Treatment FAQ

what are hospitals doing for pediactric cancer psychosocial treatment and neurocognitive funtuins

by Maybell O'Conner Published 3 years ago Updated 2 years ago
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How can psychosocial research help pediatric cancer survivors?

Conclusions As the numbers of pediatric cancer survivors increase, psychosocial researchers will be better able to conduct longitudinal studies not only of adjustment and its predictors but also of the impact of the emerging medical treatments and interventions to ameliorate late effects of treatment.

What do physicians and nurses know about psychosocial issues in pediatric oncology?

Objective: The purpose of this study was to investigate physicians' and nurses' perceptions of psychosocial issues in pediatric oncology including their awareness of the psychosocial impact of childhood cancer on families and their knowledge and views of psychosocial interventions.

Can the children’s Oncology Group be used to study psychosocial outcomes?

There have been to date relatively few studies on psychosocial (i.e., nonneuropsychological) outcomes conducted within the framework of the Children’s Oncology Group. As a result, it is often faster and easier to form informal, limited institutional collaborations to try to answer psychosocial questions of interest.

How can mental health staff help children with cancer?

The presence of mental health staff also fostered an awareness of cancer’s impact on the whole family, including parents and siblings as well as the child with cancer. Over the past 30 years, it was the courage of many parents and physicians in pursuing new treatments that led to the resounding improvements in survival for children with cancer.

Why is psychosocial screening important?

How does psychosocial stress affect cancer?

Can cancer affect school?

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Why is psychosocial screening important?

Psychosocial screening is recognized as necessary and important early in treatment to ensure optimal, efficient care and access to evidence-based psychosocial services. Early systematic assessment of psychosocial risks and resources facilitates the delivery of evidence-based psychosocial interventions at critical times over the cancer treatment trajectory. Prompt assessment of the psychosocial risks and needs of families facing pediatric cancer treatment promotes delivery of psychosocial care in a systematic way that addresses the family’s needs while leveraging family resources to reduce distress and improve treatment outcomes including health-related quality of life.

How does psychosocial stress affect cancer?

A large body of research confirms the presence of psychosocial distress and resiliencies of families as they initiate and complete pediatric cancer treatment. Although most families adapt and are able to cope with the stressors associated with a cancer diagnosis and treatment for their child, there are currently many “missed opportunities” for identifying problems for which we have effective preventative or early interventions. If untreated, psychosocial stress has the potential to escalate and impact cancer care and outcomes. For example, psychological factors are important, across cancers, in adherence to treatment and ongoing medical monitoring and health promoting behaviors.

Is pediatric oncology a randomized clinical trial?

In pediatric psycho-oncology, as in the rest of psychological and medical research, there is an increasing interest in evidence-based practice and in randomized clinical trials ( Stinson, McGrath, & Yamada, 2003 ). As survival rates continue to improve, there will be increasing primary interest in psychosocial outcomes in studies of differential medical treatments. As more psychosocial interventions are proposed and tested for use with pediatric cancer survivors, there will be some increased opportunities for using the “gold standard” of empiric scientific research—the randomized clinical trial (RCT). Currently, however, RCTs are rare in pediatric psychology. Stinson et al. (2003) found that about 5% of articles in the Journal of Pediatric Psychology and the Journal of Consulting and Clinical Psychology were reports of pediatric RCTs. Of the 28 studies reviewed, 3 concerned pediatric oncology patients. An accompanying editorial ( Brown, 2003) offered help from senior investigators in the challenge of planning of RCTs and in the priority publication for the results of studies that conform to Consolidated Standards of Reporting Trials guidelines ( Altman et al., 2001; Begg et al., 1996 ). Recent attention toward the use of such guidelines in pediatric research suggests that additional or amended items may be needed in applying these standards to the reporting of psychosocial research ( Davidson et al., in press) and that there may be special challenges in studies using pediatric populations ( Drotar, 2002 ). Use of the guidelines in pediatric journals will, however, have a number of advantages ( McGrath, Stinson, & Davidson, 2003 ), including facilitating the comparison of future studies. As has been pointed out ( Stinson, McGrath, & Yamada, 2003 ), it is important to differentiate clinical significance (i.e., whether there is value to the patient) from statistical significance in the findings from RCTs.

Is pediatric cancer a psychosocial illness?

As the third generation of pediatric psycho-oncologists begins their work, survival of children with cancer is much improved but not ensured. Pediatric cancer remains a life-threatening illness. One area for abundant future work is the development of interventions to address the fear of recurrence, which lingers in many patients despite good psychological functioning. Entering the 21st century, the medical community understands a great deal more about late effects, but there is still much work to be done in understanding the interdependence of physical and psychosocial impact, especially for vulnerable subpopulations, and in developing targeted interventions (see Kazak, 2005 ). Zebrack and Zeltzer (2003) suggest that the current goal in pediatric psycho-oncology research is to define “who might benefit from which intervention when.” As an example, they point to infertility as an area where knowledge of late effects needs much-deeper exploration. They discuss the fact that we have known for many years about the reproductive problems associated with pediatric oncology treatment protocols. Despite this, there is a lack of research about how cancer survivors experience and deal with the resulting infertility and about possible educational interventions that might aid consideration of alternative reproductive technologies. The authors caution, however, that such research would have to include ethical and economic discussion about whether most survivors would have the resources to make use of these technologies.

What are the effects of neurocognitive therapy on PBT?

The late neurocognitive and psychosocial effects of treatment for pediatric brain tumor (PBT) represent important areas of clinical focus and ongoing research. Neurocognitive sequelae and associated problems with learning and socioemotional development negatively impact PBT survivors’ overall health-related quality of life, educational attainment and employment rates. Multiple factors including tumor features and associated complications, treatment methods, individual protective and vulnerability factors and accessibility of environmental supports contribute to the neurocognitive and psychosocial outcomes in PBT survivors. Declines in overall measured intelligence are common and may persist years after treatment. Core deficits in attention, processing speed and working memory are postulated to underlie problems with overall intellectual development, academic achievement and career attainment. Additionally, psychological problems after PBT can include depression, anxiety and psychosocial adjustment issues. Several intervention paradigms are briefly described, though to date research on innovative, specific and effective interventions for neurocognitive late effects is still in its early stages. This article reviews the existing research for understanding PBT late effects and highlights the need for innovative research to enhance neurocognitive and psychosocial outcomes in PBT survivors.

What are the effects of central nervous system tumors?

... Survivors of central nervous system tumors have lower self-reported life satisfaction and health-related quality of life, 7 and are at increased risk for neurocognitive impairments across numerous domains , including executive functioning, processing speed, and academic achievement. [8] [9] [10] [11] These impairments may decrease survivors' ability to participate and learn effectively in distance learning, where they may have fewer educational supports. Social and emotional impairment, including social withdrawal, 12 difficulties with friendships, 13 emotional/affective dysfunction, 12 and depression 8 are also prevalent. ...

What is the best imaging for pediatric brain tumors?

Computed tomography and/or magnetic resonance imaging are critical to the diagnosis of pediatric brain tumors, although surgical resection or biopsy of tissue is usually necessary for definitive histological diagnosis.

Why is CRT used for brain tumors?

For many children with malignant brain tumors, CRT remains a primary therapeutic modality, along with resection and chemotherapy, because of the lack of success of approaches based on chemotherapy alone to preserve survival.

What is cognitive remediation?

Cognitive remediation refers to systematic attempts to improve cognitive functioning following a brain injury ( Butler & Namerow, 1988 ). These methods typically involve massed practice and drill approaches, along with other psychologically based intervention methods. The theoretical basis for cognitive remediation can be traced to the work of Alexander Luria (1963). He proposed that the brain is not a static organ and that functional reorganization of neural pathways can occur after a CNS insult. Cognitive deficits must be analyzed and subdivided into their individual components. Retraining then involves extended practice and overlearning on tasks similar in nature to that of the component deficit. An NIH (1998) consensus statement concluded that while research methods remain somewhat equivocal, there is support for the use of cognitive rehabilitation methods. The clinical validity of these interventions is further advanced by a recent article documenting the effectiveness of remediation efforts to improve attention, memory, functional communication, and executive functioning in adults ( Cicerone et al., 2000 ). A resurgence in the field of cognitive remediation is documented by the publication of five textbooks on this subject within the past half decade ( Christensen & Uzzell, 2000; Prigatano, 1999; Raskin & Mateer, 2000; Sohlberg & Mateer, 2001; Stuss, Winocur, & Robertson, 1999 ). Of note, only three of these texts address rehabilitation issues in the pediatric population, and within each of these three texts only one chapter is devoted to interventions for the brain-injured child.

Is childhood leukemia permanent?

Background It is well recognized that many cures for childhood leukemia and brain tumors entail some relatively permanent neurocognitive and psychological costs to the patient and family. As cure rates have improved over the past three decades, increasing efforts have been directed toward reducing treatment-related late effects.

Is a brain tumor more common in children?

Pediatric brain tumors are considerably more heterogeneous than ALL in that they vary by histology as well as location. Next to ALL, brain tumors are the second most frequently diagnosed malignancy of childhood and are the most common pediatric solid tumor, with an annual incidence of 3.3 per 100,000.

Is CRT a prophylactic treatment?

Pediatric oncologists have been successful in reducing the frequency and severity of neurocognitive impairments associated with CRT as a prophylactic treatment for ALL. Nevertheless, the risk remains significant for those treated with intrathecal chemotherapy ( Moleski, 2000 ). In contrast, CRT remains a curative modality for children with malignant brain tumors. A compromise has been to combine lower doses of CRT with chemotherapy and to attempt to reduce the volume of normal brain irradiated. Ongoing clinical trials are being conducted to determine whether these treatment alterations will result in decreased neurocognitive dysfunction.

Background

A high proportion of pediatric patients with brain tumors (BTs) are known to experience a decline in neurocognitive function after treatment. We prospectively examined neuropsychological functioning of patients with BTs of varying tumor types at different time points before, during, and after proton beam therapy.

Materials and methods

A total of 98 patients with posterior fossa tumors (PFTs; n = 33), germ cell tumors (GCTs; n = 52), and other supratentorial tumors (STTs; n = 13) underwent baseline neuropsychological assessments and 57 patients underwent follow-up assessments.

Results

All groups displayed significantly lower performance intelligence quotient (PIQ) and processing speed (PS) scores than the normative means at baseline. The PFT group exhibited significantly lower scores for full-scale IQ, PIQ, PS, attention, and executive function.

Conclusion

Because patients with BTs exhibit various types of neurocognitive deficit before radiotherapy, early cognitive treatment tailored to the tumor type maybe beneficial. Interventions for psychological problems and memory function may be necessary, especially for patients with GCT.

Why is psychosocial screening important?

Psychosocial screening is recognized as necessary and important early in treatment to ensure optimal, efficient care and access to evidence-based psychosocial services.

How does psychosocial stress affect cancer?

If untreated, psychosocial stress has the potential to escalate and impact cancer care and outcomes. For example, psychological factors are important, across cancers, in adherence to treatment and ongoing medical monitoring and health promoting behaviors.

Can cancer affect school?

Although many families adjust to post-treatment life with strength and success, the physical, neurocognitive, and psychosocial consequences of cancer treatment can make it difficult to return to school, impair neurocognitive functioning, and impact family functioning.

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Abstract

Communication and Consent

Physical Symptoms and Distress During and After Treatment

Psychological Adjustment

Coping and Adaptation

Populations at Particular Risk

Methodological Difficulties in Pediatric Psycho-Oncology Research

Measurement Challenges

Discussion

  • Directions for Future Research
    We are still at the beginning, perhaps at the end of the beginning, of our understanding of psychosocial aspects of childhood cancer. As the third generation of pediatric psycho-oncologists begins their work, survival of children with cancer is much improved but not ensured…
  • Future Opportunities
    Evidence for the importance of continued work relating to psychosocial concerns of survivors of pediatric malignancy comes from the findings of two recent reports. First, the “National Action Plan for Childhood Cancer” (Arceci et al., 2002) recommends increased and improved screening…
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Conclusion

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