Psychosocial Aspects of Pediatric Oncology
http://www.100md.com
《新英格兰医药杂志》
In this monograph, the editors have brought together 17 contributions that describe the intertwining medical, psychological, and social aspects of the study and care of children with cancer. In many ways it is an update and extension of Bearison and Mulhern's textbook, Pediatric Psychooncology (New York: Oxford University Press, 1994), in that it covers many of the same topics with some of the same authors. However, the contributors to the new book represent several nations, primarily Israel, whereas the Bearison and Mulhern book is written strictly by U.S. authors. As a result, the considerable overlap among the chapters allows the reader to recognize interesting international differences in thought and practice in regard to meeting the psychosocial needs of children with cancer and their families.
For example, a chapter by a U.S. author states that more than half of children with progressive cancer die at home, whereas an Israeli contribution indicates that only rarely does the death of the child occur at home. Also, some authors leave it to the parents to decide whether or not the child should be told the diagnosis and prognosis. For me, the critical need for honesty with children was confirmed 40 years ago by Vernick and Karon in their landmark paper, "Who's Afraid of Death on a Leukemia Ward?" (American Journal of Diseases of Children 1965;109:393). Currently, in the United States, clinicians need to obtain informed consent of children older than seven years of age to register them in cancer studies, which leaves no option but candor. This entails patient, tactful discussion among the health care team, the child, and the family so that all can communicate openly.
This book contains many outstanding discussions that are valuable to all who care for children with cancer. The chapters by Wolfe et al. on palliative care, Hain on pain control, and Postovsky and Ben Arush on "do not attempt to resuscitate" offer especially practical and useful information. Highly illuminating to me were the chapters on the role of fantasy, art therapies, humor, and pets and on complementary and alternative therapies. The lengthy, well-organized, detailed review of the measurement of the quality of life in children deserves to become a standard reference.
Most representative of quantitative science is the chapter by Mulhern and colleagues on the neuropsychological sequelae of childhood cancer and its treatment. This chapter is based on a review of the literature and the extensive clinical studies that have been conducted at St. Jude Children's Research Hospital since 1970 — the year we recognized that acute lymphoblastic leukemia was no longer an incurable disease.
Some general statements in the introduction need to be modified. The first sentence says that cancer is the leading cause of death from disease in children past the neonatal period. Worldwide, malnutrition and infectious disease cause far more deaths. A later statement names osteosarcoma rather than Wilms' tumor of the kidney as the model for adjuvant chemotherapy. Finally, for the rising cure rates among children with cancer during the past 40 years, one must credit not just drug sensitivity and cooperative clinical trials, as the authors say, but also chemists at pharmaceutical companies and those who studied their drugs singly, in combination, and in strategic combinations with other treatment methods.
Reading this book evoked memories for me, such as the child in whom I diagnosed acute lymphoblastic leukemia during the first month of my pediatric internship in 1951. The kindly professor of child psychiatry joined me to help inform the parents of the diagnosis and the prognosis of a fatal outcome. Despite this expert help, the parents were inconsolable. It was apparent that reasonable hope for cure would have been the most valuable psychosocial intervention.
Currently, only a minority of the world's children with cancer have access to curative therapy. The progress in the provision of psychosocial services and the adoption of ever more elaborate and expensive treatment regimens further widen the gap between the care of that minority and the care of the majority, who lack access to curative therapy. How can we narrow this gap? This question resolves to another question, of how we can influence people to choose national leaders who are peacemakers instead of warriors. With the tremendous human, material, and financial resources that are being wasted now by war and its aftermath, we could eventually provide adequate medical and psychosocial care, as well as nutrition, shelter, safety, and control of infection, for all the world's children, not just those with cancer.
On a final note, this monograph is fittingly dedicated to the memory of the late grandson of Drs. Jim and Jimmy Holland, a couple whose dedication and contributions to the care of people with cancer during the past half-century continue.
Donald Pinkel, M.D.
California Polytechnic State University
San Luis Obispo, CA 93407
donpinkel@yahoo.com(Edited by Shulamith Kreit)
For example, a chapter by a U.S. author states that more than half of children with progressive cancer die at home, whereas an Israeli contribution indicates that only rarely does the death of the child occur at home. Also, some authors leave it to the parents to decide whether or not the child should be told the diagnosis and prognosis. For me, the critical need for honesty with children was confirmed 40 years ago by Vernick and Karon in their landmark paper, "Who's Afraid of Death on a Leukemia Ward?" (American Journal of Diseases of Children 1965;109:393). Currently, in the United States, clinicians need to obtain informed consent of children older than seven years of age to register them in cancer studies, which leaves no option but candor. This entails patient, tactful discussion among the health care team, the child, and the family so that all can communicate openly.
This book contains many outstanding discussions that are valuable to all who care for children with cancer. The chapters by Wolfe et al. on palliative care, Hain on pain control, and Postovsky and Ben Arush on "do not attempt to resuscitate" offer especially practical and useful information. Highly illuminating to me were the chapters on the role of fantasy, art therapies, humor, and pets and on complementary and alternative therapies. The lengthy, well-organized, detailed review of the measurement of the quality of life in children deserves to become a standard reference.
Most representative of quantitative science is the chapter by Mulhern and colleagues on the neuropsychological sequelae of childhood cancer and its treatment. This chapter is based on a review of the literature and the extensive clinical studies that have been conducted at St. Jude Children's Research Hospital since 1970 — the year we recognized that acute lymphoblastic leukemia was no longer an incurable disease.
Some general statements in the introduction need to be modified. The first sentence says that cancer is the leading cause of death from disease in children past the neonatal period. Worldwide, malnutrition and infectious disease cause far more deaths. A later statement names osteosarcoma rather than Wilms' tumor of the kidney as the model for adjuvant chemotherapy. Finally, for the rising cure rates among children with cancer during the past 40 years, one must credit not just drug sensitivity and cooperative clinical trials, as the authors say, but also chemists at pharmaceutical companies and those who studied their drugs singly, in combination, and in strategic combinations with other treatment methods.
Reading this book evoked memories for me, such as the child in whom I diagnosed acute lymphoblastic leukemia during the first month of my pediatric internship in 1951. The kindly professor of child psychiatry joined me to help inform the parents of the diagnosis and the prognosis of a fatal outcome. Despite this expert help, the parents were inconsolable. It was apparent that reasonable hope for cure would have been the most valuable psychosocial intervention.
Currently, only a minority of the world's children with cancer have access to curative therapy. The progress in the provision of psychosocial services and the adoption of ever more elaborate and expensive treatment regimens further widen the gap between the care of that minority and the care of the majority, who lack access to curative therapy. How can we narrow this gap? This question resolves to another question, of how we can influence people to choose national leaders who are peacemakers instead of warriors. With the tremendous human, material, and financial resources that are being wasted now by war and its aftermath, we could eventually provide adequate medical and psychosocial care, as well as nutrition, shelter, safety, and control of infection, for all the world's children, not just those with cancer.
On a final note, this monograph is fittingly dedicated to the memory of the late grandson of Drs. Jim and Jimmy Holland, a couple whose dedication and contributions to the care of people with cancer during the past half-century continue.
Donald Pinkel, M.D.
California Polytechnic State University
San Luis Obispo, CA 93407
donpinkel@yahoo.com(Edited by Shulamith Kreit)