Pediatric Cancer &
Leukemia
December 4, 2007
Pediatric Oncology
 Acute leukemia
 Brain tumors
 Lymphoma
 Neuroblastoma
 Wilm’s tumor
 Rhabdomyosarcoma
 Retinobl...
What is Leukemia?
 Most common
childhood
malignancy
 Acute lymphoblastic
leukemia (ALL)
 Acute
nonlymphoblastic
leukemi...
Brain Tumors
 2nd
most common type
of cancer
 1200 US cases
diagnosed/year
 Described in terms of:
 Metastasis (M stag...
Brain Tumors
 Terminal to curable
 Neuropsychological
impact varies based on:
 Location, size, tumor
type
 Type of tre...
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
...
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 therap...
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. Esta...
Treatment
 Disruption of life
 Complex treatment
schedules
 Feeling poorly
 Reaction of others
 Maintain contact with...
Treatment
 Coping with acute & chronic pain
 Bone marrow aspirations (BMA) & lumbar
punctures (LP)
 Distraction, relaxa...
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 gi...
Coping Strategies
Adaptive
 Positive reframing
 Acceptance
 Social support
 Maintaining
objectivity
 Active involveme...
Remission or Stabilization
 Maintenance
chemotherapy
 Return to school
 Social re-entry concerns
 Academic performance...
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
...
Terminal Illness & Death
 Communication issues
 What do children know about “death?”
 What do children fear about “deat...
Children’s Understanding of
Death
Ages 3-5 Some understanding
Ages 6-8 Understand that death is
irrevocable & universal
Ag...
Common Fears of Death
 Fear of pain
 Fear of being alone
 Fear of the unknown
 Fear of disappointing
parents
 Fear of...
Parents Talking to their
Children about Death
 Concerns
 Will it lead to difficulty coping after the
child’s death?
 Wi...
Parents Talking to their
Children about Death
 What can they say?
 Answer questions honestly
 Give the child permission...
Preparing for Death
 Anticipatory grieving
 Preparation for death
 Hospice care
After child’s death…
 Mourning
 Support groups
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Cancer.ppt

  1. 1. Pediatric Cancer & Leukemia December 4, 2007
  2. 2. Pediatric Oncology  Acute leukemia  Brain tumors  Lymphoma  Neuroblastoma  Wilm’s tumor  Rhabdomyosarcoma  Retinoblastoma  Osteosarcoma  Ewing’s sarcoma
  3. 3. What is Leukemia?  Most common childhood malignancy  Acute lymphoblastic leukemia (ALL)  Acute nonlymphoblastic leukemia (ANLL)  Acute myelogenous leukemia (AML)
  4. 4. 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)
  5. 5. Brain Tumors  Terminal to curable  Neuropsychological impact varies based on:  Location, size, tumor type  Type of treatment  Disease of complications  Patient factors  Social factors
  6. 6. Medical Treatment  Radiation  Chemotherapy  Surgery  Most cancers considered CURED if no relapse in 5 years.
  7. 7. 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
  8. 8. Stages of BMT  Donor search & initial evaluation  Preparative treatment  Bone marrow infusion
  9. 9. Stages of BMT  Severe neutropenia  Engraftment  Graft-versus-Host disease  Follow-up
  10. 10. 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
  11. 11. Diagnosis  Address emotional reaction  Evaluate family understanding  Determine financial resources  Financial  Social
  12. 12. 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
  13. 13. Treatment  Disruption of life  Complex treatment schedules  Feeling poorly  Reaction of others  Maintain contact with school
  14. 14. Treatment  Coping with acute & chronic pain  Bone marrow aspirations (BMA) & lumbar punctures (LP)  Distraction, relaxation, hypnosis  Anticipatory nausea & vomiting  Classical conditioning  Relaxation, imagery, distraction
  15. 15. Treatment  Parents need to feel some control during the treatment process  Helplessness  Hopelessness
  16. 16. 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
  17. 17. Coping Strategies Adaptive  Positive reframing  Acceptance  Social support  Maintaining objectivity  Active involvement Maladaptive  Denial  Helplessness  Cognitive escape  Behavioral escape
  18. 18. Remission or Stabilization  Maintenance chemotherapy  Return to school  Social re-entry concerns  Academic performance  Role of doubts and fears
  19. 19. Completion of Treatment  Emotional reliance on treatment  Weaning from frequent appointments
  20. 20. Completion of Treatment  Marital stress  Difficulty with discipline
  21. 21. Long-term Survival & Care  Learning & memory problems  Endocrine dysfunction  Emotional outcomes
  22. 22. Relapse & Recurrence  Occurs in 40-50% of pediatric oncology patients  May be harder emotionally than initial diagnosis  Re-learn basic info  Experimental treatments, etc.
  23. 23. 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?
  24. 24. 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
  25. 25. Common Fears of Death  Fear of pain  Fear of being alone  Fear of the unknown  Fear of disappointing parents  Fear of leaving others behind
  26. 26. 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?
  27. 27. 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
  28. 28. Preparing for Death  Anticipatory grieving  Preparation for death  Hospice care
  29. 29. After child’s death…  Mourning  Support groups
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