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Cancer.ppt

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Cancer.ppt Cancer.ppt Presentation Transcript

  • 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
    • 2 nd 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?
      • Go slowly
      • Encourage questions
      • Convey hope
      • Establish trust
      • 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 Recognize cause of death; have mature conception of death Ages 9+ Understand that death is irrevocable & universal Ages 6-8 Some understanding Ages 3-5
  • 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