[Neurocognitive outcome in childhood brain tumor survivors]

[Ethical issues in long-term follow-up of pediatric cancers]

INTRODUCTION

Advances in knowledge about late effects of childhood cancer treatments have led to implement long-term follow-up care. This raises the question of the ethical issues involved in providing information to survivors, and in proposals for long-term follow-up consultations.

METHOD

We conducted a two-part qualitative study: (1) A semi-directive interview survey to explore survivors' experiences of medical proposals for follow-up consultations; (2) The creation of a multidisciplinary ethical reflection group aimed at identifying the ethical issues associated with the systematization of follow-up care.

RESULTS

The study identified five key issues related to medical requests and the implementation of follow-up care: (1) The needs and expectations of former patients regarding information; (2) The temporality of after-cancer; (3) The ambivalence of categorizations in light of the diversity of post-cancer experiences; (4) The role of various professionals and the responsibility for follow-up; (5) The plurality of needs and proposed approaches.

DISCUSSION

In light of these issues, five areas of concern emerge: (1) Provide information about a risk in life after the disease? (2) When should follow-up be proposed? (3) The category of "former patients": relevant or problematic? (4) Who can or should assume the role and responsibility for follow-up? (5) The diversity of follow-up approaches: balancing standardization with reliance on informal networks.

Consultations de suivi à long terme d’adultes guéris d’un cancer survenu dans l’enfance : vécus traumatiques et travail de narration. Récits dans l’après-coup de la maladie

Dans le cadre du dispositif de suivi médical destiné aux adultes guéris d'un cancer pédiatrique à l'Institut Gustave-Roussy (Villejuif, France), un entretien psychologique est proposé. Cet article s'appuie sur 198 entretiens auprès de patients ayant entre 18 et 67 ans, diagnostiqués entre 0 et 24 ans. Ces rencontres donnent à entendre la subjectivité du vécu du cancer et de la guérison, révélant les traces de cette expérience dans l'après-coup. Les enjeux de l'activité narrative amorcée dans le cadre de cette consultation, et pouvant se poursuivre au-delà, sont abordés dans une perspective métapsychologique.

What do you need to learn in paediatric psycho-oncology?

Paediatric psycho-oncology is an evolving speciality and is increasingly being recognised as an essential component in children's cancer care. Modern paediatric oncology services aspire to integrate physical care with psycho-social care and build capacity within clinical teams to address the emotional needs of parents and children side by side with other aspects of medical care. This article discusses the unique challenges of paediatric psycho-oncology and common situations where psychological assessment and management of children and young people with cancer become especially important. The authors propose a tiered structure of training. Providing empathic evidence-based psycho-social care is 'everyone's business' in paediatric oncology and not merely that of mental health professionals. However, there are times when a more specialist intervention by a paediatric liaison psychiatrist and/or a clinical psychologist is needed for optimum outcome. Learning interviewing techniques suitable for children and adolescents should be a core part of the training in paediatric psycho-oncology. Professionals should be encouraged to reflect on their own emotional wellbeing, which in turn will provide a stable foundation of emotionally matured care to children, young people and their families.