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Pediatric Cancer & Leukemia

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Pediatric Cancer & Leukemia December 4, 2007 Pediatric Oncology Acute leukemia Brain tumors Lymphoma Neuroblastoma Wilm s tumor Rhabdomyosarcoma Retinoblastoma ... – PowerPoint PPT presentation

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Title: Pediatric Cancer & Leukemia


1
Pediatric Cancer Leukemia
  • December 4, 2007

2
Pediatric Oncology
  • Acute leukemia
  • Brain tumors
  • Lymphoma
  • Neuroblastoma
  • Wilms tumor
  • Rhabdomyosarcoma
  • Retinoblastoma
  • Osteosarcoma
  • Ewings sarcoma

3
What is Leukemia?
  • Most common childhood malignancy
  • Acute lymphoblastic leukemia (ALL)
  • Acute nonlymphoblastic leukemia (ANLL)
  • Acute myelogenous leukemia (AML)

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
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
Medical Treatment
  • Radiation
  • Chemotherapy
  • Surgery
  • Most cancers considered CURED if no relapse in 5
    years.

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
Stages of BMT
  • Donor search initial evaluation
  • Preparative treatment
  • Bone marrow infusion

9
Stages of BMT
  • Severe neutropenia
  • Engraftment
  • Graft-versus-Host disease
  • Follow-up

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
Diagnosis
  • Address emotional reaction
  • Evaluate family understanding
  • Determine financial resources
  • Financial
  • Social

12
Diagnosis
  • Communication with others
  • What to tell the child?
  • Go slowly
  • Encourage questions
  • Convey hope
  • Establish trust
  • Gauge details to developmental ability

13
Treatment
  • Disruption of life
  • Complex treatment schedules
  • Feeling poorly
  • Reaction of others
  • Maintain contact with school

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
Treatment
  • Parents need to feel some control during the
    treatment process
  • Helplessness
  • Hopelessness

16
Dont 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
Coping Strategies
  • Adaptive
  • Positive reframing
  • Acceptance
  • Social support
  • Maintaining objectivity
  • Active involvement
  • Maladaptive
  • Denial
  • Helplessness
  • Cognitive escape
  • Behavioral escape

18
Remission or Stabilization
  • Maintenance chemotherapy
  • Return to school
  • Social re-entry concerns
  • Academic performance
  • Role of doubts and fears

19
Completion of Treatment
  • Emotional reliance on treatment
  • Weaning from frequent appointments

20
Completion of Treatment
  • Marital stress
  • Difficulty with discipline

21
Long-term Survival Care
  • Learning memory problems
  • Endocrine dysfunction
  • Emotional outcomes

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
Terminal Illness Death
  • Communication issues
  • What do children know about death?
  • What do children fear about death?
  • How can parents discuss the childs own death
    with him/her?

24
Childrens Understanding of Death
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
Parents Talking to their Children about Death
  • Concerns
  • Will it lead to difficulty coping after the
    childs death?
  • Will it interfere with the childs sense of hope?
  • Will it impact the childs medical care?

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
Preparing for Death
  • Anticipatory grieving
  • Preparation for death
  • Hospice care

29
After childs death
  • Mourning
  • Support groups
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