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Cancer.ppt

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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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