Management of septic shock in children with cancer—Common challenges and research priorities

Agulnik, Asya

doi:10.1016/j.jped.2023.01.001

Cited by 5 publications

(4 citation statements)

References 53 publications

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“…We can attribute this to several factors, including centralization of cancer treatment at hospital‐based centers for children and AYA due to specialist team needs which leads to longer hospital stays and increased costs. Because of their weak immune systems, children with cancer are more susceptible to severe illnesses, such as septicemia, fever, and neutropenia, resulting in increased hospitalizations during treatment 80–84 …”

Section: Discussionmentioning

confidence: 99%

“…Because of their weak immune systems, children with cancer are more susceptible to severe illnesses, such as septicemia, fever, and neutropenia, resulting in increased hospitalizations during treatment. [80][81][82][83][84] Although over 50% of new cancer cases are from lowand middle-income (LMICs), 85 there are several obstacles to the conduct of quality research in these countries such as limited resources, poor research infrastructure and general lack of comprehensive cancer registration and surveillance systems that generate reliable data. 85…”

Section: Summary Of Evidencementioning

confidence: 99%

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Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Nabukalu,

Gordon,

Lowe

et al. 2024

Cancer Medicine

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ObjectiveTo collate and critically review international evidence on the direct health system costs of children and adolescents and young adults (AYA) with cancer.MethodsWe conducted searches in PubMed, MEDLINE, CINAHL, and Scopus. Articles were limited to studies involving people aged 0–39 years at cancer diagnosis and published from 2012 to 2022. Two reviewers screened the articles and evaluated the studies using the Consolidated Health Economic Evaluation Reporting Standards checklist. The reviewers synthesized the findings using a narrative approach and presented the costs in 2022 US dollars for comparability.ResultsOverall, the mean healthcare costs for all cancers in the 5 years post diagnosis ranged from US$36,670 among children in Korea to US$127,946 among AYA in the USA.During the first year, the mean costs among children 0–14 years ranged from US$34,953 in Chile to over US$130,000 in Canada. These were higher than the costs for AYA, estimated at US$61,855 in Canada. At the end of life, the mean costs were estimated at over US$300,000 among children and US$235,265 among adolescents in Canada.Leukemia was the most expensive cancer type, estimated at US$50,133 in Chile, to US$152,533 among children in Canada. Overall, more than a third of the total cost is related to hospitalizations. All the included studies were of good quality.ConclusionsHealthcare costs associated with cancer are substantial among children, and AYA. More research is needed on the cost of cancer in low‐ and middle‐income countries and harmonization of costs across countries.

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Section: Discussionmentioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Nabukalu,

Gordon,

Lowe

et al. 2024

Cancer Medicine

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“…There is limited data on the incidence of sepsis and septic shock in neutropenic pediatric cancer patients. Studies suggest that there are common causes of critical illness in children with cancer, with mortality rates between 41% and 64% [1]. Initial manifestations of sepsis in children include fever, tachycardia, tachypnea, hypotension, and hypothermia.…”

Section: Introductionmentioning

confidence: 99%

"Predictive Potential of Interleukin-6, Pentraxin-3, and Procalcitonin in Identifying Sepsis and Septic Shock Among High-Risk Fever and Neutropenia Pediatric Cancer Patients Running Head: Biomarkers Predictive Value for Septic Shock"

EL-hemaly

2024

ARR

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Background: This study aimed to assess the role of interleukin-6(IL-6), Pentraxin-3(PTX-3), and procalcitonin (PCT) in predicting pediatric cancer patients who may develop sepsis or septic shock.Aim: The study aimed to determine which biomarker has the highest diagnostic value for sepsis/septic shock and to analyze the correlation of the biomarkers with the severity of organ dysfunction represented by the pediatric sequential organ failure assessment (PSOFA) scores.Methods: Serum levels of interleukin-6, Pentraxin-3, and procalcitonin were measured in 86 pediatric cancer patients who presented with FN, sepsis, and septic shock. Blood samples for IL-6, PTX3, and PCT were obtained within 6 hours of presentation. Patients were categorized into septic and non-septic groups and PSOFA scores at D1, D3, and D28 were calculated. Optimal cut-off values for sepsis and prognostic PSOFA scores were determined.Results: IL-6, as a single biomarker had the highest ability to predict sepsis at a cut-off value of 89.8 pg/mL with 100% sensitivity and 60.3% specificity (P value <0.001). Combining biomarkers increased the sensitivity and specificity for predicting septic shock and mortality at D28. There was a positive relationship between delta PSOFA and in-hospital mortality. The median levels of IL-6, PTX3, and procalcitonin in gramnegative MDR septic shock patients were significantly higher than the medians in septic shock patients without gram-negative MDR (P value was < 0.05). Conclusion:Novel biomarkers can help predict sepsis and guide protocols for managing high-risk fever and neutropenia.

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“…The mortality rate of untreated or inappropriate treatment of febrile neutropenia was 2-21% [1]. However, mortality could be up to 41-46% when children with hemato-oncological diseases develop severe sepsis/septic shock [2]. Therefore, not only early administration of broad-spectrum antibiotics and/or antifungal agents but also positive developments in supportive therapies for severe sepsis/septic shock are believed to improve the outcome of febrile neutropenia in children with hemato-oncological disease.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Tocilizumab Treatment in Febrile Neutropenic Children with Severe Sepsis/Septic Shock in a Single-Center Retrospective Case Series

Chen,

Chang,

Wang

et al. 2024

Cancers

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Purpose: To assess the efficacy of an IL-6 blockade with tocilizumab on treatment outcome of severe sepsis/septic shock in children with febrile neutropenia. Methods: We performed a retrospective study of febrile neutropenic patients younger than 18 years old who developed severe sepsis/septic shock at a single medical center between November 2022 and October 2023. Results: Seven patients with febrile neutropenia complicated with severe sepsis/septic shock were identified. Four of seven patients received tocilizumab in addition to standard of care. The median IL-6 level before administration of tocilizumab was 14,147 pg/mL (range: 672–30,509 pg/mL). All four patients successfully recovered from severe sepsis/septic shock. Three of seven patients received standard of care without tocilizumab. IL-6 levels were checked intwo2 patients, with a median of 1514.5 (range: 838–2191). Only one of three (33%) patients without tocilizumab therapy made a full recovery from severe sepsis/septic shock. The mortality rate was higher in patients without tocilizumab therapy compared to patients with tocilizumab therapy (67% vs. 0%). Conclusions: Administration of tocilizumab reduced mortality of severe sepsis/septic shock in children with febrile neutropenia. However, it warrants confirmation with a larger number of patients and a longer follow-up.

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Management of septic shock in children with cancer—Common challenges and research priorities

Cited by 5 publications

References 53 publications

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

Healthcare costs of cancer among children, adolescents, and young adults: A scoping review

"Predictive Potential of Interleukin-6, Pentraxin-3, and Procalcitonin in Identifying Sepsis and Septic Shock Among High-Risk Fever and Neutropenia Pediatric Cancer Patients Running Head: Biomarkers Predictive Value for Septic Shock"

Outcome of Tocilizumab Treatment in Febrile Neutropenic Children with Severe Sepsis/Septic Shock in a Single-Center Retrospective Case Series

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