Request for Funding
Mentor: Patrick Leavey
Department: Pediatrics; Pediatric hematology Oncology
Room number: G3.240
Mail Code:
Phone number: 214-648-8605
E-mail: Patrick.leavey@utsouthwestern.edu
Project title: Use of psychotherapy in pediatric oncology patients
Human subjects IRB approved project number (where applicable): Will be applied for
Animal subjects IRB approved project number (where applicable):
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Patient-based
Brief Description of Project:
Overall concept: We have experienced a significant number of patients in the oncology clinic who are depressed and merit either medical or behavioral anti-depressants therapies. As a background for a future psychotherapy interventional study in children with cancer we will do a retrospective review of our institutional experience.
Objectives: The goal of this retrospective review is to review our oncology
patient population to determine
a) the prevalence of symptoms of depression and anxiety,
b) to evaluate the co-morbid oncological diagnoses, stage of cancer therapy
and types of therapies
c) what interventions have been instituted to treat these patients psychiatric
illness and how these therapies have been monitored for success.
Background: Measures of outcome in cancer therapy are well defined. Tumor size
by clinical palpation and radiological measurement define treatment response
and further therapies. Toxic side effects of cancer therapy are monitored carefully
and dictate both the use and dosing of chemotherapy and radiation therapy. These
cancer directed therapies are given most often by a pediatric oncologist working
as part of an inter-disciplinary team which includes social workers, child life
specialists, physiotherapists, prosthetists, pastoral care service as well as
other medical specialties (surgeons, radiologists, pathologists and radiation
oncologists). The systematic use of this inter-disciplinary team in managing
pediatric patients with cancer has been integrated into therapy for the last
20 years. While the impact of social work and child life, physiotherapy and
prosthetic services, psychological and psychiatric support services are all
too obvious to parents and staff, measures of these interventions are harder
to define, specifically in the areas of treating depression and anxiety related
illness in children with cancer.
Children with cancer and their families deal with the loss of the life they
knew, the loss of the life they hoped for and the challenge of the life they
have imposed on them by cancer therapy. The interdisciplinary team helps the
family navigate these changes in lifestyle. The role of the psychiatrist in
the team is clear. Children with life threatening illness need to be able to
discuss their fears and anxiety with trained professionals. The signs and symptoms
of maladaptive behavior and either depression or anxiety disorders will be most
quickly recognized by psychiatry personnel. However, somewhat counter-intuitively,
the literature would suggest that rates of depression are not higher in children
with cancer compared to normal controls. Phipps et al. describe the difficulties
of self reporting evaluation tools such as the Children's Depression Inventory
(CDI) to identify depression in children with cancer because of learned methods
of defensiveness. While other tools to detect depression and anxiety disorders
in children exist, still little is reported about the interventional outcome
of psychotherapy either medical or behavioral in children with cancer. Since
our experience with psychotherapy includes both medical and behavioral we first
want to retrospectively review our experience to establish a background for
a psychotherapy interventional study for children in cancer.
Methods: We will identify patients in the following ways
Review pharmacy records for patients treated with anti-depressants and anti-psychotics
both on the in-patient service and out-patient clinic
We will review psychiatry medical records for oncology patients seen in consultation
We will examine records for the following demographic and oncological data: age, sex, diagnosis, stage, therapies (chemotherapy: on therapy, phase of therapy; surgery: biopsy only, other surgery; Radiation: CNS or local tumor; BMT: date, allo vs. auto)
We will examine the psychiatry consult records for the following data: diagnostic criteria for depression, record of school attendance, family functioning / rating scale, family history of psychiatric illness, use of psychiatric medications (antidepressants and anti-psychotics), comments on compliance, comments on success of therapies, notes regarding parents refusal of medications.
Previous Research Activities or Publications with Medical Students:
Prior mentoring experience for medical students:
My prior experience with summer students is with one MS3 student 4 years ago.
Michael Day then an MS3 at UTSW spent a summer with me working on a retrospective
study for patients with osteosarcoma and a clinical case report of a patient
with infantile myofibromatosis.
Both these projects were published and the primary project was presented in
poster form at the American Society for Pediatric Hematology Oncology in Baltimore,
MD. Michael attended the meeting and presented the data.
a. Skip Metastasis (SM) in Osteosarcoma: a 25 Year Institutional Review. Day,
M.D., Booth, T., Maale, G., and Leavey, P.J. J Pediatr Hematol Oncol Vol 23,
(3), pA19, #1190. The American Society of Pediatric Hematology / Oncology 14th
Annual Meeting, Baltimore, Maryland in April 2001
b. Leavey, P.J., Day, M.D., Booth, T., and Maale, G. Survival in two patients
with skip metastasis and osteosarcoma J Pediatr Hematol Oncol 2003;25:806-808
c. Day, M., Edwards, A. and Leavey, P.J. Successful Therapy for a Patient with
Infantile Generalized Myofibromatosis (IM). Med Pediatr Oncol 2002, Vol 38 (5):371-373.
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