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Papers by Catherine Habashy

Pediatric Drugs, Jul 26, 2018

Methadone is a synthetic opioid with unique pharmacodynamic and pharmacokinetic properties. It is... more Methadone is a synthetic opioid with unique pharmacodynamic and pharmacokinetic properties. It is effective in treating both nociceptive and neuropathic pain, which commonly co-exist in children with cancer. Upon reviewing the literature describing the use of methadone in pediatric oncology patients, publications are limited in number and low in quality of evidence; nevertheless, there is support for the safety and efficacy of methadone in treating pain in children with cancer, particularly when pain is refractory to conventional treatment. Although the risk of life-threatening arrhythmia is commonly cited as an argument against the use of methadone, our review of the literature did not support this finding in children. Further evaluation with prospective studies is warranted to develop evidence-based recommendations for the use of methadone in pediatric oncology.

Journal of Medical Education and Curricular Development

Background: The physical examination (PE) skills of residents are often not improved since medica... more Background: The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods. Methods: Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. Residents and faculty answered questions about both their own opinions and about their perception of the other group’s opinions. Results: About 283 residents (70%) and 61 faculty (66%) completed the survey. Both residents and faculty rated the importance of PE similarly. Residents rated being too busy, followed by a lack of feedbac...

American Journal of Hospice and Palliative Medicine®, 2020

Background: The goal of adequate pain control becomes increasingly salient for children with canc... more Background: The goal of adequate pain control becomes increasingly salient for children with cancer and their families as the patients approach the end of life. Methadone is one option that is particularly desirable in end-of-life care given its long duration of action and NMDA antagonism that may help in controlling pain refractory to conventional opioids. The purpose of this study was to describe a single institution’s experience with methadone for the treatment of cancer pain in pediatric end-of-life care. Methods: This retrospective, observational, single-center study included all patients during a 9-year period who died in the inpatient setting and were receiving methadone in their last 30 days of life. Results: Twenty patients were identified, 18 (90%) of whom received methadone for nociceptive pain. The median duration of methadone use was 32 days (range 2-323 days). Methadone doses ranged from 0.09 to 7.76 mg/kg per day. There were no instances of discontinuing methadone due...

Pediatric Blood & Cancer

A considerable barrier to global pediatric oncology efforts has been the scarcity and even absenc... more A considerable barrier to global pediatric oncology efforts has been the scarcity and even absence of trained professionals in many low‐ and middle‐income countries, where the majority of children with cancer reside. In 2013, no dedicated pediatric hematology‐oncology (PHO) programs existed in Ethiopia despite the estimated annual incidence of 6000‐12000 cases. The Aslan Project initiative was established to fill this gap in order to improve pediatric cancer care in Ethiopia. A major objective was to increase subspecialty PHO‐trained physicians who were committed to practicing locally and empowered to lead programmatic development.

Children

Effective communication is essential to the practice of pediatric oncology. Clear and empathic de... more Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.

Blood

Background: Human resources are essential to the sustainability and scalability of health interve... more Background: Human resources are essential to the sustainability and scalability of health interventions. A barrier to global cancer efforts has been the scarcity of trained pediatric hematology/oncology (PHO) professionals in low- and middle-income countries (LMIC). Studies highlight this inequity and the need to develop a global PHO workforce through allocation of financial resources, strengthening of healthcare infrastructure, and development of innovative training programs. Ethiopia is the second most populous country in Africa. Because of recent reduction in infant mortality and improved treatment of Malaria and HIV in Ethiopia, non-communicable diseases contribute an increasing proportion of childhood mortality. The annual incidence of pediatric cancer in Ethiopia is estimated to be 6000-8000 cases. Prior to 2013, no dedicated PHO programs existed in Ethiopia, and there was no formal process for training local physicians in PHO. The following intervention aimed to increase loca...

A Field Manual for Palliative Care in Humanitarian Crises

The concept of essential medicines (EM) was developed by the World Health Organization (WHO) to p... more The concept of essential medicines (EM) was developed by the World Health Organization (WHO) to promote equitable access to safe, effective, and low-cost medicines. Access to EM is considered part of the right to health and is critical to the provision of palliative care. Access to EM is often disrupted in the setting of humanitarian crises, leading to further physical and psychological suffering. The recently published WHO document, Integrating Palliative Care and Symptom Relief into the Response to Humanitarian Emergencies and Crises, provides guidance on the prioritization and utilization of EM as part of an essential package of care. This chapter draws on the recommendations of the WHO as well as those of other expert committees and multilateral organizations. It provides an overview of commonly used medicines in palliative care and is applicable to the delivery of palliative care in humanitarian crises. It also provides general dosage guidelines.

Pediatric Drugs, Jul 26, 2018

Methadone is a synthetic opioid with unique pharmacodynamic and pharmacokinetic properties. It is... more Methadone is a synthetic opioid with unique pharmacodynamic and pharmacokinetic properties. It is effective in treating both nociceptive and neuropathic pain, which commonly co-exist in children with cancer. Upon reviewing the literature describing the use of methadone in pediatric oncology patients, publications are limited in number and low in quality of evidence; nevertheless, there is support for the safety and efficacy of methadone in treating pain in children with cancer, particularly when pain is refractory to conventional treatment. Although the risk of life-threatening arrhythmia is commonly cited as an argument against the use of methadone, our review of the literature did not support this finding in children. Further evaluation with prospective studies is warranted to develop evidence-based recommendations for the use of methadone in pediatric oncology.

Journal of Medical Education and Curricular Development

Background: The physical examination (PE) skills of residents are often not improved since medica... more Background: The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods. Methods: Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. Residents and faculty answered questions about both their own opinions and about their perception of the other group’s opinions. Results: About 283 residents (70%) and 61 faculty (66%) completed the survey. Both residents and faculty rated the importance of PE similarly. Residents rated being too busy, followed by a lack of feedbac...

American Journal of Hospice and Palliative Medicine®, 2020

Background: The goal of adequate pain control becomes increasingly salient for children with canc... more Background: The goal of adequate pain control becomes increasingly salient for children with cancer and their families as the patients approach the end of life. Methadone is one option that is particularly desirable in end-of-life care given its long duration of action and NMDA antagonism that may help in controlling pain refractory to conventional opioids. The purpose of this study was to describe a single institution’s experience with methadone for the treatment of cancer pain in pediatric end-of-life care. Methods: This retrospective, observational, single-center study included all patients during a 9-year period who died in the inpatient setting and were receiving methadone in their last 30 days of life. Results: Twenty patients were identified, 18 (90%) of whom received methadone for nociceptive pain. The median duration of methadone use was 32 days (range 2-323 days). Methadone doses ranged from 0.09 to 7.76 mg/kg per day. There were no instances of discontinuing methadone due...

Pediatric Blood & Cancer

A considerable barrier to global pediatric oncology efforts has been the scarcity and even absenc... more A considerable barrier to global pediatric oncology efforts has been the scarcity and even absence of trained professionals in many low‐ and middle‐income countries, where the majority of children with cancer reside. In 2013, no dedicated pediatric hematology‐oncology (PHO) programs existed in Ethiopia despite the estimated annual incidence of 6000‐12000 cases. The Aslan Project initiative was established to fill this gap in order to improve pediatric cancer care in Ethiopia. A major objective was to increase subspecialty PHO‐trained physicians who were committed to practicing locally and empowered to lead programmatic development.

Children

Effective communication is essential to the practice of pediatric oncology. Clear and empathic de... more Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers. This review aims to identify key communication skills that healthcare providers can employ throughout the illness journey to provide information, encourage shared decision-making, promote therapeutic alliance, and empathically address end-of-life concerns. By reviewing the relevant evidence and providing practical tips for skill development, we strive to help healthcare providers understand the value of effective communication and master these critical skills.

Blood

Background: Human resources are essential to the sustainability and scalability of health interve... more Background: Human resources are essential to the sustainability and scalability of health interventions. A barrier to global cancer efforts has been the scarcity of trained pediatric hematology/oncology (PHO) professionals in low- and middle-income countries (LMIC). Studies highlight this inequity and the need to develop a global PHO workforce through allocation of financial resources, strengthening of healthcare infrastructure, and development of innovative training programs. Ethiopia is the second most populous country in Africa. Because of recent reduction in infant mortality and improved treatment of Malaria and HIV in Ethiopia, non-communicable diseases contribute an increasing proportion of childhood mortality. The annual incidence of pediatric cancer in Ethiopia is estimated to be 6000-8000 cases. Prior to 2013, no dedicated PHO programs existed in Ethiopia, and there was no formal process for training local physicians in PHO. The following intervention aimed to increase loca...

A Field Manual for Palliative Care in Humanitarian Crises

The concept of essential medicines (EM) was developed by the World Health Organization (WHO) to p... more The concept of essential medicines (EM) was developed by the World Health Organization (WHO) to promote equitable access to safe, effective, and low-cost medicines. Access to EM is considered part of the right to health and is critical to the provision of palliative care. Access to EM is often disrupted in the setting of humanitarian crises, leading to further physical and psychological suffering. The recently published WHO document, Integrating Palliative Care and Symptom Relief into the Response to Humanitarian Emergencies and Crises, provides guidance on the prioritization and utilization of EM as part of an essential package of care. This chapter draws on the recommendations of the WHO as well as those of other expert committees and multilateral organizations. It provides an overview of commonly used medicines in palliative care and is applicable to the delivery of palliative care in humanitarian crises. It also provides general dosage guidelines.