Living beyond cure. Transcending survival

Improving the Quality of Life for Children with Cancer

There are now more than one million new cases of cancer every year in the European Community (EC) including the children to whom particular needs should be addressed. Besides the disease-free survival other outcomes reflecting the impact of treatment on the patient and their families must also be assessed and include their physical, psychological and social functioning throughout their care: during therapy, after completion of treatment or, for some, in the terminal phase of their illness. To provide optimal care and thus improve the quality of life for these children needs:

a) an appropriately structured Paediatric Cancer Unit;

b) well trained and permanent staff members: comprising doctors, nurses, psychologists, social workers and other health care professionals;

c) facilities such as a specific out-patient clinic, a hospital school, a residence for parents;

d) a well defined programme for the terminally ill children;

e) a well defined programme for controlling the late effects of therapy.

Developing a Scale to Measure Parental Worry and Their Attitudes Toward Childhood Cancer After Successful Completion of Treatment

The purpose of this study is to develop and evaluate the psychometric characteristics of a scale designed to measure parents’ attitude toward childhood cancer after treatment has ended. In this study, the 2 theoretical frameworks (theory of attitude and theory of worry) were used as they related to the study. An attitude is an idea charged with negative or positive emotion, directed to a psychological object, such as cancer. A sample of 84 White, middle class, American parents (n = 49 mothers, n = 35 fathers) of 51 childhood cancer survivors, whose treatment ended between 1988 and 2005, was surveyed between November 2005 and February 2006. Two factors were extracted using principal component analysis with oblique rotation. Cronbach’s alpha reliability for Factor 1 was .91 and for Factor 2 was .76. This study suggests that most parents of cancer survivors tend to perseverate, ruminating on the idea that their child’s cancer will return; as a result, they remain in a heightened state of alertness and develop uncontrollable thoughts, or inconsolable worry, about the recurrence of the disease.

Antiangiogenesis: the fifth cancer treatment modality?

PURPOSE/OBJECTIVES

To describe the biologic process of angiogenesis and the potential role of antiangiogenesis therapy in cancer treatment.

DATA SOURCES

Published articles, conference proceedings, and computerized databases.

DATA SYNTHESIS

Angiogenesis is the development of blood vessels. Antiangiogenic agents prevent the development of blood vessels, therefore preventing one mode of cancer metastasis. Clinical trials must be conducted to ascertain the most powerful antiangiogenic therapies. Trials combine chemotherapy, biotherapy, and radiotherapy with antiangiogenic therapy.

CONCLUSIONS

Information from animal studies has revealed that antiangiogenesis is a viable option in treating cancer and preventing metastasis. Although human studies are rare, preliminary results are promising, especially when antiangiogenesis is used in combination with current cancer treatment modalities.

IMPLICATIONS FOR NURSING

Nurses are in a unique position to teach patients about new treatments for cancer. Nurses must be knowledgeable about angiogenesis and the availability of potential antiangiogenesis agents. Nurses will be vital in collecting data in clinical trials, considering the subjective data that will be obtained.

Marriage in the survivors of childhood cancer: a preliminary description from the Childhood Cancer Survivor Study

BACKGROUND

The goal of this paper is to provide a preliminary description of the marital status for a large number of childhood cancer survivors participating in the Childhood Cancer Survivor Study (CCSS).

PROCEDURE

This report includes children and adolescents (< 21 years of age) diagnosed with cancer between 1970 and 1986 at 25 oncology centers in the United States and Canada who survived at least 5 years from diagnosis. Self-reported data from 10,425 survivors are used in this preliminary descriptive summary. The proportion of survivors ever married and divorced/separated is compared to the U.S. population according to age-specific groups. The median age of the survivor population at diagnosis was 7 years and 26 years at the time martial status was ascertained. Excluded from this assessment are children < 15 years of age at the time of study, those whose martial status was unknown, and those married prior to diagnosis. Data for marital status of the U.S. population, as tabulated in the Bureau of Census 1995 Update, is used as a general comparison to the survivor population.

RESULTS

Overall, 32% of the survivors reported being married or living as married, 6% being divorced or separated, 0% being widowed, and 62% having never been married. In general, compared to the U.S. population, survivors were less likely to have ever married, particularly females and whites, but, once married, were less likely to divorce/separate, again particularly females and whites. Black survivors were generally found to be more likely to have married, with males and blacks more likely to divorce/separate once married. Comparison of childhood tumor types suggested that survivors of CNS tumors, particularly males, were less likely to have ever married and more likely to divorce/separate compared to those with other cancer diagnoses and the general U.S. population.

CONCLUSIONS

This interim evaluation of the CCSS cohort provided preliminary data describing a suggested decreased likelihood of marriage, which may be influenced by gender and/or race. These patterns must be confirmed within the entire CCSS cohort and comparisons made with an appropriate sibling comparison group before making final conclusions.

Positive and negative psychosocial sequelae of bone marrow transplantation: implications for quality of life assessment

Life-threatening disease can trigger positive effects such as greater appreciation for life and enhanced interpersonal relationships. Little research has examined these salutary effects or their association with quality of life (QOL). Adult bone marrow transplantation (BMT) survivors (n = 90) were interviewed regarding psychosocial sequelae of BMT and completed indices of QOL and psychological adjustment. Thematic analysis was used to code interview responses into discrete categories of negative and positive sequelae. Multiple regression analyses indicated POSTOTAL scores were inversely associated with time post-BMT and positively associated with negative prognostic factors at BMT. Scores on indices of QOL and psychological adjustment were significantly correlated with reports of negative post-BMT sequelae but unrelated to positive sequelae. It was concluded that life-threatening disease can trigger positive sequelae that can contribute to QOL. However, standard QOL indices may not measure this positive QOL dimension, thus yielding a potentially incomplete picture of current QOL.

Pediatric Clinical Trials

Clinical trials specifically tailored to the unique tumors and leukemias of children have resulted in increased survival rates approaching or exceeding 70% for most diseases. These studies have been carried out by investigators at large, independent institutions or through the auspices of the Children's Cancer Group or Pediatric Oncology Group. The National Cancer Institute has also supported pediatric disease—focused efforts for rhabdomyosarcoma, Wilms tumor, Ewing's sarcoma, osteosarcomas and other diseases. The present-day training of pediatric hematology/oncology fellows assures continuing contributions to the biology of childhood malignant lesions through applications of translational research.

Future life expectations and self-esteem of the adolescent survivor of childhood cancer

The number of adolescent cancer survivors has increased dramatically over the past decade as the result of improved treatment and diagnostic techniques. This population brings with them unique characteristics and concerns. The present study consisted of interviews with 10 adolescent survivors of childhood cancer and their parents. It investigated the adolescent's present self-esteem, the future life expectations held by both the teenagers and parents, and the relationship between the variables. Results indicated that the adolescents felt moderately competent in their lives (measures of self-esteem) and the parents felt more certain than their children that the teenagers would accomplish the tasks deemed appropriate for entry into a healthy adulthood. Pearson correlations showed a strong relationship between parents' future life expectations and adolescents' self-esteem (r = .82; P = .002), but not between parents' and adolescents' future life expectations or between the adolescents' future life expectations and self-esteem. The results are significant in addressing the impact parents can have on their child's self-esteem.

Psychologic functioning in 8- to 16-year-old cancer survivors and their parents

This study presents data on psychologic adjustment (self-concept, depression, locus of control, family environment, and parental distress) for a sample of 8- to 16-year-old long-term cancer survivors (n = 138) and their mothers, and for a sample consisting of a matched group of healthy children (n = 92) and their mothers. The null hypothesis of no group differences between survivors and control subjects was tested with respect to these variables. It was hypothesized that survivors with severe late effects would have poorer self-concepts, a more external locus of control, and more depressive symptoms than children with no or mild-to-moderate late effects. The children completed the Piers-Harris Self-Concept Scale, the Nowicki-Strickland Locus of Control Scale, and the Children's Depression Inventory. Mothers completed the Family Environment Scale and the Derogatis Stress Profile. The majority of former patients are functioning within normative limits on these standardized measures, although their scores were lower than those in the comparison group. One-way analyses of variance on the dependent measures indicate that the children with severe medical late effects have a poorer total self-concept, more depressive symptoms, and a more external locus of control than those with no or mild-to-moderate late effects. Therapies for childhood cancer are now well standardized and many long-term deleterious effects are known, so children at risk can be identified readily and steps taken early in treatment to prevent or mitigate future psychologic problems.