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Jestico ECL, Schutz SE, Finlay TMD, Appleton JV. How 'significant others' may support parents with decision-making about their child's cancer care: An integrative literature review. J Clin Nurs 2022; 32:1821-1840. [PMID: 35040523 DOI: 10.1111/jocn.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM To synthesise what is known from current international evidence about how parents are supported by significant others when they are faced with making decisions about their child's cancer care. BACKGROUND Parents are faced with making challenging decisions when their child has cancer and may benefit from support. Whilst previous research has comprehensively explored how healthcare professionals can offer support, little attention has been given to how support may be informally provided from a parent's network of significant others. METHOD An integrative literature review was undertaken and reported following the ENTREQ framework. Literature was identified from comprehensive database searching across four relevant databases (CINAHL, PubMed, PsychINFO and British Nursing Database) and hand-searching reference lists of retrieved studies. Studies that met the inclusion criteria were critically appraised and then analysed using the Constant Comparative Analysis method. RESULTS Twenty-six articles were included in the review. Two overarching themes were identified. Theme 1-Dimensions of Decision-Making support-included three sub-themes: informational, emotional and instrumental mechanisms of support. Theme 2-Expectations of Decision-Making support-identified that parents' expectations of their own role, and the role of their significant others, affected how decision-making was supported. CONCLUSIONS Parents may seek and receive support from various significant members of their network, but there is a fine line between supportive and unsupportive behaviours. RELEVANCE TO CLINICAL PRACTICE Each family's unique personal, social and cultural context strongly impacts on their support needs, and nurses and other healthcare professionals should be mindful of how parents may access support from their significant others. Further in-depth research around this area would contribute important knowledge around parents' support needs.
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Affiliation(s)
| | - Susan E Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Teresa M D Finlay
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Jane V Appleton
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
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2
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Indraswari BW, Kelling E, Vassileva SM, Sitaresmi MN, Danardono D, Mulatsih S, Supriyadi E, Widjajanto PH, Sutaryo S, Kaspers GL, Mostert S. Impact of universal health coverage on childhood cancer outcomes in Indonesia. Pediatr Blood Cancer 2021; 68:e29186. [PMID: 34114307 DOI: 10.1002/pbc.29186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low- and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital. METHODS Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained. FINDINGS After introduction of UHC, the number of insured patients increased from 38% to 82% (P < 0.001). Among low SES population, insurance coverage increased from 40% to 85% (P < 0.001), and among high SES population from 33% to 77% (P < 0.001). In the overall population, treatment abandonment decreased from 36% to 22% (P < 0.001). Event-free survival estimates at four years after diagnosis of overall population improved from 16% to 22% (P < 0.001). Hazard ratio for treatment failure was 1.26 (CI: 1.07-1.48, P = 0.006) for uninsured versus insured patients. In the low SES population, treatment abandonment decreased from 36% to 19% (P < 0.001). Event-free survival estimates at four years after diagnosis of low SES population improved from 14% to 22% (P < 0.001). INTERPRETATION Introduction of UHC in Indonesia contributed significantly to better treatment outcome and event-free survival of children with cancer from low SES families.
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Affiliation(s)
- Braghmandita Widya Indraswari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Emil Kelling
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sofi M Vassileva
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Danardono Danardono
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Mulatsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Eddy Supriyadi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Pudjo Hagung Widjajanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Sutaryo Sutaryo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Gertjan L Kaspers
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Pediatric Oncology, Emma's Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Kakkar S, Anand V, Mahajan M, Sandhu P, Rana M, Singh K, Kaur A, Kaur I, Jindal A, Gupta H, Bagai P. Stakeholder collaboration: Government, private sector and non-governmental organizations can build pediatric oncology services in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Afungchwi GM, Hesseling P, van Elsland SL, Kouya F, Kruger M. Destitution, treatment adherence and survival of children with Burkitt lymphoma in a twinning programme in Northwest Cameroon. Pediatr Blood Cancer 2019; 66:e27946. [PMID: 31436364 DOI: 10.1002/pbc.27946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Burkitt lymphoma (BL) is a curable childhood cancer. Treatment adherence is crucial for a good outcome, but is potentially problematic in low- and middle-income countries owing to parental financial constraints. AIMS To investigate the association of destitution with treatment adherence and its effect on the survival of patients with BL. METHODS Patients received free medical treatment from a twinning programme at two Cameroon Baptist hospitals. A destitution assessment questionnaire, based on socioeconomic status, was completed at diagnosis. Medical records were reviewed for treatment adherence and survival. Chi-squared and Fisher's exact tests were used to compare groups. Kaplan-Meier plots were used to calculate overall survival, and log-rank chi-squared tests when comparing survival rates between patient subgroups. Significance was measured at P < .05. RESULTS The 225 children with BL had a mean age of 8.2 years (median 8.0) and the overall survival was 52%. The mean family destitution score was 56% on a linear scale. Few (8%) patients delayed treatment appointments. A quarter (25%) experienced more than a 1-week follow-up delay and 9.8% absconded within 1 year. The destitution score was not significantly associated with delay of treatment, but with delay in follow-up (P < .001). Guardian relationship (single mother) and patient's age were significantly associated with overall survival (P = .025). CONCLUSIONS Though linked to poor follow-up, destitution was not significantly associated with absconding patients, poor outcome or poor adherence to treatment, probably due to comprehensive financial support from the international twinning programme. However, additional support for single mothers should be considered.
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Affiliation(s)
- Glenn M Afungchwi
- Department of Paediatrics, Mbingo Baptist Hospital, Banso, Cameroon.,Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sabine L van Elsland
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Francine Kouya
- Department of Paediatrics, Mbingo Baptist Hospital, Banso, Cameroon
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Lan BN, Castor A, Wiebe T, Toporski J, Moëll C, Hagander L. Adherence to childhood cancer treatment: a prospective cohort study from Northern Vietnam. BMJ Open 2019; 9:e026863. [PMID: 31383696 PMCID: PMC6687055 DOI: 10.1136/bmjopen-2018-026863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Global incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment. DESIGN A prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors. SETTING The largest tertiary paediatric oncology centre in Northern Vietnam. PARTICIPANTS All children offered curative cancer treatment, from January 2008 to December 2009. PRIMARY AND SECONDARY OUTCOME MEASURES Family decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment. RESULTS Among 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03). CONCLUSIONS Non-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.
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Affiliation(s)
- Bui Ngoc Lan
- Pediatric Oncology Hematology Center, Vietnam National Children’s Hospital (VNCH), Hanoi, Vietnam
| | - Anders Castor
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Thomas Wiebe
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Jacek Toporski
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Christian Moëll
- Pediatric Oncology, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Lars Hagander
- Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden
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Rayala S, Bäckdahl T, Reddy N, Jacob J, Gebre-Medhin E, Karonen E, Palat G, Sinha S, Schyman T, Wiebe T, Brun E, Segerlantz M. Low-Dose Oral Ketamine for Procedural Analgesia in Pediatric Cancer Patients Undergoing Lumbar Puncture at a Resource-Limited Cancer Hospital in India. J Palliat Med 2019; 22:1357-1363. [PMID: 31090488 DOI: 10.1089/jpm.2018.0667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: The aim of this study was to evaluate the therapeutic efficacy and safety profile of orally administered low-dose ketamine for procedural pain management in pediatric cancer patients undergoing lumbar puncture (LP) in a resource-limited hospital setting. Methods: Patients between 4 and 15 years of age, with leukemia, undergoing LP were asked to participate. The study was designed as a two-armed blinded placebo-controlled trial where 0.8 mg/kg (bodyweight) of ketamine mixed in juice was given 30 minutes before the procedure to Group K (ketamine) compared with placebo, only juice, to Group P (placebo). In addition, topical analgesia (EMLA®) was given according to established standard of care. Patients and caregivers assessed the pain using the Wong-Baker Faces Pain Rating Scale. Results: A total number of 52 patients, equally distributed between Group K and Group P, were included in the study. The placebo-controlled group had significantly higher self-reported pain score than the group receiving ketamine (p = 0.046), as well as in caregiver-assessed pain (p = 0.033). Only three incidents of mild adverse effects were reported. Conclusion: Low-dose oral ketamine can be safely administered for procedural analgesia in pediatric cancer patients undergoing LP in a resource-limited hospital setting and have significant pain-reducing effect compared with placebo.
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Affiliation(s)
- Spandana Rayala
- Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Tim Bäckdahl
- Faculty of Medicine, University of Lund, Lund, Sweden
| | - Naresh Reddy
- Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Jean Jacob
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
| | | | - Emil Karonen
- Faculty of Medicine, University of Lund, Lund, Sweden
| | - Gayatri Palat
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada.,Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Sudha Sinha
- Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Tommy Schyman
- Skane University Hospital, Clinical Studies Sweden-Forum South, Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences and Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences and Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden.,Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Region Skåne, Lund, Sweden
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7
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Rayala S, Kyander M, Haridass V, Palat G, Ström A, Wiebe T, Brun E, Segerlantz M. Low-dose Oral Ketamine as a Procedural Analgesia in Pediatric Cancer Patients Undergoing Bone Marrow Aspirations at a Resource-limited Cancer Hospital in India. Indian J Palliat Care 2019; 25:501-507. [PMID: 31673202 PMCID: PMC6812415 DOI: 10.4103/ijpc.ijpc_110_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Many pediatric cancer patients undergo repeated bone marrow aspirations (BMAs) for diagnostic and treatment evaluation purposes. Full anesthesia is the standard of care during this procedure in high-income countries. At hospitals with low resources in low/middle-income countries many children undergo these painful procedures without sufficient pain relief. This study aimed to evaluate the usefulness of low-dose oral ketamine as a procedural analgesic in a low-resource pediatric cancer care department. Materials and Methods: Pediatric patients, 4–15 years of age, who underwent BMAs between September 31 and November 30, 2018, were invited to participate. The study was designed as a placebo-controlled, single-blinded trial with three trial groups. Group K received 1.0 mg/kg of ketamine and Group KM received 1.0 mg/kg ketamine with an addition of 0.2 mg/kg midazolam, mixed in juice 30 min before procedures. Group P received placebo consisting of plain juice. All three groups also received the hospital's current standard treatment for procedural pain in BMAs. Patients and caregivers assessed the procedural pain, as did the performing doctors. For the patients, Faces Pain Scale – Revised was used and the Numeric Rating Scale-11 for caregivers and doctors. Results: A total of 87 patients were included in the study distributed with 29 in Group K, 29 in Group KM, and 29 in Group P. Seven patients were excluded, one patient denied participation and the remaining did not meet the inclusion criteria. There was no significant difference between the pain reported by the groups. A total of 69% patients in Group KM and 35% in Group K had somnolence reported as a side effect compared to 14% in Group P. Conclusion: We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.
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Affiliation(s)
- Spandana Rayala
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | | | - Vikranth Haridass
- Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Gayatri Palat
- Department of Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada.,Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Axel Ström
- Skane University Hospital, Clinical Studies Sweden-Forum South, Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences, Oncology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiotherapy and Radiophysics, Skane University Hospital, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Region Skane, Lund, Sweden.,Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane, Lund, Sweden
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8
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Chien CH, Chang YY, Huang XY. The Lived Experiences of Adolescents With Cancer: A Phenomenological Study. Clin Nurs Res 2018; 29:217-225. [PMID: 30188183 DOI: 10.1177/1054773818799226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This descriptive phenomenological study was conducted to explore the lived experiences of adolescents with cancer. Purposive sampling was used to recruit participants. In-depth, nonstructured interviews were conducted to collect data, and narratives were analyzed using Colaizzi's seven-step method. Data saturation was achieved after interviewing 16 participants. The study was divided into three main themes and 16 subthemes: suffering (caused by symptoms, therapy, cancer recurrence, the feeling of being trapped in hospital, the burden of food therapy, delayed education, the absence of peer relationships, and limited activities), emotional reactions (fear, worry, sadness, anger, and loneliness), and rebalancing (strong family relationships, optimistic thinking, and healthy lifestyles). While adolescents with cancer experience changes in lifestyle, and physical, psychological, and social burden, they also have positive life experiences. Building appropriate learning systems, improving communication skill, and providing appropriate food therapy may alleviate the psychological burden experienced by young patients.
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Affiliation(s)
- Ching-Hui Chien
- National Taipei University of Nursing and Health Sciences, Taiwan
| | | | - Xuan-Yi Huang
- National Taipei University of Nursing and Health Sciences, Taiwan
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Belgaumi AF, Anas M, Siddiqui KS, Akhter MF, Al-Kofide A. Risk-adapted stratification for optimally intensive treatment assignment of pediatric patients with non-Hodgkin lymphoma is an effective strategy in developing countries. Pediatr Blood Cancer 2017; 64. [PMID: 27878966 DOI: 10.1002/pbc.26335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/28/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pediatric patients with non-Hodgkin lymphoma (NHL) in developing countries (DCs) present with greater tumor load even at lower stages and with comorbidities that impact therapy delivery. This causes toxic mortality with "standard" intensive protocols or recurrences with "gentler" treatment. OBJECTIVES We developed and evaluated a risk stratification schema that guides intensity of therapy. DESIGN/METHODS Sixty-nine patients were prospectively assigned to five risk groups (A-E; n = 6, 15, 16, 15, and 17) following staging and treated with protocols of risk-stratified intensity. Risk stratification utilized St. Jude stage, disease bulk, and sites involved. RESULTS Between 2006 and 2011, 69 patients with B-cell NHL were enrolled. Among these, 72.5% were boys with mean age of 6.9 years (±3.33 [SD]; range 2.4-14.2 years). Eighty-seven percent had Burkitt lymphoma, 82.6% had advanced stage (25 [36.2%] stage III; 32 [46.4%] stage IV), and 24.6% were central nervous system positive. Mean lactate dehydrogenase increased progressively across the risk strata. Among these, 0/6, 1/15, 3/16, 2/15, and 7/17 patients relapsed/progressed within each risk stratum. Fifteen patients died; three from treatment-related toxicity. At a median follow-up of 6.2 years, the overall and event-free survival (EFS) for all patients was 78.1 and 75.4%, respectively; EFS was related to risk assignment. The frequency of documented infectious and noninfectious toxicities increased with higher risk group assignment causing prolongation of admissions and potential treatment delays. CONCLUSIONS Reduction in treatment intensity for an identified subset of patients with NHL is feasible, while high-intensity therapy is required for high-risk groups. This risk stratification system may be a first step toward improving the outcomes in some DCs.
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Affiliation(s)
- Asim F Belgaumi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Sidra Medical and Research Center, Doha, Qatar.,Weill Cornell Medical College-Qatar, Cornell University, Doha, Qatar
| | - Mohammed Anas
- Division of Nursing, King Fahd National Center for Children's Cancer, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Khawar S Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohammed F Akhter
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amani Al-Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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10
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Determinants of Treatment Abandonment in Childhood Cancer: Results from a Global Survey. PLoS One 2016; 11:e0163090. [PMID: 27736871 PMCID: PMC5063311 DOI: 10.1371/journal.pone.0163090] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding and addressing treatment abandonment (TxA) is crucial for bridging the pediatric cancer survival gap between high-income (HIC) and low-and middle-income countries (LMC). In childhood cancer, TxA is defined as failure to start or complete curative cancer therapy and known to be a complex phenomenon. With rising interest on causes and consequences of TxA in LMC, this study aimed to establish the lay-of-the-land regarding determinants of TxA globally, perform and promote comparative research, and raise awareness on this subject. METHODS Physicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Queries addressed social, economic, and treatment-related determinants of TxA. Free-text comments were collected. Descriptive and qualitative analyses were performed. Appraisal of overall frequency, burden, and predictors of TxA has been reported separately. RESULTS 581 responses from 101 countries were obtained (contact rate = 26%, cooperation rate = 70%). Most respondents were physicians (86%), practicing pediatric hematology/oncology (86%) for >10 years (54%). Providers from LMC considered social/economic factors (families' low socioeconomic status, low education, and long travel time), as most influential in increasing risk of TxA. Treatment-related considerations such as preference for complementary and alternative medicine and concerns about treatment adverse effects and toxicity, were perceived to play an important role in both LMC and HIC. Perceived prognosis seemed to mediate the role of other determinants such as diagnosis and treatment phase on TxA risk. For example, high-risk of TxA was most frequently reported when prognosis clearly worsened (i.e. lack of response to therapy, relapse), or conversely when the patient appeared improved (i.e. induction completed, mass removed), as well as before aggressive/mutilating surgery. Provider responses allowed development of an expanded conceptual model of determinants of TxA; one which illustrates established and emerging individual, family, center, and context specific factors to be considered in order to tackle this problem. Emerging factors included vulnerability, family dynamics, perceptions, center capacity, public awareness, and governmental healthcare financing, among others. CONCLUSION TxA is a complex and multifactorial phenomenon. With increased recognition of the role of TxA on global pediatric cancer outcomes, factors beyond social/economic status and beliefs have emerged. Our results provide insights regarding the role of established determinants of TxA in different geographical and economic contexts, allow probing of key determinants by deliberating their mechanisms, and allow building an expanded conceptual model of established and emerging determinants TxA.
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11
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Thibodeaux AG, Deatrick JA. Cultural Influence on Family Management of Children With Cancer. J Pediatr Oncol Nurs 2016; 24:227-33. [PMID: 17588895 DOI: 10.1177/1043454207303941] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A family's cultural context directly influences how they define and manage their child's cancer. Knowing this dynamic can guide nurses in delivering holistic, culturally competent care. This literature review examines the international and domestic pediatric oncology research as it relates to the inclusion of family and cultural variables. Most international studies and comparative studies have investigated Asian cultures and found that health beliefs, communication beliefs, religious practice, and family structure are common themes of cultural influences on families. Additional studies within the United States are needed to explore cultural beliefs through carefully tailored family assessments. Implications for practice include the possibility of providing evidence-based culturally competent care to families of children with cancer.
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12
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Goh XTW, Tan YB, Thirumoorthy T, Kwan YH. A systematic review of factors that influence treatment adherence in paediatric oncology patients. J Clin Pharm Ther 2016; 42:1-7. [PMID: 28045208 DOI: 10.1111/jcpt.12441] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/01/2016] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population. METHODS A literature search was carried out using related keywords on electronic databases. RESULTS AND DISCUSSION A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention. WHAT IS NEW AND CONCLUSION Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.
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Affiliation(s)
- X T W Goh
- Duke-NUS Medical School, Singapore, Singapore
| | - Y B Tan
- Duke-NUS Medical School, Singapore, Singapore
| | - T Thirumoorthy
- Duke-NUS Medical School, Singapore, Singapore.,Centre for Medical Ethics and Professionalism at Singapore Medical Association, Singapore, Singapore
| | - Y H Kwan
- Duke-NUS Medical School, Singapore, Singapore
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13
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Woods M. Balancing Rights and Duties in ‘Life and Death’ Decision Making Involving Children: a role for nurses? Nurs Ethics 2016; 8:397-408. [PMID: 16004094 DOI: 10.1177/096973300100800504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, increasing pressures have been brought to bear upon nurses and others more closely to inform, involve and support the rights of parents or guardians when crucial ‘life and death’ ethical decisions are made on behalf of their seriously ill child. Such decisions can be very painful for all involved, and may easily become deadlocked when there is an apparent clash of moral ideals or values between the medical team and the parents or guardians. This article examines a growing number of such cases in New Zealand and analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. The article concludes with a recommendation that nurses should be recognized as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.
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Affiliation(s)
- M Woods
- School of Health Sciences, Massey University, Private Bag 11 222, Palmerston North, New Zealand.
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14
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Making a difference? Teaching communication skills in preregistration nurse education in England. A comparison of Project 2000 and Making a Difference curricula. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960300800606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper reports on a survey of the teaching of communication skills on pre-registration nursing programmes in England in 2000. Questionnaires were devised for the Common Foundation Programme and the four Branch Programmes. These were sent to academic staff responsible for both Project 2000 and Making a Difference curricula. Comparisons are made between the two curricula, between matched pairs of curricula in institutions offering them both, and according to whether the institutions were designated as pilot sites for the Making a Difference curricula. The overwhelming finding was that there was no difference between any of the particular comparisons made. Lecturer-practitioners were more likely to be used to teach communication skills on Making a Difference curricula, but otherwise the picture was one of inconsistency and widespread differences between curricula and institutions. The lack of a greater emphasis on communication skills in Making a Difference curricula is surprising, given that it is intended to be skills-based. Recommendations are made for further research.
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15
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Hallström I, Elander G. Decision Making in Paediatric Care: an overview with reference to nursing care. Nurs Ethics 2016; 12:223-38. [PMID: 15921340 DOI: 10.1191/0969733005ne785oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this overview of published articles on decision making in paediatric care was to identify important aspects of its possible use in clinical practice and to obtain a base for future research. A literature review was undertaken utilizing snowball sampling to identify articles because of the diversity present within the area of decision making in paediatric care. The databases PubMed and CINAHL were used. The search was limited to articles published in English during the period 1994-2004. The analysis entailed a series of comparisons across articles, focusing on major areas of enquiry and patterns of results. Various levels of decision making are described because these seem to form a basis for how decisions are made. Concepts found to be of importance for decision making are described under the following headings: competence, the child’s best interests, knowledge, values and attitudes, roles and partnership, power, and economy. Further research is suggested.
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Affiliation(s)
- Inger Hallström
- Department of Nursing, Lund University, S-221 00 Lund, Sweden.
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16
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Pain buddy: A novel use of m-health in the management of children's cancer pain. Comput Biol Med 2016; 76:202-14. [PMID: 27479493 DOI: 10.1016/j.compbiomed.2016.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8-18 years undergoing cancer treatment. METHODS An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient's data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. RESULTS Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. CONCLUSION Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment.
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Martinson IM, Yee KH. Parental Involvement in Restoring the Health of a Child with Cancer in Hong Kong. J Pediatr Oncol Nurs 2016; 20:233-44. [PMID: 14632098 DOI: 10.1177/1043454203254037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The parents of 93 children with cancer in Hong Kong participated in a research study to identify concepts related to the category of restoring health in their child with cancer. These concepts included providing adequate nutrition such as attempting to increase the child's appetite, the preparation of soups, providing food supplements, and restricting the intake of certain foods; using alternative therapy to supplement the Western medicine, using tonics to strengthen the body, using Chinese medicine to regulate the body functions, using Chinese herbs to prevent metastasis or reoccurrence, as well as providing another chance of a cure when Western medicine was not effective; and preventing infections by reducing exposure to crowded places, having a clean home environment, using a face mask to protect the child from infections, and screening visitors.
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Affiliation(s)
- Ida M Martinson
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, USA.
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Gorbanzadeh B, Rahmani A, Mogadassian S, Behshid M, Azadi A, Taghavy S. Levels of Conscience and Related Factors among Iranian Oncology Nurses. Asian Pac J Cancer Prev 2016; 16:8211-4. [PMID: 26745062 DOI: 10.7314/apjcp.2015.16.18.8211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having a conscience is one of the main pre-requisite of providing nursing care. The knowledge regarding levels of conscience among nurses in eastern countries is limited. So, the purpose of this study was to examine the level of conscience and its related factors among Iranian oncology nurses. MATERIALS AND METHODS This descriptive-correlational study was conducted in 3 hospitals in Tabriz, Iran. Overall, 68 nurses were selected using a non-probability sampling method. The perceptions of conscience questionnaire was used to identify the levels of conscience among nurses. The data were analyzed using SPSS version 13.0. RESULTS The mean nurses' level of conscience scores was 72.7. In the authority and asset sub-scales nurses acquired higher scores. The mean of nurses' scores in burden and depending on culture sub-scales were the least. Also, there were no statistical relationship between some demographic characteristics of participants and their total score on the perceptions of conscience questionnaire. CONCLUSIONS According to study findings Iranian nurses had high levels of conscience. However, understanding all the factors that affect nurses' perception of conscience requires further studies.
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Affiliation(s)
- Behrang Gorbanzadeh
- Medical-Surgical Department, Nursing and Midwifery Faculty, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran E-mail :
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19
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Rossell N, Gigengack R, Blume S. Childhood cancer in El Salvador: A preliminary exploration of parental concerns in the abandonment of treatment. Eur J Oncol Nurs 2015; 19:370-5. [PMID: 25726358 DOI: 10.1016/j.ejon.2015.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/28/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE In El Salvador, children under 12 diagnosed with cancer have access to free treatment at a specialized national facility. Until recently, 13 percent of patients annually abandoned therapy--a serious loss of lives and scarce resources. This qualitative study explores how some parents perceived their child's cancer and treatment, and what led them to stop bringing their child for chemotherapy. METHOD In in-depth interviews, parents of six children who abandoned their child's cancer treatment discussed sickness and life circumstances during the course of treatment. RESULTS Poverty, effects of treatment, mistrust, emotions and religious convictions all figured in the parents' explanation of their actions. However, each family weighed these concerns differently. It was the interaction of the concerns, and not the concern per se, that represented the explanatory frameworks the families used to explain stopping their child's treatment. This finding illustrates the parents' navigation among a collection of variable concerns, rather than exposing one fixed cause for their behavior. For example, poverty affects a parent's worldview as well as concrete living conditions, and therefore has a complex relationship with abandonment of treatment. Thus, it follows that strategies to reduce treatment abandonment (and increase a child's chance for survival) must be multidimensional. CONCLUSIONS Qualitative studies of how families perceive childhood cancer and treatment can illuminate the processes and relationships involved in abandonment of treatment. This approach can also show how families' living circumstances frame their perceptions and inform strategies to improve how medical services are provided, thus reducing abandonment of treatment.
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Affiliation(s)
- Nuria Rossell
- Amsterdam Institute of Social Science Research AISSR, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands; Sociology of Development and Change Chair Group, Wageningen University and Research, Hollandseweg 1, 6700 EW Wageningen, The Netherlands; Oncology Department, Hospital Nacional de Niños Benjamin Bloom, Boulevard Los Heroes, Contiguo Hospital Anexo, San Salvador, El Salvador.
| | - Roy Gigengack
- Sociology of Development and Change Chair Group, Wageningen University and Research, Hollandseweg 1, 6700 EW Wageningen, The Netherlands.
| | - Stuart Blume
- Department of Sociology and Anthropology, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands; University of Cuenca, Cuenca, Ecuador.
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20
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Gunawan S, Wolters E, van Dongen J, van de Ven P, Sitaresmi M, Veerman A, Mantik M, Kaspers G, Mostert S. Parents' and health-care providers' perspectives on side- effects of childhood cancer treatment in Indonesia. Asian Pac J Cancer Prev 2015; 15:3593-9. [PMID: 24870763 DOI: 10.7314/apjcp.2014.15.8.3593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efficacy of childhood cancer treatment in low-income countries may be impacted by parents' and health-care providers' perspectives on chemotherapy-related side-effects. This study explores prevalence and severity of side-effects in childhood cancer, and compares health beliefs about side-effects between parents and health-care providers, and between nurses and doctors in Indonesia. MATERIALS AND METHODS Semi-structured questionnaires were filled in by 40 parents and 207 health-care providers in an academic hospital. RESULTS Parents exporessed a desire to receive more information about side-effects (98%) and worried about this aspect of treatment (90%), although side-effects were less severe than expected (66%). The most frequent was behavior alteration (98%) and the most severe was hair loss. Only 26% of parents consulted doctors about side-effects. More parents, compared to health-care providers, believed that medicines work better when side-effects are more severe (p<0.001), and accepted severe side-effects (p=0.021). More health-care providers, compared to parents, believed that chemotherapy can be stopped or the dosage altered when there are side-effects (p=0.011). More nurses, compared to doctors, stated that side-effects were unbearable (p=0.004) and made them doubt efficacy of treatment (p<0.001). CONCLUSIONS Behavior alteration is the most frequent and hair loss the most severe side-effect. Apparent discrepancies in health beliefs about side-effects exist between parents and health-care providers. A sustainable parental education program about side-effects is recommended. Health-care providers need to update and improve their knowledge and communication skills in order to give appropriate information. Such measures may improve outcome of childhood cancer treatment in low-income countries, where adherence to therapy is a major issue.
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Affiliation(s)
- Stefanus Gunawan
- Department of Pediatric Oncology-Hematology, Prof Dr RD Kandou Hospital, Manado, Indonesia E-mail :
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21
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Mostert S, Gunawan S, Wolters E, van de Ven P, Sitaresmi M, Dongen JV, Veerman A, Mantik M, Kaspers G. Socio-economic status plays important roles in childhood cancer treatment outcome in Indonesia. Asian Pac J Cancer Prev 2014; 13:6491-6. [PMID: 23464480 DOI: 10.7314/apjcp.2012.13.12.6491] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital. MATERIALS AND METHODS Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires. RESULTS Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/ relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%). CONCLUSIONS Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed.
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Affiliation(s)
- Saskia Mostert
- Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, the Netherlands.
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22
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Njuguna F, Mostert S, Slot A, Langat S, Skiles J, Sitaresmi MN, van de Ven PM, Musimbi J, Muliro H, Vreeman RC, Kaspers GJL. Abandonment of childhood cancer treatment in Western Kenya. Arch Dis Child 2014; 99:609-14. [PMID: 24681695 DOI: 10.1136/archdischild-2013-305052] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The most important reason for childhood cancer treatment failure in low-income countries is treatment abandonment. OBJECTIVE The aim of this study was to explore reasons for childhood cancer treatment abandonment and assess the clinical condition of these children. DESIGN This was a descriptive study using semistructured questionnaires. Home visits were conducted to interview families of childhood cancer patients, diagnosed between January 2007 and January 2009, who had abandoned treatment at the Moi Teaching and Referral Hospital (MTRH). RESULTS Between January 2007 and January 2009, 222 children were newly diagnosed with a malignancy at MTRH. Treatment outcome was documented in 180 patients. Of these 180 patients, 98 (54%) children abandoned treatment. From December 2011 until August 2012, 53 (54%) of the 98 families were contacted. Due to lack of contact information, 45 families were untraceable. From 53 contacted families, 46 (87%) families agreed to be interviewed. Reasons for abandonment were reported by 26 families, and they were diverse. Most common reasons were financial difficulties (46%), inadequate access to health insurance (27%) and transportation difficulties (23%). Most patients (72%) abandoned treatment after the first 3 months had been completed. Of the 46 children who abandoned treatment, 9 (20%) were still alive: 6 (67%) of these children looked healthy and 3 (33%) ill. The remaining 37 (80%) children had passed away. CONCLUSIONS Prevention of childhood cancer treatment abandonment requires improved access to health insurance, financial or transportation support, proper parental education, psychosocial guidance and ameliorated communication skills of healthcare providers.
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Mostert S, Njuguna F, van de Ven PM, Olbara G, Kemps LJPA, Musimbi J, Strother RM, Aluoch LM, Skiles J, Buziba NG, Sitaresmi MN, Vreeman RC, Kaspers GJL. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatr Blood Cancer 2014; 61:913-8. [PMID: 24347434 DOI: 10.1002/pbc.24896] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/15/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. PROCEDURE This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. RESULTS Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. CONCLUSIONS Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop.
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Affiliation(s)
- S Mostert
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor Program, VU University Medical Center, Amsterdam, The Netherlands
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Wu LM, Chiou SS, Sheen JM, Lin PC, Liao YM, Chen HM, Hsiao CC. Evaluating the acceptability and efficacy of a psycho-educational intervention for coping and symptom management by children with cancer: a randomized controlled study. J Adv Nurs 2013; 70:1653-62. [DOI: 10.1111/jan.12328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Li-Min Wu
- School of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Shyh-Shin Chiou
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Pediatrics; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Pei-Chin Lin
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Pediatrics; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yu Mei Liao
- Department of Pediatrics, Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsing-Mei Chen
- Department of Nursing; National Cheng Kung University; Tainan Taiwan
| | - Chih-Cheng Hsiao
- Department of Pediatrics; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
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Wanchai A, Armer JM, Stewart BR. Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand. Int J Nurs Pract 2013; 21:118-24. [DOI: 10.1111/ijn.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ausanee Wanchai
- Department of Nursing Administration; Boromarajonani College of Nursing; Buddhachinaraj Phitsanulok Thailand
| | - Jane M Armer
- Sinclair School of Nursing; University of Missouri; Columbia MO USA
- Nursing Research; Ellis Fischel Cancer Center; Columbia MO USA
| | - Bob R Stewart
- Sinclair School of Nursing; University of Missouri; Columbia MO USA
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26
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Mostert S, Gunawan S, van Dongen JAP, van de Ven PM, Sitaresmi MN, Wolters EE, Veerman AJP, Mantik M, Kaspers GJL. Health-care providers' perspectives on childhood cancer treatment in Manado, Indonesia. Psychooncology 2013; 22:2522-8. [DOI: 10.1002/pon.3314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 04/26/2013] [Accepted: 04/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- S. Mostert
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - S. Gunawan
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - J. A. P. van Dongen
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - P. M. van de Ven
- Epidemiology and Biostatistics; VU University Medical Center; Amsterdam The Netherlands
| | - M. N. Sitaresmi
- Department of Pediatrics, Dr Sardjito Hospital; Gadjah Mada University; Yogyakarta Indonesia
| | - E. E. Wolters
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - A. J. P. Veerman
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
| | - M. Mantik
- Department of Pediatric Oncology-Hematology; Prof Dr RD Kandou Hospital; Manado Indonesia
| | - G. J. L. Kaspers
- Department of Pediatric Oncology-Hematology; VU University Medical Center; Amsterdam The Netherlands
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Park YH, Jang YE, Byon HJ, Kim JT, Kim HS. Comparison of the efficacy of ramosetron and ondansetron in the prophylaxis of postoperative vomiting in children receiving fentanyl by patient-controlled analgesia after orthopedic surgery: a randomized controlled trial. Paediatr Anaesth 2013; 23:360-4. [PMID: 23281658 DOI: 10.1111/pan.12103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was designed to compare the efficacy of prophylactic ramosetron and ondansetron in preventing postoperative vomiting in children who received fentanyl by patient-controlled analgesia after orthopedic surgery. METHODS Two hundred and eighteen children, 2-15 years old, ASA physical status 1 or 2, scheduled for elective orthopedic surgeries, were randomly divided into the ramosetron group (n = 109) or ondansetron group (n = 109). Patients in ondansetron group received ondansetron 100 μg·kg(-1) and patients in ramosetron group received ramosetron 6 μg·kg(-1) after surgery. Intravenous patient-controlled analgesia with fentanyl was used in both groups. The incidence of postoperative vomiting and side effects were assessed during the 48 h after surgery. RESULTS There was significantly less vomiting during the first 24-h and 6-24-h period after surgery in ramosetron group than in ondansetron group (P < 0.01). There were no significant differences in side effect of 5-HT(3) antagonist between the two groups. CONCLUSION Ramosetron was more effective during the first 24-h period after surgery than ondansetron in children using fentanyl patient-controlled analgesia after general anesthesia.
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Affiliation(s)
- Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
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28
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A survey of procedural sedation and analgesia practices in pediatric oncology centers in India. Indian J Pediatr 2012; 79:1610-6. [PMID: 22421934 DOI: 10.1007/s12098-012-0724-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 02/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Repeated lumbar punctures (LP) and bone marrow aspirations (BMA) are part of childhood cancer management. Adequate sedation and analgesia for these procedures in a safe environment is desirable. We evaluate current practice related to this in pediatric oncology centers in India. METHODS Clinicians attending the 2nd Annual India Pediatric Oncology Initiative meeting at New Delhi in February 2010 were invited to complete a questionnaire. Questionnaires were also sent by email to the remaining major pediatric oncology centers not represented at the meeting. Responses for LP and BMA were separately collated and variability by type of hospital and patient caseload was assessed. RESULTS Responses were obtained from 26 of 32 centers (81%) approached. A median of 3 personnel (mostly pediatric residents and nurses) were present during the procedures. Some form of sedation and analgesia was used for LP and BMA in 88.5% and 100% centers respectively. However, use of systemic sedation and analgesia (usually midazolam +/- ketamine) for LP and BMA in ≥75% patients was seen in 47.8% and 61.6% centers respectively. General anesthesia was not used in any center. Additional restraint was commonly used and its use was significantly more in public hospitals (p = 0.01). Monitoring was usually done by observation of vital signs, with use of pulse-oximetry in less than half of the centers. CONCLUSIONS There is varied use of sedation and analgesia for LP and BMA in pediatric oncology centers in India. Further research is needed to identify the reasons for this. Availability of resources is likely to be a factor.
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Abstract
BACKGROUND Children with cancer often experience significant levels of pain and their pain is generally undermanaged. Management of care to patients with cancer has shifted from the hospital to the home, and as such parents are charged with managing children's pain. However, parents may have misconceptions of analgesic use, which can lead to undertreatment of pain in children. The purpose of this study is to examine attitudes toward pain medication and perceptions of pain expression among parents of children undergoing cancer treatment. PROCEDURE Parents of children who were undergoing cancer treatment at a hospital were recruited to take part in a survey study. A total of 187 parents completed a survey examining their attitudes toward medication and perceptions of pain expression in children. RESULTS Many parents reported concerns regarding analgesic use to treat their children's pain and misconceptions about how children can express pain. Regression analyses noted that parental perceptions of pain expression were related to children's experience of chronic or recurring pain and the 2 dimensions of child temperament: emotionality and sociability. CONCLUSIONS Many parents of children with cancer have misconceptions regarding issues of pain management; these misconceptions can potentially lead to undertreatment of pain in children. These misconceptions are associated with aspects of children's temperament.
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Forsey M, Salmon P, Eden T, Young B. Comparing doctors' and nurses' accounts of how they provide emotional care for parents of children with acute lymphoblastic leukaemia. Psychooncology 2011; 22:260-7. [PMID: 21976310 DOI: 10.1002/pon.2084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 08/10/2011] [Accepted: 09/05/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Despite the emphasis that communication skills training (CST) programmes place on attending to the emotional care of patients, evidence suggests that practitioners neglect this aspect of patient care. We describe and compare doctors' and nurses' accounts of managing the emotional care of parents of children with leukaemia, with the overall objective of examining how their accounts might inform training and policy. METHODS Audio-recorded qualitative interviews with 30 doctors and nurses working in six UK paediatric oncology and haematology treatment centres were analysed interpretatively, drawing on the constant comparative method. RESULTS Doctors' and nurses' descriptions of managing emotional care differed markedly. Doctors described reassuring parents through their ongoing clinical care of the child and by explaining the potentially curative nature of treatment. Doctors did not think they could reassure parents by eliciting and explicitly discussing parents' fears. In contrast, nurses relied on psychological skills and explicit discussion of parents' emotions to provide reassurance. Both doctors and nurses relied on each other to ensure that parents' emotional needs were met by the multidisciplinary team rather than by individual practitioners. CONCLUSION Nurses' accounts of providing emotional care resembled the emphasis on explicit emotional talk in CST. However, doctors' accounts indicated that they provided emotional care in ways that diverged markedly from expectations in CST but that were more consistent with their biomedical and authoritative role in patient care. These findings may have implications for CST in future revisions of guidelines, but work is first needed to explore parents' perspectives on emotional care.
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Affiliation(s)
- Mary Forsey
- Division of Clinical Psychology, School of Population, Community and Behavioural Sciences, University of Liverpool, Brownlow Hill, Liverpool, UK
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Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2011; 47:1005-10. [PMID: 21220796 DOI: 10.1007/s13312-010-0172-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Treatment refusal and abandonment is the principal cause of therapy failure in children with cancer in the developing world. A complex interplay of biological, socio-economic and treatment-related factors underlies this problem. Interventions are likely to succeed when they try and address all of these issues simultaneously, as exemplified by the success of twinning programs linking resource-rich and resource-limited countries. Hitherto, there has been no systematic attempt to understand and address this problem in India. Based on the knowledge gained from research in other parts of the developing world, we offer suggestions for dealing with this problem.
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Affiliation(s)
- R S Arora
- Cancer Research UK Paediatric and Familial Cancer Research Group, University of Manchester, Manchester, UK.
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Wu LM, Chin CC, Chen CH, Lai FC, Tseng YY. Development and validation of the paediatric cancer coping scale. J Adv Nurs 2011; 67:1142-51. [DOI: 10.1111/j.1365-2648.2010.05567.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wanchai A, Armer JM, Stewart BR. Breast cancer survivors' perspectives of care practices in Western and alternative medicine. Oncol Nurs Forum 2010; 37:494-500. [PMID: 20591809 DOI: 10.1188/10.onf.494-500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore perspectives of breast cancer survivors about their care with Western medicine and alternative medicine. RESEARCH APPROACH Qualitative, ethnonursing. SETTING Cancer center in the midwestern region of the United States. PARTICIPANTS 9 breast cancer survivors who had experienced health care involving Western medicine and alternative medicine. METHODOLOGIC APPROACH Semistructured interviews were conducted to elicit each participant's perspective about care practices. Data were analyzed with an ethnonursing qualitative data analysis method. MAIN RESEARCH VARIABLES Care practices in Western medicine and care practices in alternative medicine. FINDINGS Western medicine was seen as traditional or mainstream treatment, whereas alternative medicine was seen as anything not involving hospitals and doctors or as complementary. Perceived outcomes from alternative therapies were coping with disease and treatment, holistic care, and emotional support, whereas perceived outcomes from Western medicine were negative things that they had to go through and as an instrument of God. Kinship, social, economical, educational, and belief factors influenced care practices. CONCLUSIONS Care practices from alternative medicine or Western medicine vary for breast cancer survivors. Many factors influence their selection decisions about care practices. INTERPRETATION Nurses should be concerned about what care practices mean to breast cancer survivors. Further research should be considered to evaluate the potential contribution of each factor to breast cancer survivors' decision making about care practices.
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Affiliation(s)
- Ausanee Wanchai
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA.
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CHIARETTI A, RUGGIERO A, BARONE G, ANTONELLI A, LAZZARESCHI I, GENOVESE O, PAIANO S, SAMMARTINO M, MAURIZI P, RICCARDI R. Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression. Eur J Cancer Care (Engl) 2010; 19:212-20. [PMID: 19490010 DOI: 10.1111/j.1365-2354.2008.01006.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wu LM, Chin CC, Haase JE, Chen CH. Coping experiences of adolescents with cancer: a qualitative study. J Adv Nurs 2009; 65:2358-66. [PMID: 19737322 DOI: 10.1111/j.1365-2648.2009.05097.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Li-Min Wu
- Fooyin University, Taiwan. [corrected]
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CHIANG YC, YEH CH, WANG KW, YANG CP. The experience of cancer-related fatigue in Taiwanese children. Eur J Cancer Care (Engl) 2009; 18:43-9. [DOI: 10.1111/j.1365-2354.2007.00884.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jackson C, Cheater FM, Reid I. A systematic review of decision support needs of parents making child health decisions. Health Expect 2008; 11:232-51. [PMID: 18816320 DOI: 10.1111/j.1369-7625.2008.00496.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child. CONTEXT The first step towards implementing patient decision support is to assess patients' information and decision-making needs. SEARCH STRATEGY A systematic search of key bibliographic databases for decision support studies was performed in 2005. Reference lists of relevant review articles and key authors were searched. Three relevant journals were hand searched. INCLUSION CRITERIA Non-intervention studies containing data on decision support needs of parents making child health decisions. DATA EXTRACTION AND SYNTHESIS Data were extracted on study characteristics, decision focus and decision support needs. Studies were quality assessed using a pre-defined set of criteria. Data synthesis used the UK Evidence for Policy and Practice Information and Co-ordinating Centre approach. MAIN RESULTS One-hundred and forty nine studies were included across various child health decisions, settings and study designs. Thematic analysis of decision support needs indicated three key issues: (i) information (including suggestions about the content, delivery, source, timing); (ii) talking to others (including concerns about pressure from others); and (iii) feeling a sense of control over the process that could be influenced by emotionally charged decisions, the consultation process, and structural or service barriers. These were consistent across decision type, study design and whether or not the study focused on informed decision making.
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Affiliation(s)
- Cath Jackson
- School of Healthcare, University of Leeds, Leeds, UK.
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Abstract
AbstractInvasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukemia (ALL). We investigated the safety and efficacy of two different protocols for pain relief in 20 children with ALL undergoing lumbar puncture. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. Vital and behavioural parameters, sedation and pain scores were recorded at different times during and after the procedure. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significative differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Our results show that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears more safe due to the lower incidence of side effects.
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Chiaretti A, Genovese O, Antonelli A, Tortorolo L, Ruggiero A, Focarelli B, Di Rocco C. Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain. Childs Nerv Syst 2008; 24:119-24. [PMID: 17639417 DOI: 10.1007/s00381-007-0429-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain is the most common discomfort experienced by children undergoing major operations. It is most often not adequately treated because of inexperience and unfounded fears related to the use of opioid drugs. In adults, patient-controlled analgesia (PCA) is widely administered, while in children, its use with opioid drugs is still under evaluation for safety and efficacy. OBJECTIVES The objective of the study is to evaluate the safety and efficacy of an opioid drug (fentanil) administered by PCA associated with a sedative-adjuvant drug (midazolam) administered by continuous infusion in children having undergone major neurosurgical procedures. MATERIALS AND METHODS Sixteen children with moderate to severe postoperative pain were treated with fentanil by PCA (booster doses of 1 microg/kg) plus continuous infusion of midazolam (2 microg/kg per min) by an intravenous route. To evaluate safety and efficacy of this analgesic protocol, different subjective and objective parameters were monitored at 4-h intervals. In addition, patients' satisfaction was assessed by a questionnaire at the end of the treatment. MAIN RESULTS All children experienced a good degree of analgesia and did not require any other analgesic drug during the treatment. Both subjective and objective parameters improved after starting pain-relieving treatment, and no major side effects occurred. The analysis of the answers of the questionnaire administered to the children showed a high grade of satisfaction. CONCLUSIONS PCA with fentanil plus continuous infusion of midazolam is a safe and efficacious method for analgesia in children with moderate to severe postoperative neurosurgical pain. The association of midazolam to fentanil also contributes to control anxiety and stress in this subset of patients and does not show any important side effects.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Arora RS, Eden T, Pizer B. The problem of treatment abandonment in children from developing countries with cancer. Pediatr Blood Cancer 2007; 49:941-6. [PMID: 17252565 DOI: 10.1002/pbc.21127] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is an inequality gap between the outcome of childhood cancer in resource, rich and limited countries. Abandonment of treatment is one of the reasons for this. PROCEDURE We searched the medical literature for evidence on abandonment, its causes, and any preventative interventions. RESULTS Abandonment is a very real problem all across the developing world. Cancers associated with poorer prognosis seem to have higher abandonment rates. It is also related to the socio-economic and educational status of parents, travel time to treatment centers, and affordable, locally available treatment. CONCLUSIONS Twinning between institutions, which includes several preventative interventions, has clearly been shown to work.
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Ruggiero A, Barone G, Liotti L, Chiaretti A, Lazzareschi I, Riccardi R. Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain. Support Care Cancer 2006; 15:569-73. [PMID: 17146653 DOI: 10.1007/s00520-006-0193-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 11/08/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain is the most common discomfort experienced by children with cancer and occurs in almost 89% of patients in an advanced stage of the disease. It is most often not adequately treated because of inexperience and unfounded fears of analgesic treatment. In adults, patient controlled analgesia (PCA) is widely administered, while in children with moderate to severe cancer pain its use is still under evaluation for safety and efficacy. GOALS OF WORK To evaluate the efficacy and safety of fentanyl administered by PCA in children with cancer pain. MATERIALS AND METHODS Eighteen children (range 6 to 15 years) with moderate to severe pain were enrolled and treated with fentanyl by PCA plus background infusion (BI) (BI of 1 microg/kg/h with booster doses of 1 microg/kg by intravenous route). To evaluate efficacy and safety of the analgesic treatment, different subjective and objective parameters were monitored at 4-h intervals. In addition, patients' satisfaction was assessed by a questionnaire at the end of the treatment. MAIN RESULTS All children experienced a good degree of analgesia and did not require any other analgesic drug during the treatment. Both subjective and objective parameters improved after starting pain-relieving treatment and no major side effects occurred. The questionnaire administered to the children showed a high grade of satisfaction. CONCLUSIONS PCA plus BI with fentanyl administered by intravenous route is a safe and efficacious method for analgesia in children with moderate to severe cancer pain. Our policy of fentanyl-treatment did not show any major side effects.
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Affiliation(s)
- A Ruggiero
- Division of Paediatric Oncology, Department of Paediatric Sciences, A Gemelli Hospital, Catholic University, Largo A Gemelli 8, Rome, Italy.
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Tsao JCI, Meldrum M, Bursch B, Jacob MC, Kim SC, Zeltzer LK. Treatment expectations for CAM interventions in pediatric chronic pain patients and their parents. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2005; 2:521-7. [PMID: 16322810 PMCID: PMC1297505 DOI: 10.1093/ecam/neh132] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 09/26/2005] [Indexed: 12/11/2022]
Abstract
Patient expectations regarding complementary and alternative medicine (CAM) interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation) and conventional medicine (i.e. medications, surgery) interventions in 45 children (32 girls; mean age = 13.8 years ± 2.5) and parents (39 mothers) presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P < 0.01). However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P < 0.01). When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P < 0.01). Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, CA 90024, USA.
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Stewart JL, Pyke-Grimm KA, Kelly KP. Parental Treatment Decision Making in Pediatric Oncology. Semin Oncol Nurs 2005; 21:89-97; discussion 98-106. [PMID: 15991660 DOI: 10.1016/j.soncn.2004.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review progress and future plans for a research program about parents' making treatment decisions for their children with cancer. DATA SOURCES Theoretical papers, review articles, and research reports. CONCLUSION Three important questions need to be addressed to achieve the goal of supporting parents in treatment decision making: 1) Whatfactors predict a parent's preferred role iln decision making? 2) What are the critical outcomes from parental decision making that nurses could help to improve? 3) Is it role choice, actual role assumed, or congruence between preferred and actual role in decision making that predicts decision outcomes for the parents? IMPLICATIONS FOR NURSING PRACTICE Research-based responses to the remaining questions about parent treatment decision making will help nurses develop and test interventions designed to support parents in their decision making experiences.
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Affiliation(s)
- Janet L Stewart
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA 15206, USA.
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Critique 1: Parental Treatment Decision Making in Pediatric Oncology. Semin Oncol Nurs 2005. [DOI: 10.1016/j.soncn.2004.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Unrelieved pain may have a major impact on the care of children with cancer. The type and severity of pain experienced by children with cancer varies from acute, procedure-related pain to progressive chronic pain associated with the progression of the disease or sequelae of treatment. Drugs are the mainstay of treatment. Regular pain assessments combined with appropriate analgesic administration at regular dosing intervals, adjunctive drug therapy for control of adverse effects and associated symptoms, and nonpharmacological interventions are recommended. Although standard dosing of opioids adequately treats most cancer pain in children, more complex treatment is required by a significant group. Strategies to improve analgesia include the use of epidural or intrathecal infusions of a combination of opioids and other adjuvants, or other regional anaesthesia techniques. Procedure- and treatment-related pain is an even greater problem than cancer pain. Recommendations have been published with regard to the monitoring and personnel required when children are sedated which aim to set the standard of care and minimize both physical discomfort or pain and negative psychological responses, by providing analgesia; and to maximize the potential for amnesia; and to control behaviour.
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Abstract
BACKGROUND It is recognized that there is a need for specialist nursing courses in a range of paediatric nursing specialities. Paediatric oncology nurses are facing challenges with clinical advances and the need for specialized care. At present there are no available courses in Scotland offering preparation for nurses working in a paediatric oncology setting. AIMS AND OBJECTIVES This project, supported by Macmillan Cancer Relief, addresses this deficit by developing a comprehensive framework for a small and widely dispersed speciality. METHODS Information on the needs and expectations of nurses and service managers in this field was obtained through postal questionnaires and focus groups. Due to the need for collaboration between higher educational institutions and service colleagues the views of educators were also established through questionnaires and semi-structured interviews. RESULTS Problematic practice issues were cited and these issues were further discussed and recognized as the main educational needs. Availability and accessibility of education were of great importance. CONCLUSION The framework developed aims to provide ongoing opportunities for continuing professional development within this speciality. Development of the educational framework is required to provide a course accessible to a wide geographical area of nurses. RELEVANCE TO CLINICAL PRACTICE A National Framework for Paediatric Oncology Nurse Education was developed in response to views of experts working in the field, to the views of other stakeholders and to what is known about needs and preferences of children with cancer and their families.
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Affiliation(s)
- Deborah Tomlinson
- Nursing Studies, University of Edinburgh, 31 Buccleuch Place, Edinburgh EH8 9JT, Scotland, UK.
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Yeh CH. Gender Differences in the Use of Coping Strategies Among Taiwanese Parents Whose Children Have Cancer. Cancer Nurs 2004; 27:100-7. [PMID: 15253167 DOI: 10.1097/00002820-200403000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study explores parental gender-based similarities and differences in the use of coping strategies when their children suffer from cancer. The data from the 171 parent-couples who served as subjects for this study were selected from a larger data set of surveys from parents whose children were receiving treatment or follow-up care for cancer. The results show that no major differences were found between fathers and mothers in coping behaviors while caring for children with cancer. In addition to quantitative measure of coping behaviors, a qualitative orientation with more in-depth data is needed to explore how parents cope with children with cancer. More data are needed on additional variables that may influence coping such as the presence and severity of child's illness. Nurses need to be aware of the various coping behaviors that mothers and fathers use while caring for children with cancer. Assessment of coping strategies is a prerequisite to planning care for parents with cancer.
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Affiliation(s)
- Chao-Hsing Yeh
- Graduate Institute of Nursing Science, Chang Gung University, Taiwan, Republic of China.
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Abstract
The purpose of this study was to identify a theoretical construct for the process that Taiwanese parents go through during their child's illness with cancer. Grounded theory methodology was used to gain insight into the parental responses to their child's devastating illness. One core category with five distinct components emerged from the data as parents developed their ability to endure the distress of caring for a child with cancer. "Coming to terms" was the core category. The five distinct components were as follows: confrontation of reality, management of treatments, cognitive/affective shifting, recognition of the situation, and adjusting appropriately. For the parents of those children whose illness proceeded with few complications and those children who had been successfully treated, these components had a sequential pattern. However, for parents of those children whose illnesses were more complicated, changes in clinical status occurred in rapid succession, or simultaneously. Emotional responses of these parents were dynamic; the stages were less obvious and not sequential.
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Affiliation(s)
- Chao-Hsing Yeh
- Graduate Institute of Nursing Science, Chang Gung University, Tao-Yuen, Taiwan.
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49
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Abstract
This study examined the relationships among social support, parenting stress, coping style, and psychological distress in parents caring for children with cancer. The hypothesis that coping style plays a mediating role between social support and parenting stress, and psychological distress was tested for both mothers and fathers. In total, 246 mothers and 195 fathers of 270 children participated in the study. Structural equation modeling was used to test the hypothesis. The findings indicate that the hypotheses derived from the Roy adaptation model were supported for both mothers and fathers. A longitudinal study is suggested to examine the circular process of stimulus, coping process, and adaptation outcomes.
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Chao CC, Chen SH, Wang CY, Wu YC, Yeh CH. Psychosocial adjustment among pediatric cancer patients and their parents. Psychiatry Clin Neurosci 2003; 57:75-81. [PMID: 12519458 DOI: 10.1046/j.1440-1819.2003.01082.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children with cancer face both physical and psychosocial challenges. However, there is not enough empirical evidence in Taiwan regarding how they and their families cope with their illness. The purpose of the present study was to explore the psychosocial impact of cancer on target children and their families as well as the degree of depression experienced by these children. Twenty-four pediatric cancer patients, aged 8 through 17 years, completed the Chinese version of Children Depression Inventory (CDI). Both these patients and 18 parents completed questionnaires about their psychosocial adjustment since the diagnosis of cancer. The results showed: (i) patients did not perceive significant changes in their psychosocial adjustment, whereas parents indicated significantly lower mood of patients and a slight decrease in the number of friends; (ii) both parents and siblings showed positive adjustment; and (iii) there was neither significant difference on the CDI scores between the pediatric cancer patients and a normative group, nor significant relationships between patients' CDI scores and demographic characteristics of both patients and their parents, parenting attitudes, as well as variables related to the illness. Lastly, the results are discussed in terms of issues of methodology and instruments. Possible direction for further investigations is suggested.
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Affiliation(s)
- Chia-Chen Chao
- Graduate Institute of Clinical Behavior Science, Graduate Institute of Nursing Science, Chang Gung University, Taoyuan, Taiwan
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