OBJECTIVE To identify factors associated with very long survival among all cancer cases diagnosed at age 19 years or younger registered by the Cancer Data Service at the University of Kansas Medical Center in Kansas City, Kansas, U.S.A. in the 40-year period between 1944 and 1983, with follow-up to 1993. METHODS There were 2720 pediatric patients with 2750 cancers who were studied. Forty-four types of cancer were grouped into 11 diagnostic categories. Diagnosis years spanned four eras: 1944-1953, 1954-1963, 1964-1973, and 1974-1983. Cases were compared using specific characteristics and were divided into short-term and long-term survivors with the division generously set at seven years. The proportions of the long-term survivors were compared by specific characteristics. RESULTS Among the diagnostic categories, leukemias were the most common (29.8%), followed by CNS tumors (15.2%), and Hodgkin's disease (9.0%). Male to female ratio was 4:3; average age at diagnosis was 8.83 +/- 6.08 years. Long-term survivors totaled 1148 (41.7%). Prognosis was better in cases diagnosed in earlier stages and in later eras. Proportion of long-term survivors increased from 18.7% in era I to 52.6% in era IV. Improvement of survival was statistically significant in most diagnostic categories. CONCLUSIONS This study shows continuing improvement of survival during four consecutive eras for childhood and adolescent cancer. Early diagnosis was associated with better survival. Unstaged cases decreased over time reflecting progress in diagnostic techniques. Many patients died before seven years after diagnosis. Those who survived more than seven years had excellent survival. Pediatricians can expect to participate in the care of these patients long after the original dianosis and treatment.

To determine what percentage of traditional home health nursing visits could be done by telemedicine, we carried out a retrospective review of nursing charts clinical records . Data of two types were recorded. The objective data, which were abstracted from the records, included demographic information, patient assessments, teaching activities and interventions. The subjective data were the opinions of four observers as to whether the visit could have been done using currently available telemedicine technology. Records were sampled randomly for patients who had received home nursing care from three home health agencies in rural and urban areas during the winter and summer of 1996. A 54-item coding instrument was applied to 906 different charted home nursing visits. For 412 46 of these, the on-site nursing could reasonably have been replaced by telenursing. Significant factors determining the possible use of telenursing included primary diagnosis, number of interventions and patient age. Among the 10 most common primary diagnoses, the most amenable to telenursing care were chronic airway obstruction and joint disorders; the least amenable were coagulation disorders and anaemia. Telenursing visits could substitute for a substantial fraction of on-site home nursing visits. This has important implications in terms of reducing the cost of home nursing care.

Summary The costs of providing oncology services in three different ways were measured. Services were provided to a peripheral hospital by: conventional clinics, in which the oncologist worked at the hospital concerned; outreach clinics, in which an oncologist was flown in periodically from a central hospital; and telemedicine clinics, in which the oncologist at the central hospital practised via a video-link. During a one-year study period, 2400 patients were seen in conventional clinics, 81 in outreach clinics and 103 in telemedicine clinics. At these workloads the average costs per patient were 149, 897 and 812, respectively. However, the average costs cannot be compared directly without further information about the shape of the unit cost curves.

Annals of the New York Academy of SciencesVolume 824, Issue 1 p. 232-233 Pediatric Oncology Outreach to Hungary: A Registry of Childhood Malignanciesa ENIKÖ APJOK, ENIKÖ APJOK Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorJOSEPH D. BORSI, JOSEPH D. BORSI Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorROZÁLIA KOÓS, ROZÁLIA KOÓS Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorDEZSÖ SCHULER, DEZSÖ SCHULER Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorROBERT E. BOLINGER, ROBERT E. BOLINGER The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorCATHY D. BOYSEN, CATHY D. BOYSEN The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorARIEL B. BAKER, ARIEL B. BAKER The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorFREDERICK F. HOLMES, FREDERICK F. HOLMES The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this author ENIKÖ APJOK, ENIKÖ APJOK Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorJOSEPH D. BORSI, JOSEPH D. BORSI Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorROZÁLIA KOÓS, ROZÁLIA KOÓS Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorDEZSÖ SCHULER, DEZSÖ SCHULER Second Department of Pediatrics Semmelweis University Medical School Tuzolto u 7–9 1095 Budapest, HungarySearch for more papers by this authorROBERT E. BOLINGER, ROBERT E. BOLINGER The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorCATHY D. BOYSEN, CATHY D. BOYSEN The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorARIEL B. BAKER, ARIEL B. BAKER The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this authorFREDERICK F. HOLMES, FREDERICK F. HOLMES The University of Kansas Medical Center 39th and Rainbow Boulevard Kansas City, Kansas 66160Search for more papers by this author First published: 17 December 2006 https://doi.org/10.1111/j.1749-6632.1997.tb46227.xCitations: 1 a This work was jointly sponsored by the Pediatric Oncology Outreach to Hungary project of the University of Kansas Medical Center, Kansas City, Kansas; the Second Department of Pediatrics of the Semmelweis University Medical School, Budapest, Hungary; and the National Institute of Neurosurgery, Budapest, Hungary, through a grant from the U.S. Agency for International Development. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume824, Issue1Challenges and Opportunities in Pediatric OncologySeptember 1997Pages 232-233 RelatedInformation

Costs were monitored for three different types of oncology practice: a telemedicine clinic and a fly-in outreach clinic, both held in rural areas, and a traditional clinic held in a city hospital. Total expenses were calculated over the year May 1995 to April 1996. The average cost per telemedicine visit was $812. The average cost per out reach clinic visit was $897. Flying in oncology support for this practice was therefore about 10% more costly than telemedicine. While the outreach cost may have been inappropriately high due to as low start-up phase, it was still less expensive during this period to be seen via telemedicine. For comparison, the average cost per traditional oncology clinic visit was $149. However, this figure does not take into account the costs of access to a city-based service by rural patients.

The roles of nonagricultural occupations, tobacco use, beverage consumption, medical history, and other factors in the development of soft-tissue sarcoma were examined in a population-based case-control study in Kansas. Based on 133 cases diagnosed between 1976-1982 and 948 controls, there were significant excesses associated with use of the drug chloramphenicol (odds ratio (OR) = 5.4, 95% confidence interval (Cl) 1.2-23.9) and chewing tobacco or snuff (OR = 1.8, 95% Cl 1.1-2.9). The risk associated with smokeless tobacco varied with the location of the tumors; greater risks were observed for tumors of the upper gastrointestinal tract (OR = 3.3), the lung, pleura, and thorax (OR = 3.1), and the head, neck, and face region (OR = 2.4) than other regions of the body (OR = 1.4). A nonsignificant excess was seen with the use of cholesterol-lowering drugs, such as clofibrate (OR = 1.7). Four cases reported histories of prior radiation treatment to the same area of their bodies as their tumors. Soft-tissue sarcoma was also associated with employment in woodworking occupations (OR = 1.7, 95% Cl 0.9-3.2) and risk increased with increasing duration of employment. Persons with first-degree blood relatives with a history of Hodgkin's disease, lymphoma, or cancers of the pancreas, prostate, brain, or skin were at increased risk. Many of the associations observed in this study, notably the risk of soft-tissue sarcoma with smokeless tobacco and medications such as chloramphenicol, deserve further evaluation.