Clostridium difficile infection (CDI) is the most common hospital-associated infection and is linked to increased morbidity, mortality and costs. Asymptomatically colonized patients may act as an infection reservoir and their numbers have been found to exceed symptomatic CDI cases. In addition to higher rates of CDI among children hospitalized with cancer compared to those without an oncologic diagnosis, these patients also experience substantially higher C. difficile colonization rates. However, the current published literature does not adequately address the natural history of C. difficile colonization in this population, in terms of who is at greatest risk for developing colonization, duration of colonization, or progression to CDI. A retrospective longitudinal cohort study of pediatric oncology patients admitted to the oncology ward at McMaster Children’s Hospital (MCH) was conducted from September 1 2016 to February 28 2018. Patients who were routinely screened for antibiotic-resistant organisms (AROs) upon admission per hospital policies had their stored samples subsequently tested for asymptomatic carriage of C. difficile. A retrospective analysis was completed to determine predictors of colonization and risk factors for progression to subsequent CDI. We observed a lower colonization rate than other studies have reported in the literature. Duration of colonization was likely brief and none of the colonized patients subsequently developed CDI. There were no statistically significantly associated predictors for asymptomatic colonization when colonized patients were compared to those who were never colonized. / Thesis / Master of Science (MSc)

No description available.

Conceptualizing mental health difficulties among a pediatric oncology population from a traumatic stress perspective is gaining speed. Research has shown support for the development of posttraumatic stress reactions among chronically ill children and their family members. Despite this evidence, the majority of intervention studies have not incorporated key trauma-informed intervention components that have proven to be effective in symptom reduction for trauma-exposed children. Examining key aspects of both the child trauma and pediatric psychology fields have enabled researchers to meld their strengths into one comprehensive approach. This revised perspective has clinical implications for the development of prevention and intervention techniques that are more likely to yield superior outcomes. Yet, an evidence-based, trauma-informed intervention for youth has not yet been empirically examined among a pediatric oncology population. Thus, the purpose of this study was to examine the efficacy of TF-CBT intervention program for children/adolescents diagnosed with cancer and their parents. Methods: This was a prospective longitudinal study that utilized a single-subject, non-concurrent multiple baseline design to assess the efficacy of TF-CBT intervention. A sample of five youth (ages 9 to 15) and seven parents enrolled in the study; three youth and five parents completed their participation in the study. Manualized treatment consisted of six sessions lasting approximately two hours per session (including child and parent) that targeted psychoeducation, relaxation training, affective identification and expression skills, cognitive processes, coping strategies, trauma processing, and family processes. Examined constructs, including posttraumatic stress symptomatology, depression, quality of life, parenting stress, coping utilization, coping efficacy, somatization, internalizing, and externalizing symptoms, were assessed by child self-report, parent report, and parent self-report at enrollment (baseline), post-treatment, and one-, and three-month follow-up. Results: Simulation Modeling Analysis (SMA) revealed a statistically significant reduction, from baseline to intervention, for one parent's PTSS (R = -0.711, p = .027) and another parent's PTSS reduction approached significance (R = -0.747, p = .055). Comparatively, no significant reduction was found for child PTSS. One child showed a significant improvement in coping efficacy (R = 0.619, p = .048) as a function of the intervention, and an additional two child participants approached significance (R = 0.618, p = .055; R = 0.689, p = .094). Visual inspection of the data did reveal noteworthy reductions for some study participants in both domain specific (i.e., PTSS) and broader psychological outcomes (e.g., quality of life, somatization, internalizing and externalizing symptoms, etc.). Conclusions: These results provide some support for a trauma-informed CBT intervention for pediatric oncology patients in remission and their parents. / Ph. D.

This thesis focuses on the design, statistical operating characteristics and interpretation of early phase oncology clinical trials. Anti-cancer drugs are generally highly toxic and it is imperative to deliver a dose to the patient that is low enough to be safe but high enough to produce a clinically meaningful response. Thus, a study of dose limiting toxicities (DLTs) and a determination of the maximum tolerated dose (MTD) of a drug that can be used in later phase trials is the focus of most Phase I oncology trials. We first comprehensively compare the statistical operating characteristics of various early phase oncology designs, finding that all the designs examined select the MTD more accurately when there is a clear separation between the true DLT rate at the MTD and the rates at the dose levels immediately above and below. Among the rule-based designs studied, we found that the 3+3 design under-doses a large percentage of patients and is not accurate in selecting the MTD for all the cases considered. The 5+5 a design picks the MTD as accurately as the model based designs for the true DLT rates generated using the chosen log-logistic and linear dose-toxicity curves, but requires enrolling a larger number of patients. The model based designs examined, mTPI, TEQR, BOIN, CRM and EWOC designs, perform well on the whole, assign the maximum percentage of patients to the MTD, and pick the MTD fairly accurately. However, the limited sample size of these Phase I oncology trials makes it difficult to accurately predict the MTD. Hence, we next study the effect of sample size and cohort size on the accuracy of dose selection in early phase oncology designs, finding that an adequate sample size is crucial. We then propose some integrated Phase 1/2 oncology designs, namely the 20+20 accelerated titration design and extensions of the mTPI and TEQR designs, that consider both toxicity and efficacy in dose selection, utilizing a larger sample size. We demonstrate that these designs provide an improvement over the existing early phase designs. / 2019-12-01T00:00:00Z

Philosophiae Doctor - PhD / Background: Palliative care is specialised health care to support people living with a terminal illness, and their families. Palliative care aims to prevent and relieve suffering, to help people to live as well as possible until they die, and to support the processes of dying and bereavement. Palliative care is holistic care provided by Emergency and Oncology Nurses caring for cancer patients. Palliative care protocols for Professional Nurses working in Emergency Units and Oncology Departments are not always posted or in full view in the government hospitals of the Western Cape. The researcher had noted that the development of a palliative care protocol would be unique in its use at the three targeted government hospitals. Aims and Objectives: This study focused on the development and implementation of palliative care protocols for Emergency and Oncology Nurses in the targeted government hospitals of the Western Cape, i.e., protocols could be beneficial for cancer patients and their families. The overall aim of the research was to develop applied palliative care protocols for Emergency and Oncology Nurses to provide best practice palliative care nursing for Oncology Patients who may present at any one of three Western Cape Provincial Hospitals.

No description available.

Primary Objective: According to the National Center for Health Statistics, many Americans use some type of vitamin or supplement. A recent study of cancer patients in the VA medical system found that a significant number of cancer patients do not mention the use of supplements to their healthcare providers. Many of these supplements were also found to interact with or compound side effects of chemotherapy regimens. The purpose of this study is to determine the incidence of cancer patients taking supplements and to determine the completeness of home medication lists in regard to vitamins or herbal supplements.

Research documents that breast cancer is the leading cause of death in Latina females. The exact numbers are unknown, but studies reveal that Latinas with breast cancer underuse recommended follow-up chemotherapy, decreasing their rates of survival. Although several factors may be responsible, cultural influences are a possible barrier. However, there is a gap in the literature about how culture affects decisions about breast cancer treatment. This focused ethnographic study examined the role of cultural beliefs and perceptions in the decision-making process for Latina women about whether or not to receive chemotherapy following a breast cancer diagnosis. Drawing from Douglas' cultural theory of risk, archived in-depth interview data from 20 Latina breast cancer survivors were open coded into 56 primary codes which were then categorized into hierarchical trees of overarching themes and subcategories. Unique elements of the patterns observed in these data were analyzed and interpreted to explain how culture may influence Latina breast cancer patients to underuse recommended chemotherapy. The results of this qualitative analysis revealed that various cultural factors including social role-related themes, avoidance of information and communication, as well as employment and immigration status influenced the treatment decisions of Latina women. Analysis suggested that these cultural factors influenced both the amount and quality of information Latina women had available to make these decisions, as well as how they processed information to reach their decisions. Results of this study can accelerate social change by drawing increased attention to cultural differences in medical decision making, by informing the communication process between medical providers and their Latina patients, and thus eventually increasing survival from breast cancer among Latinas.

A key component of informed consent to participate in research is the understanding that research is not the same as treatment and that scientific goals have priority over therapeutic ones. However, studies have found many research participants do not understand these important differences between research and treatment, a phenomenon termed therapeutic misconception (TM). The problem addressed in this project was research nurses' lack of education regarding the existence and concepts of TM, and their struggles to assess and address research participants' TM of clinical trials. Matutina's conceptual model of TM was used to guide this project. The purpose of this project was to develop an educational program that prepares registered nurses to assess clinical trials participants for TM and correct any misunderstandings. The educational program included concepts related to TM, guidance on recognizing TM, strategies to correct participant misunderstanding, and assessments of nurses' understanding of related concepts and strategies. The products of this project include the program with an implementation plan and an evaluation plan that outlines short- intermediate- and long- term plans for evaluating effectiveness of this program. For both short and intermediate-term evaluation, outcomes will be measured using a pre and post survey. The long-term evaluation of the educational program was designed as a study to measure TM among research participants comparing data before and after nurses receive TM education. Refining the standard education of TM for registered nurses can serve both to improve protection of trial participants and to clarify the informed consent process, ultimately contributing to a more informed population of clinical trials participants.

<p>Over the past decade, exercise has gained increasing attention from both clinicians and patients as a beneficial adjunct therapy to maintain or enhance quality of life in breast cancer patients. Recent epidemiological studies indicate that aerobic exercise following a diagnosis of breast cancer may be associated with reductions in cancer-specific and all-cause mortality. However, the mechanisms by which physical activity affects tumor physiology are poorly understood. Accordingly, clinicians lack critical information to properly advise breast cancer patients on the use of exercise as an adjunct to more conventional therapies.</p><p>The beneficial effects of exercise on systemic vasculature are well known, including improved endothelial function and increased perfusion. In this work, we evaluate the hypothesis that exercise slows tumor growth and improves the structure and function of tumor blood vessels, resulting in decreased hypoxia and increased effectiveness of cyclophosphamide chemotherapy </p><p>To investigate the effects of exercise on tumor microenvironment, we injected syngeneic 4T1 breast tumor cells into the mammary fat pad of immunocompetent BALB/c mice. The exercise intervention (voluntary wheel running) was designed to mimic four clinically relevant scenarios: 1- patients who are sedentary before and after diagnosis, 2- previously sedentary patients who begin exercising after diagnosis, 3- previously active patients who stop exercising after diagnosis, and 4- previously active patients who continue to exercise after diagnosis. Animals in Groups 3 and 4 exercised prior to tumor cell transplant, whereas Groups 1 and 2 were sedentary during that time. Immediately after transplant, Groups 2 and 4 were running, and Groups 1 and 3 were sedentary. Tumor growth was monitored for 18 days, and then perfusion was mapped using MRI and tumors were removed for analysis. In a follow-up experiment, BALB/c mice were immediately implanted with tumor cells and then randomized to running or sedentary conditions with or without cyclophosphamide chemotherapy given one week after tumor transplant (three 100 mg/kg doses, every other day). Tumors were again allowed to progress for three weeks, and MRI was performed prior to tumor removal.</p><p>Animals voluntarily ran 5-6 km per day prior to transplant and 4-5 km per day after transplant. Body weight was unaffected by exercise. Voluntary wheel running reduced tumor growth rate nearly twofold and significantly increased apoptosis. Additionally, running after tumor implantation caused significant increases in microvessel density (CD31) and vessel maturity (colocalization of CD31 with NG2 and desmin). Hypoxia (EF5) was significantly reduced in the exercising animals, and MRI showed that tumors were more uniformly perfused in the running groups. Furthermore, exercise significantly enhanced the effectiveness of cyclophosphamide in slowing tumor growth. Taken together, these results suggest that aerobic exercise slows breast tumor growth, improves tumor vessel structure and function, and augments the effectiveness of cyclophosphamide chemotherapy. </p><p>These findings have important implications for the use of exercise in cancer treatment. Using a clinically relevant animal model, we provide the first conclusive evidence that exercise may do more than decrease symptoms and improve quality of life for cancer patients. Our data suggest that exercise may, in fact, be an effective anti-tumor intervention both alone and in combination with other cytotoxic therapies.</p> / Dissertation