Clifton P. Thornton

Background: A cancer diagnosis interrupts typical schooling for children with cancer, revoking an essential social health determinant for this vulnerable population. This makes school integration programs a critical component of care. Unfortunately, there is little evidence addressing how to improve school transitions. This systematic review aims to assess the impact of school integration programs on academic, psychosocial, and educational outcomes. Additionally, the review aims to inform best practice for facilitating successful school integration following diagnosis. Method: A comprehensive literature search identified 12,184 articles, 15 of which were retained for this review. To be included, articles must have evaluated a school transition program for children (<21 years of age) diagnosed with cancer. Results: Effective school integration programs were those that provided precision-based support from transdisciplinary teams and facilitated communication between the clinical, school, and family units. The use of school liaisons and integrating neuropsychologists into the oncology clinic were particularly impactful. Information-based programs and in-services did not yield significant improvements in outcomes. Discussion: Evidence-based solutions to schooling after cancer include a diverse set of resources that match individual family needs, facilitate communication, and link families with existing educational supports. Use of transdisciplinary teams and precision care principles to link families to existing resources is effective.

Background: Precision-based immunotherapy agents are frequently being incorporated into upfront cancer treatment, and neurotoxicities have emerged as potential serious adverse effects. With this realization, nurses must augment their care to adopt a similar personalized, precision approach with unique neurotoxicity monitoring and intervention. This review aims to synthesize the existing body of literature that directs nurse-led neurotoxicity monitoring and intervention specific to immunotherapies. Method: A comprehensive literature search was conducted with a search strategy designed to identify clinical nursing care guidelines for assessment of immunotherapy-associated neurotoxicity in pediatrics and young adult oncology. The search was designed in three tiers to identify articles that addressed domains of (a) pediatric oncology, (b) immunotherapy, and (c) nursing guidelines. Results: Initially, 360 unique articles were identified, and 8 met the inclusion criteria. Most articles were narrative reviews and data-informed commentaries, with some longitudinal studies and a systematic review; all were of moderate to good quality. Many toxicities were discussed under the general terminology of neurotoxicities, with limited description of neurotoxicities specific to agents or classes. Few evidence-based recommendations for nurse-led monitoring and interventions exist. Conclusions: Immunotherapy agents have quickly become incorporated into the standard of care for many pediatric cancers. To appropriately monitor, intervene, and treat these toxicities, nurses must be aware of the neurological side effects specific to each agent and adjust care accordingly to individual patient needs while receiving these agents. Additional research is needed to develop, implement, and test monitoring protocols specific to neurotoxicities with immunotherapy in pediatrics.

Background: Dinutuximab, a GD2-directed monoclonal antibody, is now incorporated into therapy for high-risk and relapsed or refractory neuroblastoma. Despite its boxed warning for drug-induced neurotoxicity, little is known about the incidence, risk factors, monitoring guidelines, or management of this spectrum of adverse neurologic effects. This study aimed to describe neurotoxicity symptoms, summarize nursing-related interventions, and evaluate potential risk factors for neurotoxicity. Method: This retrospective descriptive study reviewed 437 dinutuximab cycles administered to 65 patients between 2018 and 2023. Data on patient demographics and clinical variables, occurrence of 11 potential distinct neurotoxicities, and nursing responses were analyzed to describe the sample and evaluate for differences and associations between variables. Results: Neurotoxicity occurred in 159 (36.4%) cycles, affecting 83.1% of participants without relation to age or sex. Neurotoxicities encompassed nine separate symptoms and typically included urinary retention (66.2% of neurotoxic cycles) and visual changes (16.9% of neurotoxic cycles). Symptoms appeared on day 1 in 73.7% of cycles. Neurotoxicity was unrelated to dinutuximab use in upfront versus relapsed therapy ( OR = 1.20, p = .484) or Curie score ( OR = 1.0, p = .883). A total of 11 nursing interventions were identified and ranged from calling a code (0.46% of all cycles) to additional medication administration (29.5% of all cycles). Discussion: Dinutuximab-associated neurotoxicity is common and appears early in treatment. Findings suggest patients may be universally at risk for toxicity with relation to demographics or clinical factors. Targeted neurologic monitoring and nursing interventions are needed for safe administration and should be developed and tested.

Artificial intelligence (AI) is poised to become an integral component in health care research and delivery, promising to address complex challenges with unprecedented efficiency and precision. However, many clinicians lack training and experience with AI, and for those who wish to incorporate AI into research and practice, the path forward remains unclear. Technical barriers, institutional constraints, and lack of familiarity with computer and data science frequently stall progress. In this tutorial, we present a transparent account of our experiences as a newly established interdisciplinary team of clinical oncology researchers and data scientists working to develop a natural language processing model to identify symptomatic adverse events during pediatric cancer therapy. We outline the key steps for clinicians to consider as they explore the utility of AI in their inquiry and practice, including building a digital laboratory, curating a large clinical dataset, and developing early-stage AI models. We emphasize the invaluable role of institutional support, including financial and logistical resources, and dedicated and innovative computer and data scientists as equal partners in the research team. Our account highlights both facilitators and barriers encountered spanning financial support, learning curves inherent with interdisciplinary collaboration, and constraints of time and personnel. Through this narrative tutorial, we intend to demystify the process of AI research and equip clinicians with actionable steps to initiate new ventures in oncology research. As AI continues to reshape the research and practice landscapes, sharing insights from past successes and challenges will be essential to informing a clear path forward.

Background: Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, SMS text messaging, and email, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings. Objective: This review aimed to summarize contemporary literature on pediatric caregivers’ experiences with and perspectives of e-communication with their child’s health care team to identify how e-communication has been optimized to improve patient care. Methods: A scoping review following the Arksey and O’Malley methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as “Electronic Health Records” and “Communication” from 2013 to 2023 that discussed caregiver experiences and perspectives of e-communication with their child’s health care provider. Studies were excluded if they were abstracts, non-English papers, nonscientific papers, systematic reviews, or quality improvement initiatives, or pertained to synchronous telemedicine. We conducted a two-step screening process by scanning the title and abstract and reviewing the full text by two independent screeners to confirm eligibility. From an initial 903 articles identified via the database search, 23 articles fulfilled all the inclusion criteria and are included in this review. Results: Of the 23 articles meeting the inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. The caregiver sample sizes ranged from 51 to 3339 in the quantitative studies and 8 to 36 in the qualitative and mixed methods studies. A majority (n=17) used the patient portal that was self-categorized by the study. Secure messaging through a portal or other mobile health app was used in 26% (n=6) of the studies, while nonsecure messaging outside of the portal was used 17% (n=4) of the time and email was used 33.3% (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods. Conclusions: The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in health care, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address.

BACKGROUND Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, text messaging, and e-mail, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings. OBJECTIVE To summarize contemporary literature on pediatric caregivers’ experiences with and perspectives of e-communication with their child’s healthcare team to identify how e-communication has been optimized to improve patient care. METHODS A scoping review following Arksey and O-Malley’s methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as “Electronic Health Records” and “Communication” spanning 2013-2023 that discussed caregiver experiences and perspectives of e-communication with their child’s healthcare provider. Studies were excluded if they were abstracts, non-English, non-scientific papers, systematic reviews, quality improvement initiatives, and pertained to synchronous telemedicine. We conducted a two-step screening process involving title and abstract scans and full-text reviews by two independent screeners to confirm eligibility. From an initial 903 articles identified via database search, 23 articles fulfilled all inclusion criteria and are included in this review. RESULTS Of the 23 articles meeting inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. Caregiver sample sizes ranged from 51 to 3339 in quantitative studies and 8 to 36 in qualitative and mixed-method studies. A majority (n=17) used the patient portal as self-categorized by the study. Secure messaging through a portal or other mobile health application was used in 26% of the studies (n=6), while non-secure messaging outside of the portal was used 17% of the time (n=4) and e-mail was used one-third (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods. CONCLUSIONS The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in healthcare, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address.

Conducting patient-centered engagement quality improvement projects requires careful consideration of methodologies that will allow a core project team to fully include participants as partners. Engagement activities must ensure that heterogeneous members of the project team are given an equal voice in investigation processes and that potential barriers to meaningful participation are reduced. This tutorial provides a model for intentionally blending elements of the Stakeholder Engagement in quEstion Development and prioritization (SEED) and Delphi methods to maximize participant engagement in a patient-centered quality improvement project to generate research questions related to patient-clinician communication of neurocognitive late effects of childhood cancers.

Dose-limiting toxicities are ubiquitous to cancer-directed therapy, presenting with severity to a degree that necessitates therapy de-escalation, pause, or discontinuation. To date, there is incredible limited understanding if these therapy de-escalations present risk for survival by limiting delivery of intensive therapy, or if they indicate physiologic susceptibility and are a favorable prognostic indicator. Mucositis is an excellent illustration of the current paradox of dose-limiting toxicities—it has existed alongside therapy for eight decades, but despite its presence, there is an incomplete understanding of how it develops, why it varies between oncologic populations, and if it relates to cancer survival. Rigorous methodologic approaches in symptom science holds potential to better understand mucositis, to determine if it is a marker of response or threat, and evaluate if it holds potential to guide therapy delivery.