Most Significant Publications by Area of Interest
1. Identification of Effective Strategies to Reduce Fatigue in Pediatric Cancer Patients
We recognized that fatigue is an important symptom in children receiving treatment for cancer. First, we conducted a systematic review to identify suitable outcome measures for clinical trials focused on fatigue. Next, we designed and conducted a pilot study of homeopathy and determined that this intervention is not feasible to study in pediatric cancer patients because of lack of acceptability. We then conducted a pilot study of individualized yoga for fatigue in pediatric cancer and HSCT patients and concluded that this intervention is promising for further study with high acceptability among patients, families and providers.
Diorio C, Schechter-Finkelstein T, Lee M, O’Sullivan C, Hesser T, Tomlinson D, Piscione J, Armstrong C, Tomlinson G, Sung L: A pilot study to evaluate the feasibility of individualized yoga for inpatient children receiving intensive chemotherapy. BMC Complementary and Alternative Medicine 2015: 24(15): 2.
Diorio C, Celis A, Hesser T, O’Sullivan C, Lee M, Schechter T, Sung L: Development of an individualized yoga intervention to address fatigue in hospitalized children undergoing intensive chemotherapy. Integrative Cancer Therapies 2016: [in press].
Tomlinson D, Hinds PS, Ethier MC, Ness KK, Zupanec S, Sung L: Psychometric properties of instruments used to measure fatigue in children and adolescents with cancer: A systematic review. Journal of Pain and Symptom Management 2013: 45(1): pp 83-91.
Brulé D, Gillmeister B, Lee M, Alexander S, Gassas A, Hendershot E, Zupanec S, Dupuis L, Sung L. A feasibility pilot trial of individualized homeopathic treatment for fatigue in children receiving chemotherapy. Integrative Cancer Therapies 2015: [in press].
2. Development of a Pediatric Cancer-Specific Symptom Screening and Assessment Tool
By conduct of a systematic review and a focus group of clinicians, we identified the lack of suitable symptom screening tools for use in pediatric cancer. We were awarded a CCSRI Impact Grant (2014) in order to develop and validate a new tool. Development of SSPedi was completed and early psychometric properties have been favorable. SSPedi on an iPad is currently undergoing evaluation.
Tomlinson D, de Mol Van Otterloo S, O'Sullivan C, Gibson P, Johnston DL, Portwine C, Spiegler B, Baggott C, Tolend M, Dupuis LL, Sung L: Methodological issues identified during cognitive interviews in the development of a pediatric cancer symptom screening tool. Psycho‐Oncology 2016: 25(3): 249-53.
O’Sullivan C, Dupuis LL, Gibson P, Johnston DL, Baggott C, Portwine C, Spiegler B, Kuczynski S, Tomlinson D, de Mol Van Otterloo S, Tomlinson GA, Sung L: Refinement of the Symptom Screening in Pediatrics tool (SSPedi). British Journal of Cancer 2014: 111(7): pp 1262-8.
Tomlinson D, Dupuis L, Gibson P, Johnston D, Portwine C, Baggott C, Zupanec S, Watson J, Spiegler B, Kuczynski S, Macartney G, Sung L: Initial development of the Symptom Screening in Pediatric (SSpedi) Tool. Supportive Care in Cancer 2014: 22(1): pp 71-5.
3. Development of a Pediatric-Specific Instrument to Measure Oral Mucositis
We developed a new pediatric-specific instrument to measure oral mucositis. We conducted a systematic review of instruments to evaluate oral mucositis and noted a gap in instruments suitable for children. Thus, we developed the Children’s International Mucositis Evaluation Scale (ChIMES). With CIHR and NIH R21 operating grants, we found that the psychometric properties of ChIMES are excellent. We have also converted ChIMES to an electronic version (eChIMES) and have evaluated its understandability and usability. This instrument was incorporated into a COG randomized trial of Caphosol to prevent oral mucositis (ACCL1031).
Jacobs S, Baggott C, Agarwal R, Hesser T, Schechter T, Judd P, Tomlinson D, Beyene J, Sung L: Validation of the Children’s International Mucositis Evaluation Scale (ChIMES) in paediatric cancer and SCT. British Journal of Cancer 2013: 109(10): pp 2515-22.
Tomlinson D, Gibson F, Treister N, Baggott C, Judd P, Hendershot E, Maloney A M, Doyle J, Feldman B, Sung L: Designing an oral mucositis assessment instrument for use in children: Generating items using a nominal group technique. Supportive Care Cancer 2009: 17(5): pp 555-62.
Tomlinson D, Judd P, Hendershot E, Maloney AM, Sung L: Establishing literature based items for an oral mucositis assessment tool in children. Journal of Pediatric Oncology Nursing 2008: 25(3): pp 139-47.
4. Improved Understanding and Management of Infections in Pediatric Cancer
One focus of our research has been to understand infections in high risk oncology patients. This research included a CCSRI funded study that identified that two polymorphisms are associated with the risk of infections in pediatric acute myeloid leukemia (AML). We assembled a cohort of pediatric AML patients across Canada and we found that corticosteroid exposure is an important risk factor for infections, sepsis and death. We also described the importance of invasive fungal infection in pediatric AML. We also linked institutional supportive care strategies with infection outcomes in pediatric AML. This work led to the development and implementation of four large randomized trials of infection prophylaxis within COG focusing on the role of caspofungin versus azole (ACCL1131) or fluconazole (ACCL0933) prophylaxis, levofloxacin prophylaxis (ACCL0934) and chlorhexidine wipes (ACC1034) in high risk pediatric patients. We have a concept in development that focuses on determining whether fidaxomycin is a more effective treatment for Clostridium difficile colitis compared with usual antibiotics; this infection in an emerging major concern in cancer patients.
Sung L, Dix D, Cellot S, Gillmeister B, Ethier MC, Roslin MN, Johnston DL, Feusner J, Mitchell D, Lewis V, Aplenc R, Yanofsky R, Portwine C, Price V, Zelcer S, Silva M, Bowes L, Michon B, Stobart K, Traubici J, Allen U, Beyene J, denHollander N, Paterson A: Single nucleotide polymorphism in IL1B is associated with infection risk in pediatric acute myeloid leukemia. Clinical Microbiology and Infection 2016: [in press].
Sung L, Aplenc R, Alonzo TA, Gerbing RB, Lehrnbecher T, Gamis AS: Effectiveness of supportive care measures to reduce infections in pediatric AML: A report from the Children's Oncology Group. Blood 2013: 121(18): pp 3573-7.
Dix D, Cellot S, Price V, Gillmeister B, Ethier MC, Johnston DL, Lewis V, Michon B, Mitchell D, Stobart K, Yanofsky R, Portwine C, Silva M, Bowes L, Zelcer S, Brossard J, Traubici J, Allen U, Beyene J, Sung L: Association between corticosteroids and infection, sepsis and infectious death in pediatric acute myeloid leukemia: from the Canadian Infections in AML Research Group. Clinical Infectious Disease 2012: 55(12): pp 1608-14.
5. Identifying the Optimal Management Strategies for Fever and Neutropenia (FN)
We have conducted a series of studies to determine the optimal management strategy for pediatric FN. Areas included outpatient versus inpatient management, oral versus intravenous antibiotics and role of once daily aminoglycosides. This work cumulated in leading an international effort to develop a pediatric-specific guideline for FN with inter-professional representation from 10 countries. This guideline has been endorsed by multiple national/international groups including the American Society of Clinical Oncology, the Multinational Association for Supportive Care in Cancer and the American Society of Pediatric Hematology/Oncology.
Robinson PD, Lehrnbecher T, Phillips B, Dupuis LL, Sung L: Strategies for empiric management of pediatric fever and neutropenia in cancer and hematopoietic stem cell transplantation recipients: a systematic review of randomized trails. Journal of Clinical Oncology 2016: 34(17): 2054-60.
Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B, Hakim H, Santolaya M, Castagnola E, Davis BL, Dupuis LL, Gibson F, Groll AH, Gaur A, Gupta A, Kebudi R, Petrilli S, Steinbach WJ, Villarroel M, Zaoutis T, Sung L: Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem cell transplantation. Journal of Clinical Oncology 2012: 30(35): pp 4427-38.
Manji A, Beyene J, Dupuis LL, Phillips R, Lehrnbecher T, Sung L: Outpatient and oral antibiotic management of low-risk febrile neutropenia are effective in children - a systematic review of prospective trials. Supportive Care in Cancer 2012: 20(6): pp 1135-1145.
Cheng S, Teuffel O, Ethier MC, Diorio C, Martino J, Mayo C, Regier D, Wing R, Alibhai SMH, Sung L: Health related quality of life anticipated with different management strategies for paediatric febrile neutropaenia. British Journal of Cancer 2011: 105(5): pp 606-11.