pediatric cancer & leukemia december 4, 2007. pediatric oncology acute leukemia brain tumors ...
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Pediatric Cancer & Leukemia
December 4, 2007
Pediatric Oncology
Acute leukemia Brain tumors Lymphoma Neuroblastoma Wilm’s tumor Rhabdomyosarcoma Retinoblastoma Osteosarcoma Ewing’s sarcoma
What is Leukemia?
Most common childhood malignancy
Acute lymphoblastic leukemia (ALL)
Acute nonlymphoblastic leukemia (ANLL) Acute myelogenous
leukemia (AML)
Brain Tumors
2nd most common type of cancer
1200 US cases diagnosed/year
Described in terms of: Metastasis (M stage) Size of tumor (T stage)
Brain Tumors
Terminal to curable
Neuropsychological impact varies based on: Location, size, tumor
type Type of treatment Disease of complications Patient factors Social factors
Medical Treatment
Radiation Chemotherapy Surgery
Most cancers considered CURED if no relapse in 5 years.
Bone Marrow Transplantation
Aggressive treatment for malignancies Give near-lethal doses
of chemotherapy or radiation
Replace dead cells with transplanted healthy cells
Autologous vs. Allogenic
Stages of BMT
Donor search & initial evaluation
Preparative treatment
Bone marrow infusion
Stages of BMT
Severe neutropenia
Engraftment Graft-versus-Host
disease
Follow-up
Phases of Cancer
Diagnosis Initiation of treatment Remission or illness stabilization Completion of medical therapy Long-term survival and cue vs. Relapse
or deterioration Terminal illness & death Post-death adjustment of family
Diagnosis
Address emotional reaction
Evaluate family understanding
Determine financial resources Financial Social
Diagnosis
Communication with others What to tell the child?
1. Go slowly
2. Encourage questions
3. Convey hope
4. Establish trust
5. Gauge details to developmental ability
Treatment
Disruption of life Complex treatment
schedules Feeling poorly Reaction of others Maintain contact with
school
Treatment
Coping with acute & chronic pain Bone marrow aspirations (BMA) & lumbar
punctures (LP) Distraction, relaxation, hypnosis
Anticipatory nausea & vomiting Classical conditioning Relaxation, imagery, distraction
Treatment
Parents need to feel some control during the treatment process Helplessness Hopelessness
Don’t forget the siblings!
Suggestions for parents Give them time too Choose caregivers
carefully Set limits on gifts Allow them to “help
out” Answer questions
Coping Strategies
Adaptive Positive reframing Acceptance Social support Maintaining
objectivity Active involvement
Maladaptive Denial Helplessness Cognitive escape Behavioral escape
Remission or Stabilization
Maintenance chemotherapy
Return to school Social re-entry concerns Academic performance
Role of doubts and fears
Completion of Treatment
Emotional reliance on treatment
Weaning from frequent appointments
Completion of Treatment
Marital stress
Difficulty with discipline
Long-term Survival & Care
Learning & memory problems
Endocrine dysfunction
Emotional outcomes
Relapse & Recurrence
Occurs in 40-50% of pediatric oncology patients
May be harder emotionally than initial diagnosis
Re-learn basic info Experimental treatments, etc.
Terminal Illness & Death
Communication issues What do children know about “death?”
What do children fear about “death?”
How can parents discuss the child’s own death with him/her?
Children’s Understanding of Death
Ages 3-5 Some understanding
Ages 6-8 Understand that death is irrevocable & universal
Ages 9+ Recognize cause of death; have mature conception of death
Common Fears of Death
Fear of pain Fear of being alone Fear of the unknown Fear of disappointing
parents Fear of leaving
others behind
Parents Talking to their Children about Death
Concerns Will it lead to difficulty coping after the
child’s death? Will it interfere with the child’s sense of
hope? Will it impact the child’s medical care?
Parents Talking to their Children about Death
What can they say? Answer questions honestly Give the child permission to cry, be angry,
or be sad Tell children that adults do not understand
death Reassure child that loss is never complete
Preparing for Death
Anticipatory grieving
Preparation for death Hospice care
After child’s death…
Mourning
Support groups