Childhood cancer

Question 1

Most common cancer

Answer 1

Leukemia (37%)
Brain and other CNS tumors (25%)
Lymphomas (24%)

Question 2

Race differences in cancer development

Answer 2

In adults: high incidence among blacks than whites

In children: higher incidence for whites than for blacks.

Question 3

Survivorship of cancer

Answer 3

Surviving at least 5 year from diagnosis, and at least two years from the child’s last treatment.

Question 4

Survival rate for childhood cancer

Answer 4

1975-1977 = under 60%

Now = greater than 80%

Question 5

Who has poorer outcome of survival?

Answer 5

Hispanic and black children have poorer outcomes than white children.

It is most likely related to complex interplay between disease biology, pharmacogenetics, SES, and cultural factors.

Question 6

Late effects of childhood cancer

Answer 6

Almost 70% develops late effects, it can be either chronic of life threatening such as infertility, cardiovascular/lung disease, renal dysfunction, endocrinepathies, cognitive impairments etc.

Question 7

The childhood Cancer Survivor Study (CCSS)

Answer 7

A retrospective study of over 20.000 adult survivors of childhood cancer.

Health behavior: as a group, they tend to engage in less physical activity relative to controls, and fall short of recommended nutritional standards.

Neurocognitive and psychosocial: poor quality of life and ongoing psychological late effects and struggle with normal developmental tasks and the establishment of adult identities.
They are also less likely to have educational plans, beyond high school. More difficulties leaving home, achieving romantic/sexual relationship and finding marriage partners.

Question 8

Key psychological contribution to pediatric oncology care (pain, nausea etc.)

Answer 8

Pain has a biological, cognitive, and emotional component.

interventions: distractions, relaxation, hypnotherapy, cognitive behavioral approaches, and pharmacology have been established.

Distraction = more effective in younger children.

Guided imagery, relaxation and self-hypnosis = Bettie with older children

Question 9

Effective in treating pain in younger children

Answer 9

Distraction

Question 10

Effective in treating pain in older children

Answer 10

Guided imagery, relaxation and self-hypnosis.

Question 11

Cognitive remediation program (CRP)

Answer 11

Cognitive rehabilitation model
20 x 2hour sessions

Directed at the most commonly described domains of cognitive vulnerability associated with academic problems.

Paper-and-pencil tasks to improve a childs ATTENTION, CONCENTRATION, AND MEMORY.

Question 12

Children with CNS tumors (problems?)

Answer 12

They tend to be at higher risk for longer term problems with adjustment.

Question 13

lone parents vs. couples

Answer 13

Myth that parents of sick child have destructive marriages.

There is evidence that lone parents experience more distress than those with partners.

Question 14

Bright IDEAS problem solving skills training (PSST)

Answer 14

for mothers to adjust after their child had been diagnosed with cancers.

Most effective for mothers from disadvantaged background.

Question 15

The most significant event of distress

Answer 15

Relapse or potential referral to palliative care.

Even events that are positive (ending treatment) can result in anxiety.

Question 16

The pediatric preventive psychosocial health model (PPPHM)

Answer 16

Was conceptualized to distinguish among levels of family risk with matched treatment strategies proposed.

Clinical/treatment: top of the pyramide are families with more severe problems and few resources (10%). HIGH RISK FACTORS. consult behavioral health specialist.

Targeted: some pre-existing risk factors and moderate resources. Intervention approach: reduce symptoms (pain, anxiety etc.)

Universal: majority of families. The intervention approach: basic psychosocial care (education, resources, assistance) They are distressed but resilient.

Question 17

The psychosocial assessment tool (PAT)

Answer 17

A brief parent report screener based on social ecological theory which maps on to the PPPHM and generates a trivial classification of families into universal, targeted or clinical risk.

It is advantage to screen with the PAT within 48h of a childs diagnosis.

Question 18

Cause of childhood cancer

Answer 18

The reason are unknown but it is NOT caused by behavioral factors but PRESIDPOSING factors: chromosomal abnormality, radiation, toxic chemicals, genetic, environmental and immune factors.

Pediatric cancers are more curable

Question 19

Leukemia

Answer 19

2nd most frequent

• Bone marrow that produces white blood cell tissue is affected.
• White blood cells rises rapidly
• Healthy red blood cells, thrombocytes and white blood cells production decrease.

Question 20

Non-hodgkin

Answer 20

Lymphoid tissue outside the bone marrow is affected

Question 21

Hodkin

Answer 21

lymph nodes are affected

Question 22

Central nervous system tumors

Answer 22

• Most frequent

- Brain and spinal cord tumors

Question 23

Psychological problems during and after treatment

Answer 23

• telling the diagnosis
• The reaction of the parents, family
• The siblings
• Getting into the hospital
• Getting out from the everyday life environment
• Illness awareness, regression
• Symbolic relationships with the parents
• Seing other children being sick
• Drastic reduction of peer relations

Question 24

Behavioral therapies (in the hospital)

Answer 24

Goal: reduce distress, ease nausea and vomitting, pain management, strengthen cooperation

Form: distraction techniques, autogenic training, hypnosis, emotive imagination, role change

Question 25

Play therapy (in hospital)

Answer 25

Basic tool for communication, symbolic experience and emotion sharing, help socialization and adaption

Question 26

Death consciousness of children

Answer 26

3-5 y: death is reversible, appears in the form of separation anxiety

5-9y: they can imagine it

9y: same death consciousness as adults.