatment for patients <= 40 years of age with nonmetastatic osteosarcoma of the extremity. Patients and Methods From March 1997 to September 2000, 182 patients were evaluated. Primary treatment consisted of two blocks of high-dose ifosfamide (15 g/m(2)), methotrexate (12 g/m(2)), cisplatin (120 mg/m(2)), and doxorubicin (75 mg/m(2)). Postoperatively, patients received two cycles of doxorubicin (go mg/m(2)), and three cycles each of high-dose ifosfamide, methotrexate, and cisplatin (120 to 150 mg/m(2)). Granulocyte colony-stimulating factor support was mandatory after the high-dose ifosfamide/cisplatin/doxorubicin combination. Results No disease progression was recorded during primary chemotherapy, 164 patients (92%) underwent limb-salvage surgery, four patients (2%) underwent rotation plasty, and 11 patients (6%) had limbs amputated. Three (1.6%) patients died as a result of treatment-related toxicity, and one died as a result of pulmonary embolism after pathologic fracture. Grade 4 neutropenia and thrombocytopenia followed 52% and 31% of all courses, respectively, and mild to severe nephrotoxicity was recorded in 19 patients (10%). The median received dose-intensity compared with protocol was 0.82. With a median follow-up of 55 months, the 5-year probability of event-free survival was 64% (95% CI 57% to 71%) and overall survival was 77% (95% CI 67% to 81%), whereas seven patients (4%) experienced local recurrence. Conclusion The addition of high-dose ifosfamide to methotrexate, cisplatin, and doxorubicin in the preoperative phase is feasible, but with major renal and hematologic toxicities, and survival rates similar to those obtained with four-drug regimens using standard-dose ifosfamide. Italian Sarcoma Group/Scandinavian Sarcoma Group study I showed that in a multicenter setting, more than 90% of patients with osteosarcoma of the extremity can undergo conservative surgery.
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