scholarly journals Supportive care utilization and treatment toxicity in children with Down syndrome and acute lymphoid leukaemia at free-standing paediatric hospitals in the United States

2016 ◽  
Vol 174 (4) ◽  
pp. 591-599 ◽  
Author(s):  
Elizabeth G. Salazar ◽  
Yimei Li ◽  
Brian T. Fisher ◽  
Susan R. Rheingold ◽  
Julie Fitzgerald ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
Supportive Care ◽  
The United States ◽  
Care Utilization ◽  
Lymphoid Leukaemia ◽  
Free Standing ◽  
Acute Lymphoid Leukaemia ◽  
Treatment Toxicity ◽  
Children With Down Syndrome

Treatment Toxicity and Supportive Care Utilization in Children with Down Syndrome and Acute Lymphoid Leukemia at Free-Standing Pediatric Hospitals in the United States

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 553-553
Author(s):  
Elizabeth K Goodman ◽  
Yimei Li ◽  
Alix E. Seif ◽  
Julie Fitzgerald ◽  
Yuan-Shung Huang ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Supportive Care ◽  
Guideline Implementation ◽  
The United States ◽  
Care Utilization ◽  
Successful Implementation ◽  
Lymphoid Leukemia ◽  
Children With Down Syndrome ◽  
Acute Lymphoid Leukemia ◽  
Increased Risk

Abstract Introduction: Children with Down syndrome (DS) and acute lymphoid leukemia (ALL) have inferior outcomes due to increased treatment-related toxicity. In 2005 and 2006, multiple clinical trial protocols were modified to increase supportive care measures for these children; however, national supportive care utilization patterns for these patients have not been subsequently evaluated. Methods: A validated retrospective cohort of pediatric patients with ALL admitted from 1999 to 2011 was assembled from the Pediatric Health Information System (PHIS) database to examine organ toxicity, sepsis, and resource utilization in children with and without DS. A sub-analysis of mortality in children with DS ALL before and after the 2006 supportive care recommendation was also conducted. Results: 10699 patients with ALL were identified; 298 of these children had DS ALL (2.8%). Children with DS ALL had a significantly higher percentage of patients who were female (52% vs. 44%, p = 0.003), white (83% vs. 75%, p = 0.005), publically insured (48% vs. 38%, p = 0.002), and who had a congenital cardiac abnormality (26% vs. 2%, p < 0.0001). DS was associated with an increased risk of cardiovascular failure (OR 2.0, 95% CI 1.6-2.7), respiratory failure (OR 2.1, 95% CI: 1.6-2.9) and sepsis (OR 1.8, 95% CI: 1.4-2.4) in adjusted analyses (Table 1). Children with DS ALL had significantly greater utilization of antibiotics indicated for gram-positive infections, quinolones, azoles, supplemental oxygen, and ventilation, as well as significantly less utilization of opiate and non-opiate analgesics, PCAs, and antiemetics compared to children with non-DS ALL. Cardiac failure and sepsis rates were decreased in all children diagnosed after 2006 (OR 0.8, CI: 0.8-0.9, and OR 0.7, CI: 0.6-0.7, respectively). Children with DS ALL demonstrated a non-significant decrease in mortality after the 2006 guideline implementation (6.6% to 2.8%, p=0.116). Conclusion: In conclusion, children with DS ALL have significantly increased cardiac, respiratory, and infectious toxicity. The elevated antibiotic and antifungal usage in children with DS ALL and trend towards mortality decrease may suggest successful implementation of supportive care measures; however, decreased analgesic and antiemetic use may suggest other unmet supportive care needs in these patients. Table Table 1. Adjusted analyses of organ failure by Down syndrome status, demographics, congenital cardiac defects, and year of admission.CardiovascularFailure OR (95% CI)RespiratoryFailure OR (95% CI)Sepsis OR (95% CI)NeurologicFailure OR (95% CI)LiverFailure OR (95% CI)Down syndrome2.0 (1.6-2.7)***2.1 (1.6-2.9)***1.8 (1.4-2.4)***3.4 (1.9-6.2)***1.4 (1.0-1.9)*Age< 1 yr.4.5 (3.5-5.8)***7.4 (5.7-9.7)***8.3 (4.9-8.2)***1.4 (0.6-3.3)1.9 (1.4-2.5)***³ 1 yr. and < 5 yrs.0.7 (0.6-0.7)***0.7 (0.6-0.8)***0.9 (0.7-1.0)*0.4 (0.3-0.7)**1.0 (0.8-1.1)³ 5 yrs. and < 10 yrs.-----³ 10 yrs. and < 15 yrs.2.2 (1.9-2.5)***1.8 (1.5-2.1)***1.7 (1.4-1.9)***2.1 (1.4-3.2)**1.4 (1.2-1.6)***³ 15 yrs.2.4 (2.0-2.8)***2.2 (1.8-2.7)***2.0 (1.6-2.3)***2.7 (1.7-1.2)***1.7 (1.4-2.0)***RaceNon-Whitea0.9 (0.8-1.0)1.1 (0.9-1.2)1.0 (0.9-1.2)1.4 (1.0-2.0)*0.8 (0.7-0.9)**White----InsurancePublicb1.3 (1.1-1.4)***1.2 (1.1-1.4)**1.5 (1.3-1.6)***1.3 (0.9-1.9)1.0 (0.9-1.1)Otherc1.2 (1.0-1.3)*0.8 (0.7-1.0)*1.0 (0.9-1.1)1.5 (1.0-2.3)*1.0 (0.8-1.1)Private----GenderFemale1.1 (1.0-1.2)*1.0 (0.9-1.1)1.2 (1.1-1.3)**1.0 (0.7-1.3)1.1 (1.0-1.2)Male----Congenital Cardiac Defectd1.6 (1.2-2.1)**1.5 (1.1-2.1)**1.3 (0.9-1.7)1.7 (0.8-3.4)1.1 (0.8-1.6)Diagnosis in 2006-20110.8 (0.8-0.9)**1.0 (0.9-1.2)0.7 (0.6-0.7)***0.8 (0.6-1.0)1.0 (0.9-1.1)a Non-white includes Black, Asian/Pacific Islander, American Indian, Other, and Unknown. bPublic includes Medicaid, Medicare, other government, and Title V. cOther includes Self-pay, Other, and Unknown. d Congenital cardiac defect was defined by ICD-9 codes as described in supplemental table 1. *** p < 0.001; ** p < 0.01; * p < 0.05. Disclosures No relevant conflicts of interest to declare.

scholarly journals Trends in Survival Among Children With Down Syndrome in 10 Regions of the United States

PEDIATRICS ◽  
2012 ◽  
Vol 131 (1) ◽  
pp. e27-e36 ◽  
Author(s):  
J. E. Kucik ◽  
M. Shin ◽  
C. Siffel ◽  
L. Marengo ◽  
A. Correa ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
The United States ◽  
Children With Down Syndrome

scholarly journals Growth Charts for Children With Down Syndrome in the United States

PEDIATRICS ◽  
2015 ◽  
Vol 136 (5) ◽  
pp. e1204-e1211 ◽  
Author(s):  
B. S. Zemel ◽  
M. Pipan ◽  
V. A. Stallings ◽  
W. Hall ◽  
K. Schadt ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
The United States ◽  
Growth Charts ◽  
Children With Down Syndrome

scholarly journals Income Growth Trajectory For Parents Of Children With Down Syndrome In The United States

2016 ◽  
Vol 19 (3) ◽  
pp. A17
Author(s):  
D Samuelson ◽  
A Kageleiry ◽  
MS Duh ◽  
P Lefebvre ◽  
JY Campbell ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
The United States ◽  
Growth Trajectory ◽  
Income Growth ◽  
Children With Down Syndrome

scholarly journals Out-of-pocket medical costs for parents with Children with down Syndrome in the United States

2015 ◽  
Vol 18 (3) ◽  
pp. A258
Author(s):  
A. Kageleiry ◽  
D. Samuelson ◽  
M.S. Duh ◽  
P. Lefebvre ◽  
M. DerSarkissian ◽  
...  
Keyword(s):  
United States ◽  
Down Syndrome ◽  
Medical Costs ◽  
The United States ◽  
Children With Down Syndrome

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization

A Systematic Review on Barriers to Palliative Care in Oncology

2021 ◽  
pp. 104990912098328
Author(s):  
Jyotsana Parajuli ◽  
Judith E. Hupcey
Keyword(s):  
United States ◽  
Systematic Review ◽  
Palliative Care ◽  
Full Text ◽  
Literature Search ◽  
Intervention Development ◽  
The United States ◽  
Care Utilization ◽  
Review Of Literature ◽  
Meta Analyses

The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.

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