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.

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.

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).

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.

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.

 

Complete List of Published Work in My Bibliography