Browsing by Author "Belsky, Jennifer A."
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item Caregiver Perspectives on Patient Participation in Biological Pediatric Cancer Research(MDPI, 2022-06-16) Kendel, Nicole E.; Belsky, Jennifer A.; Stanek, Joseph R.; Streby, Keri A.; Shah, Nilay; Pediatrics, School of MedicineAdolescent cancer patients and their caregivers have demonstrated willingness to participate in invasive biological sampling, either for their own potential benefit or for research purposes. However, many malignancies occur primarily in prepubescent patients and there are no similar studies in this population. Our study objective was to assess the willingness of caregivers to consent to research studies involving invasive biological sampling in children ≤ 13 years of age. Participants completed a survey assessing their willingness to allow various procedures both with and without clinical benefit to their children. Most respondents were willing to allow additional blood draws regardless of potential benefit to their children (95.6% were willing when there would be benefits and 95.6% were willing when there would not). Although the overall willingness was lower with other hypothetical procedures, the majority of respondents were still willing to allow additional biopsies for research purposes. Caregivers of young children with cancer will allow their children to undergo additional invasive procedures for research purposes. This willingness decreased with more invasive procedures without potential direct benefit, but interest remained in more than half of participants. Caregivers for young patients with cancer should be approached for participation in future biological/correlative studies.Item Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication(Wolters Kluwer, 2024-02-05) Gahagen, Rachel E.; Gaylord, William C.; Drayton Jackson, Meghan D.; McCallister, Anne E.; Lutfi, Riad; Belsky, Jennifer A.; Pediatrics, School of MedicineBackground: Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass. Methods: Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined. Results: The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4. Conclusions: By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.Item Investigating the safety and feasibility of osteopathic medicine in the pediatric oncology outpatient setting(Walter de Gruyter, 2022) Belsky, Jennifer A.; Stanek, Joseph R.; Rose , Melissa J.; Pediatrics, School of MedicineContext: Pediatric patients receiving chemotherapy experience unwanted therapy-induced side effects, commonly constipation and pain that diminish quality of life. To date, few studies have investigated the safety and feasibility of osteopathic manipulative treatment (OMT) in pediatric oncology. Objectives: The primary objective of this study is to investigate the safety and feasibility of OMT in pediatric oncology outpatient clinics. Methods: This is a single institutional pilot study evaluating children aged ≥2–21 years receiving chemotherapy for an oncological diagnosis at Nationwide Children’s Hospital (NCH). Permission was obtained from the NCH Institutional Review Board. Participants were enrolled for 8 weeks and received weekly OMT. OMT was deemed feasible by participating in six out of eight weekly treatments, and safety was assessed through adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE). During the clinic visit, patients answered validated surveys on constipation (Bristol Stool Scale) and pain (FACES Scale) pre/post-OMT. Feasibility was analyzed utilizing a one-sided exact binomial test while validated tools and adverse events were summarized descriptively. Results: A total of 23 patients were enrolled, with 21 included in feasibility analyses. The majority of the patients were female (n=13, 61.9%), with a median age of 12 years at enrollment (range, 2.7–20.8 years). There were no serious adverse events attributed to OMT intervention, and among the patients assessed for feasibility, 100% of them participated in at least two-thirds of their weekly OMT treatments, meeting our defined feasibility criteria. The intervention lasted an average of 14.2 min (range, 7.2–19.2 min). There were no FACES or Bristol Stool Scale scores that correlated with worsening pain on constipation post-OMT intervention. Conclusions: Pediatric oncology patients were feasibly and safely able to receive OMT during a regularly scheduled chemotherapy visit. The limitations include the small sample size. These findings support the need to further investigate the safety and feasibility, as well as efficacy, of OMT in the pediatric oncology clinical setting.Item Malnutrition identification and management variability: An administrative database study of children with solid tumors(Wiley, 2022) Runco, Daniel V.; Stanek, Joseph R.; Yeager, Nicholas D.; Belsky, Jennifer A.; Pediatrics, School of MedicineBackground: Malnutrition during cancer treatment increases treatment-related morbidity and mortality. Our study better characterizes variability in malnutrition identification and treatment by examining nutrition-related diagnoses and support for children with central nervous system (CNS) and non-CNS solid tumors during therapy. We examined diagnosis of malnutrition, use of tube feeding or parenteral nutrition (PN), and appetite stimulants. Methods: We retrospectively reviewed 0 to 21-year-old patients in the Pediatric Health Information System from 2015 to 2019. Patients were classified as having (1) billed malnutrition diagnosis, (2) malnutrition diagnosis or using PN and enteral nutrition ("functional malnutrition"), and (3) any previous criteria or prescribed appetite stimulants ("possible malnutrition"), as well as associated risk factors. Results: Among 13,375 unique patients, CNS tumors were most common (24.4%). Overall, 26.5% of patients had malnutrition diagnoses, 45.4% met functional malnutrition criteria, and 56.0% had possible malnutrition. Patients with adrenal tumors had highest billed, functional, and possible malnutrition (36.6%, 64.1%, and 69.4%, respectively) followed by CNS tumors (29.1%, 52.4%, and 64.1%). Patients with adrenal tumors had highest rates of PN use (47.4%) and those with CNS tumors had the highest tube feeding use (26.8%). Hospital admissions with malnutrition had a longer hospital length of stay (LOS) (6 vs 3 days, P < 0.0001), more emergency department admissions (24.4% vs 21.8%, P < 0.0001), and more opioid use (58.6% vs 41.4%, P < 0.0001). Conclusions: Variability in malnutrition diagnoses hinders clinical care and nutrition research in pediatric oncology. Improving disease-specific recognition and treatment of malnutrition can target nutrition support, ensure appropriate reimbursement, and potentially improve outcomes for children with solid tumors.Item Pediatric relapsed/refractory ALK-positive anaplastic large cell lymphoma treatment and outcomes in the targeted-drug era(American Society of Hematology, 2025) Marks, Lianna J.; Ritter, Victor; Agrusa, Jennifer E.; Kamdar, Kala Y.; Rivers, Julie; Gardner, Rebecca; Ehrhardt, Matthew J.; Devine, Kaitlin J.; Phillips, Charles A.; Reilly, Anne; August, Keith; Weinstein, Joanna; Satwani, Prakash; Forlenza, Christopher J.; Moore Smith, Christine; Greer, Chelsee; Afify, Zeinab; Lin, Carol H.; Belsky, Jennifer A.; Ding, Hilda; Hoogstra, David; Toner, Keri; Link, Michael P.; Schultz, Liora M.; Lowe, Eric J.; Aftandilian, Catherine; Pediatrics, School of MedicineTreatment options for patients with relapsed or refractory (R/R) anaplastic large cell lymphoma (ALCL) have increased in the era of targeted therapies such as brentuximab vedotin (BV) and anaplastic lymphoma kinase (ALK) inhibitors. However, there is no standard treatment and published data evaluating their use are limited. The goal of this retrospective study was to describe current real-world treatment and outcomes of pediatric, adolescent, and young adult patients with R/R ALK-positive ALCL. We conducted a retrospective, multi-institutional study identifying 81 patients with R/R ALK-positive ALCL aged ≤21 years at initial diagnosis treated between 2011 and 2022 across 18 institutions. Median time from diagnosis to relapse was 8.9 months (range, 2.6-131.9). Initial reinduction regimens included ALK-inhibitor monotherapy (n = 37, 46%), BV monotherapy (n = 19, 23%), chemotherapy without targeted therapy (n = 12, 15%), chemotherapy with targeted therapy (n = 9, 11%), or vinblastine monotherapy (n = 4, 5%), with 83% of patients achieving a complete response to initial reinduction regimen. Fifty-eight patients received a hematopoietic stem cell transplant (HSCT), 11 autologous and 48 allogeneic, with 1 receiving both. Duration of treatment for patients receiving BV or the ALK-inhibitor crizotinib (CZ) varied widely (BV, 1-11 years; CZ, 2-10 years). Five-year event-free survival was 63% (95% confidence interval [CI], 53-75) and 5-year overall survival was 91% (95% CI, 84-98). This is, to our knowledge, the largest collection of patients with R/R ALK-positive ALCL treated in the era of targeted therapy. Patients achieved excellent responses to ALK-inhibitor or BV monotherapy, but questions remain about duration of therapy and role of HSCT.Item Practice patterns in the diagnosis and management of chemotherapy-induced peripheral neuropathy in adolescents and young adults with cancer: a survey of oncologists(Springer, 2025-04-04) Belsky, Jennifer A.; Dupuis, L. Lee; Sung, Lillian; Carter, Allie; Leisinger, Audrey; Orgel, Etan; Parsons, Susan K.; Roth, Michael; Pediatrics, School of MedicinePurpose: Chemotherapy-induced peripheral neuropathy (CIPN) affects > 78% of oncology patients and causes detrimental side effects. There may be practice heterogenicity in CIPN management amongst oncologists treating pediatric, adolescent young adult (AYA), and adult patients with cancer. We sought to evaluate the practice patterns of oncologists regarding their management of CIPN in AYAs with cancer. Methods: A survey was developed and sent to pediatric and medical oncologists from across the United States. Scenarios included an 18-year-old receiving vincristine (VCR) with mild neuropathy (Scenario 1) and moderate/severe neuropathy (Scenario 2). Respondents were asked how they would manage each patient. Differences between pediatric and medical oncologists' management were assessed. Results: A total of 179 responses were submitted by 132 (73.7%) pediatric, 44 (24.6%) medical oncologists, and 3 (1.6%) oncologists who care for both pediatric and adult patients. Over half of respondents for Scenario 1 would refer the patient to physical therapy (PT) (56.8%), 38.1% would prescribe a pharmacologic agent, and 27.8% would dose reduce/omit vincristine. For Scenario 2, most (81.8%) would dose reduce/omit vincristine, 69.3% would refer for PT, and 44.9% would start a pharmacologic agent. On multivariable analyses, medical oncologists were more likely to dose reduce/omit vincristine for Scenario 1 (OR, 7.68; 95% CI, 3.24-18.22) and Scenario 2 (OR, 5.52; 95% CI, 1.37-22.18, and less likely to refer to PT for Scenario 1 (OR, 0.12; 95% CI, 0.05-0.31) and Scenario 2 (OR, 0.18; 95% CI, 0.08-0.41). Conclusion: Our survey suggests a broad spectrum of CIPN management in AYAs with cancer. The heterogenicity in practices and significant differences between pediatric and medical oncologists underscores an urgent need to better understand the source of heterogeneity in CIPN management practices and barriers to evidence-based care delivery.Item Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer(American Society of Clinical Oncology, 2024) Zhao, Zhiguo; Patel, Pratik A.; Slatnick, Leonora; Sitthi-Amorn, Anna; Bielamowicz, Kevin J.; Nunez, Farranaz A.; Walsh, Alexandria M.; Hess, Jennifer; Rossoff, Jenna; Elgarten, Caitlin; Myers, Regina; Saab, Raya; Basbous, Maya; Mccormick, Meghan; Aftandilian, Catherine; Richards, Rebecca; Nessle, C. Nathan; Tribble, Alison C.; Sheth Bhutada, Jessica K.; Coven, Scott L.; Runco, Daniel; Wilkes, Jennifer; Gurunathan, Arun; Guinipero, Terri; Belsky, Jennifer A.; Lee, Karen; Wong, Victor; Malhotra, Megha; Armstrong, Amy; Jerkins, Lauren P.; Cross, Shane J.; Fisher, Lyndsay; Stein, Madison T.; Wu, Natalie L.; Yi, Troy; Orgel, Etan; Haeusler, Gabrielle M.; Wolf, Joshua; Demedis, Jenna M.; Miller, Tamara P.; Esbenshade, Adam J.; Pediatrics, School of MedicinePurpose: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation. Materials and methods: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration. Results: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics. Conclusion: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use.Item Side effects following COVID-19 vaccination in pediatric patients with sickle cell disease(Wiley, 2023) Belsky, Jennifer A.; Carroll, Whitney R.; Feliciano, Anna; Jacob, Seethal A.; Pediatrics, School of MedicineVulnerable patient populations have seen decreased rates of vaccination against SARS‐CoV2‐19 (COVID‐19) due to hesitancies and distrust, magnified by a paucity of data for certain populations. The rate of COVID‐19 vaccination in children with sickle cell disease (SCD) remains low despite the risk for severe complications, resulting in continued infections and hospitalizations from COVID‐19. We sought to describe vaccine reactions, including vaso‐occlusive crises, emergency department visits, and hospitalizations, in children with SCD. Our findings will start to provide the necessary vaccine side effect data to inform patients, caregivers, and clinicians considering the COVID‐19 primary vaccination series.Item Side Effects With a Focus on Lymphadenopathy Following COVID-19 Vaccination in Pediatric and AYA Oncology Patients(Wolters Kluwer, 2023) Belsky, Jennifer A.; Carroll, Whitney R.; Xu, Guang; Jacob, Seethal A.; Pediatrics, School of MedicineThe Coronavirus Disease 2019 (COVID-19) pandemic led to the swift development of multiple vaccinations. Vaccine side effects were well-documented in the healthy adult cohort and included fever and lymphadenopathy, however, side effects in the pediatric immunocompromised population have not been reported. This retrospective study investigated vaccine-eligible children and adolescent young adult oncology patients 12 to 35 years old. We found uncommon, mild, and self-limiting side effects among pediatric cancer patients and survivors. This data will help guide pediatric and AYA oncologists in providing anticipatory guidance and serve as a guide to managing lymphadenopathy as a potential confounder of malignancy.