{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T04:28:25Z","timestamp":1770956905736,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Treatment consists of an initial intensive phase of chemotherapy, followed by a prolonged period of maintenance chemotherapy intended to reduce the risk of relapse. During the COVID\u201019 pandemic, the need arose to identify and reduce non\u2010essential hospital visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to determine which proportion of in\u2010person clinic visits during ALL maintenance therapy was associated with a change of management based on the results of the physical examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>Medical records of children receiving maintenance chemotherapy for B\u2010precursor ALL between September 2019 and February 2020 were reviewed. Visits with a new finding on physical examination were divided into those where an in\u2010person assessment was deemed essential versus not essential. Finally, we determined the proportion of essential in\u2010person visits that resulted in a change of management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 240 maintenance visits by 75 children were analyzed. An abnormal finding on physical examination was noted during 20 visits (8.3%). Of those, 14 (5.8%) uncovered a new finding, six (2.5%) were classified as \u201cin\u2010person visit essential,\u201d and among those six visits, three (1.2%) resulted in a change of patient management (one for acute otitis media, one for wheezing, and one for limp).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings support the evaluation of care delivery models other than in\u2010person visits during ALL maintenance therapy. A prospective study is required to delineate criteria, benefits\/risks, and families\u2019 perspectives associated with virtual care delivery and the optimal frequency of in\u2010person visits.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29713","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T13:47:03Z","timestamp":1649684823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["How essential are in\u2010person clinic visits during maintenance treatment of children with acute lymphoblastic leukemia?"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3253-2047","authenticated-orcid":false,"given":"Ron","family":"Rabinowicz","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Maguire","sequence":"additional","affiliation":[{"name":"Biostatistics, Design and Analysis, Research Institute The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1158-186X","authenticated-orcid":false,"given":"Johann","family":"Hitzler","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"},{"name":"Developmental and Stem Cell Biology The Hospital for Sick Children Research Institute  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-0823","authenticated-orcid":false,"given":"Angela","family":"Punnett","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology The Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01086"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.265"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.6364"},{"key":"e_1_2_9_5_1","unstructured":"AALL1731 \u2010 a phase 3 trial investigating blinatumomab (NSC# 765986) in combination with chemotherapy in patients with newly diagnosed standard risk or Down syndrome B\u2010lymphoblastic leukemia (B\u2010ALL) and the treatment of patients with localized B\u2010lymphoblastic lymphoma (B\u2010LLy). NIH; 2019.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT03914625.Accessed on September 16 2021"},{"key":"e_1_2_9_6_1","unstructured":"AALL1732 \u2010 a phase 3 randomized trial of inotuzumab ozogamicin (NSC#: 772518) for newly diagnosed high\u2010risk B\u2010ALL; risk\u2010adapted post\u2010induction therapy for high\u2010risk B\u2010ALL mixed phenotype acute leukemia and disseminated B\u2010LLy. NIH; 2019.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT03959085.Accessed on September 16 2021"},{"key":"e_1_2_9_7_1","unstructured":"International collaborative treatment protocol for children and adolescents with acute lymphoblastic leukemia \u2010 AIEOP\u2010BFM ALL 2017. NIH; 2018.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT03643276.Accessed on September 16 2021"},{"key":"e_1_2_9_8_1","unstructured":"ALLTogether1 \u2010 a treatment study protocol of the ALLTogether Consortium for children and young adults (0\u201345 years of age) with newly diagnosed acute lymphoblastic leukaemia (ALL). NIH; 2020.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT04307576.Accessed on September 16 2021"},{"key":"e_1_2_9_9_1","unstructured":"Total Therapy XVII for newly diagnosed patients with acute lymphoblastic leukemia and lymphoma (TOT17). NIH; 2017.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT03117751.Accessed on September 16 2021"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-3026"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-020-01596-5"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-020-02299-z"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2196\/20621"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.37.8018"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00493"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djx224"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21443"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25374"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25714"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020007702"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e31820d882b"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2016.010843"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12978"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0253665"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.2196\/18488"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29713","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.29713","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T04:49:01Z","timestamp":1692852541000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.29713"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,11]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1002\/pbc.29713"],"URL":"https:\/\/doi.org\/10.1002\/pbc.29713","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,11]]},"assertion":[{"value":"2022-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e29713"}}