RESUMEN
To provide the standard of psychosocial care for children with cancer and hematological disorders and their families, multidisciplinary teams must clearly define their scope and collaborate in ways that optimize the quality and efficiency of care. A new organizational structure was leveraged to delineate roles and scope for each psychosocial discipline at our institution. We developed a document, the scope of psychosocial care (SPC), that serves as a platform for making patient care decisions and provides opportunities for the reevaluation of programming. Herein, we present the process and outcome of the SPC and make recommendations for identifying roles in pediatric psychosocial hematology-oncology.
Asunto(s)
Enfermedades Hematológicas , Hematología , Neoplasias , Rehabilitación Psiquiátrica , Niño , Enfermedades Hematológicas/terapia , Humanos , Oncología Médica , Neoplasias/terapiaRESUMEN
OBJECTIVE: To investigate the feasibility of a computer-based reading intervention completed by patients diagnosed with a brain tumor. METHODS: Patients were randomized to the intervention (n = 43) or standard of care group (n = 38). The intervention consisted of 30 sessions using Fast ForWord® exercises in a game-like format. Change in reading decoding scores over time since diagnosis was examined. Gender, race, parent education, parent marital status, and age at diagnosis were examined as covariates. RESULTS: 17 patients (39.5%) were able to complete the target goal of 30 intervention sessions. Females had significantly greater training time than males (p = .022). Age at diagnosis was associated with average training time/session for females (r = .485, p = .041). No significant differences were found in reading scores between the randomized groups. CONCLUSIONS: The study was well accepted by families and adherence by patients undergoing radiation therapy for medulloblastoma was moderate. Suggestions for improved methodology are discussed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Encefálicas/terapia , Irradiación Craneana/efectos adversos , Dislexia Adquirida/prevención & control , Meduloblastoma/terapia , Terapia Asistida por Computador , Adolescente , Factores de Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/psicología , Neoplasias Encefálicas/radioterapia , Niño , Preescolar , Terapia Combinada , Dislexia Adquirida/etiología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Meduloblastoma/tratamiento farmacológico , Meduloblastoma/psicología , Meduloblastoma/radioterapia , Calidad de Vida , Lectura , Factores Sexuales , Resultado del Tratamiento , Adulto JovenRESUMEN
Adolescent and young adult survivors of posterior fossa tumors face a wide variety of functional challenges following treatment. The concept of survival needs to include plans to regularly monitor and effectively respond to those patients considered at risk for continued morbidities associated with cancer and its treatment. The nature of impairment experienced by survivors is discussed, including predominant patient- and treatment-related risk factors. A model to respond to the cognitive needs of survivors, including risk-based evaluation and intervention, is proposed. It is imperative for the success of the survivor that a team approach is taken to care. This approach must include improving the awareness and education of teachers and other education specialists who interact with this population of survivors. There is also an obligation to put forth effort in developing and validating efficacious intervention programs.
Asunto(s)
Trastornos del Conocimiento/etiología , Neoplasias Infratentoriales/complicaciones , Neoplasias Infratentoriales/terapia , Educación del Paciente como Asunto , Calidad de Vida , Sobrevivientes/estadística & datos numéricos , Adaptación Psicológica , Adolescente , Factores de Edad , Quimioterapia Adyuvante , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/fisiopatología , Terapia Combinada , Detección Precoz del Cáncer , Femenino , Humanos , Neoplasias Infratentoriales/diagnóstico , Neoplasias Infratentoriales/psicología , Masculino , Estadificación de Neoplasias , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Pronóstico , Radioterapia Adyuvante , Medición de Riesgo , Gestión de Riesgos , Factores Sexuales , Perfil de Impacto de Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
Children surviving treatment for malignant brain tumors commonly have problems maintaining their premorbid levels of intellectual development and academic achievement. Our group has been especially interested in the effects of treatment on normal appearing white matter (NAWM) on MRI and the influence of NAWM volumes on neurocognitive functioning. The present study assessed NAWM and attentional abilities among 37 long-term survivors of malignant brain tumors, ranging in age from 1.7 to 14.8 (Mdn = 6.5) years at diagnosis, who had been treated with cranial radiation therapy with or without chemotherapy 2.6 to 15.3 (Mdn = 5.7) years earlier. On the Conners' Continuous Performance Test, the Overall Index and 7 of the other 10 indices were significantly deficient compared to age- and gender-corrected normative values. After statistically controlling for the effects of age at diagnosis and time elapsed from treatment, 5 of the 8 indices were significantly associated with cerebral white matter volumes and/or specific regional white matter volumes of the prefrontal/frontal lobe and cingulate gyrus. No gender effects were observed. The results of the present study further support the contention that NAWM is an important substrate for treatment-induced neurocognitive problems among survivors of malignant brain tumors of childhood.
Asunto(s)
Atención/fisiología , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/patología , Encéfalo/patología , Encéfalo/fisiopatología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Adolescente , Niño , Preescolar , Trastornos del Conocimiento/diagnóstico , Supervivencia sin Enfermedad , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Tiempo de ReacciónRESUMEN
BACKGROUND: The primary objective of this study was to test the hypothesis that, among survivors of pediatric brain tumors, the association between reduced volumes of normal-appearing white matter (NAWM) and intellectual/academic achievement deficits can be explained by patient problems with memory and attention. METHODS: Quantitative tissue volumes from magnetic resonance imaging scans and neurocognitive assessments were obtained for 40 long-term survivors of pediatric brain tumors. They were treated with radiotherapy (RT) with or without chemotherapy 2.6-15.3 years earlier (median, 5.7 years) at an age of 1.7-14.8 years (median, 6.5 years). Neurocognitive assessments included standardized tests of intellect (intelligence quotient [IQ]), attention, memory, and academic achievement. RESULTS: Analyses revealed significant impairments in patients' neurocognitive test performance on all measures. After statistically controlling for age at RT and time from RT, significant associations were found between NAWM volumes and both attentional abilities and IQ, and between attentional abilities and IQ. Subsequent analyses supported the hypothesis that attentional abilities, but not memory, could explain a significant amount of the relationship between NAWM and IQ. The final developmental model predicting academic achievement based on NAWM, attentional abilities, and IQ explained approximately 60% of the variance in reading and spelling and almost 80% of the variance in math. CONCLUSIONS: The authors demonstrated that the primary consequence of reduced NAWM among pediatric patients treated for brain tumors was decreased attentional abilities, leading to declining IQ and academic achievement.