What is Leukemia? Most common childhood malignancy Acute lymphoblastic leukemia (ALL) Acute nonlymphoblastic leukemia (ANLL) Acute myelogenous leukemia (AML)
Brain Tumors 2 nd most common type of cancer 1200 US cases diagnosed/year Described in terms of: Metastasis (M stage) Size of tumor (T stage)
Brain Tumors Terminal to curable Neuropsychological impact varies based on: Location, size, tumor type Type of treatment Disease of complications Patient factors Social factors
Medical Treatment Radiation Chemotherapy Surgery Most cancers considered CURED if no relapse in 5 years.
Bone Marrow Transplantation Aggressive treatment for malignancies Give near-lethal doses of chemotherapy or radiation Replace dead cells with transplanted healthy cells Autologous vs. Allogenic
Stages of BMT Donor search & initial evaluation Preparative treatment Bone marrow infusion
Stages of BMT Severe neutropenia Engraftment Graft-versus-Host disease Follow-up
Phases of Cancer Diagnosis Initiation of treatment Remission or illness stabilization Completion of medical therapy Long-term survival and cue vs. Relapse or deterioration Terminal illness & death Post-death adjustment of family
Diagnosis Address emotional reaction Evaluate family understanding Determine financial resources Financial Social
Diagnosis Communication with others What to tell the child? 1. Go slowly 2. Encourage questions 3. Convey hope 4. Establish trust 5. Gauge details to developmental ability
Treatment Disruption of life Complex treatment schedules Feeling poorly Reaction of others Maintain contact with school
Relapse & Recurrence Occurs in 40-50% of pediatric oncology patients May be harder emotionally than initial diagnosis Re-learn basic info Experimental treatments, etc.
Terminal Illness & Death Communication issues What do children know about “death?” What do children fear about “death?” How can parents discuss the child’s own death with him/her?
Children’s Understanding of Death Ages 3-5Some understanding Ages 6-8Understand that death is irrevocable & universal Ages 9+Recognize cause of death; have mature conception of death
Common Fears of Death Fear of pain Fear of being alone Fear of the unknown Fear of disappointing parents Fear of leaving others behind
Parents Talking to their Children about Death Concerns Will it lead to difficulty coping after the child’s death? Will it interfere with the child’s sense of hope? Will it impact the child’s medical care?
Parents Talking to their Children about Death What can they say? Answer questions honestly Give the child permission to cry, be angry, or be sad Tell children that adults do not understand death Reassure child that loss is never complete
Preparing for Death Anticipatory grieving Preparation for death Hospice care
After child’s death… Mourning Support groups