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- Kamsvåg, Tove, 1986-
(författare)
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Pain in pediatric oncology : Explorative and interventional studies focusing on oral mucositis
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to examine the prevalence of pain in children treated for cancer with a special focus oral mucositis. In addition, we wanted to examine if oral cryotherapy (OC) could reduce the incidence of severe oral mucositis in children undergoing hematopoietic stem cell transplantation (HSCT), and explore new methods to implement OC. In Study I, a retrospective questionnaire study including 71 parents and 38 children that had undergone HSCT in Sweden in the past three years, we found that 47% of the parents and 42 % of the children reported that the child experienced oral pain during the treatment. According to the parents, 52% of the children had needed medication for oral pain. Study II was a randomized clinical trial including 49 children randomized OC or standard oral care during HSCT. The prevalence of severe oral mucositis was 52% in the whole group with no differences between the two groups. However, compliance to OC was low, especially in younger children. In Study III a new intra oral cooling device (IOCD) was tested in 12 healthy adults. The temperature reduction in the oral cavity, after 60 minutes of OC with the IOCD, was similar to the temperature reduction seen after OC with ice, with few side effects reported. In Study IV, a questionnaire study including 120 nurses and 65 physicians, 57% of the healthcare professionals reported pain to be present often/very often in the children they treated for cancer. Treatment-related pain was perceived to be the most troublesome type of pain. In conclusion, this thesis demonstrates that pain is present in many children treated for cancer and that more than half of the children undergoing HSCT develop sever oral mucositis. Oral cryotherapy did not reduce the incidence of OM in children undergoing HSCT but compliance to the intervention was low. An IOCD has the potential benefit of less discomfort, improving compliance, but needs to be evaluated in children.
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| 2. |
- Kamsvåg, Tove, 1986-, et al.
(författare)
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Prevention of oral mucositis with cryotherapy in children undergoing hematopoietic stem cell transplantations-a feasibility study and randomized controlled trial
- 2020
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Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To evaluate the feasibility of oral cryotherapy (OC) in children and to investigate if OC reduces the incidence of severe oral mucositis (OM), oral pain, and opioid use in children undergoing hematopoietic stem cell transplantation (HSCT). Methods Fifty-three children, 4-17 years old, scheduled for HSCT in Sweden were included and randomized to OC or control using a computer-generated list. OC instructions were to cool the mouth with ice for as long as possible during chemotherapy infusions with an intended time of >= 30 min. Feasibility criteria in the OC group were as follows: (1) compliance >= 70%; (2) considerable discomfort during OC < 20%; (3) no serious adverse events; and (4) ice administered to all children. Grade of OM and oral pain was recorded daily using the WHO-Oral Toxicity Scale (WHO-OTS), Children's International Oral Mucositis Evaluation Scale, and Numerical Rating Scale. Use of opioids was collected from the medical records. Results Forty-nine children (mean age 10.5 years) were included in analysis (OC = 26, control = 23). The feasibility criteria were not met. Compliance was poor, especially for the younger children, and only 15 children (58%) used OC as instructed. Severe OM (WHO-OTS >= 3) was recorded in 26 children (OC = 15, control = 11). OC did not reduce the incidence of severe OM, oral pain, or opioid use. Conclusion The feasibility criteria were not met, and the RCT could not show that OC reduces the incidence of severe OM, oral pain, or opioid use in pediatric patients treated with a variety of conditioning regimens for HSCT.
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| 3. |
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| 4. |
- Martensson, T., et al.
(författare)
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Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft-versus-host disease
- 2020
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Ingår i: Clinical Transplantation. - : Wiley. - 0902-0063 .- 1399-0012. ; 34:7
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Tidskriftsartikel (refereegranskat)abstract
- Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft-versus-host disease (GI-GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI-GVHD (2000-2013) after receiving hematopoietic stem cell transplantation. Sixty-eight children with ninety-one endoscopic occasions were enrolled. At the time of endoscopy, anti-GI-GVHD treatment was ongoing in 71% (65/91). In 18% (12/65) with ongoing treatment, no histopathological evidence of GI-GVHD or another cause to justify anti-GI-GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re-endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (P = .007). Histopathological findings generating treatment changes were as follows: GI-GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI-GVHD.
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| 5. |
- Mårtensson, Thomas, et al.
(författare)
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Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children
- 2020
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Ingår i: Pediatric Transplantation. - : WILEY. - 1397-3142 .- 1399-3046. ; 24:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD).Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by theNIH 2014.Results: Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P = .005).Conclusion: Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second,NIH 2014based histopathological assessment should be considered before performing a re-endoscopy.
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