• Title, Summary, Keyword: Childhood cancer

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Trends in Survival of Childhood Cancers in a University Hospital, Northeast Thailand, 1993-2012

  • Wongmeerit, Phunnipit;Suwanrungruang, Krittika;Jetsrisuparb, Arunee;Komvilaisak, Patcharee;Wiangnon, Surapon
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.7
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    • pp.3515-3519
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    • 2016
  • Background: In Thailand, a national treatment protocol for childhood leukemia and lymphoma (LL) was implemented in 2006. Access to treatment has also improved with the National Health Security system. Since these innovations, survival of childhood LL has not been fully described. Materials and Methods: Trends and survival of children under 15 with childhood cancers diagnosed between 1993 and 2012 were investigated using the hospital-based data from the Khon Kaen Cancer Registry, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Childhood cancers were classified into 12 diagnostic groups, according to the ICCC based on the histology of the cancer. Survival rates were described by period, depending on the treatment protocol. For leukemias and lymphomas, survival was assessed for 3 periods (1993-99, 2000-5, 2006-12) while for solid tumors it was for 2 periods (before and after 2000). The impacts of sex, age, use of the national protocol, and catchment area on leukemia and lymphoma were evaluated. Overall survival was calculated using the Kaplan-Meier method while the Cox proportional hazard model was used for multivariate analysis. Trends were calculated using the R program. Results: A total of 2,343 childhood cancer cases were included. Survival for acute lymphoblastic leukemia (ALL) from 1993-9, 2000-5, and 2006-12 improved significantly (43.7%, 64.6%, and 69.9%). This was to a lesser extent true for acute non-lymphoblastic leukemia (ANLL) (28.1%, 42.0%, and 42.2%). Survival of non-Hodgkin lymphoma (NHL) also improved significantly (44%, 65.5%, and 86.8%) but not for Hodgkin disease (HD) (30.1%, 66.1%, and 70.6%). According to multivariate analysis, significant risk factors associated with poor survival in the ALL group were age under 1 and over 10 years, while not using the national protocol had hazard ratios (HR) of 1.6, 1.3, and 2.3 respectively. In NHL, only non-use of national protocols was a risk factor (HR 3.9). In ANLL and HD, none of the factors influenced survival. Survival of solid tumors (liver tumors, retinoblastomas) were significantly increased compared to after and before 2000 while survival for CNS tumors, neuroblastoma and bone tumors was not changed. Conclusions: The survival of childhood cancer in Thailand has markedly improved. Since implementation of national protocols, this is particularly the case for ALL and NHL. These results may be generalizable for the whole country.

Socio-economic Status Plays Important Roles in Childhood Cancer Treatment Outcome in Indonesia

  • Mostert, Saskia;Gunawan, Stefanus;Wolters, Emma;van de Ven, Peter;Sitaresmi, Mei;van Dongen, Josephine;Veerman, Anjo;Mantik, Max;Kaspers, Gertjan
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.6491-6496
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    • 2012
  • Background: The influence of parental socio-economic status on childhood cancer treatment outcome in low-income countries has not been sufficiently investigated. Our study examined this influence and explored parental experiences during cancer treatment of their children in an Indonesian academic hospital. Materials and Methods: Medical charts of 145 children diagnosed with cancer between 1999 and 2009 were reviewed retrospectively. From October 2011 until January 2012, 40 caretakers were interviewed using semi-structured questionnaires. Results: Of all patients, 48% abandoned treatment, 34% experienced death, 9% had progressive/relapsed disease, and 9% overall event-free survival. Prosperous patients had better treatment outcome than poor patients (P<0.0001). Odds-ratio for treatment abandonment was 3.3 (95%CI: 1.4-8.1, p=0.006) for poor versus prosperous patients. Parents often believed that their child's health was beyond doctor control and determined by luck, fate or God (55%). Causes of cancer were thought to be destiny (35%) or God's punishment (23%). Alternative treatment could (18%) or might (50%) cure cancer. Most parents (95%) would like more information about cancer and treatment. More contact with doctors was desired (98%). Income decreased during treatment (55%). Parents lost employment (48% fathers, 10% mothers), most of whom stated this loss was caused by their child's cancer (84% fathers, 100% mothers). Loss of income led to financial difficulties (63%) and debts (55%). Conclusions: Treatment abandonment was most important reason for treatment failure. Treatment outcome was determined by parental socio-economic status. Childhood cancer survival could improve if financial constraints and provision of information and guidance are better addressed.

Parents' and Health-Care Providers' Perspectives on Side-Effects of Childhood Cancer Treatment in Indonesia

  • Gunawan, Stefanus;Wolters, Emma;Dongen, Josephine Van;De Ven, Peter Van;Sitaresmi, Mei;Veerman, Anjo;Mantik, Max;Kaspers, Gertjan;Mostert, Saskia
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3593-3599
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    • 2014
  • Background: Efficacy of childhood cancer treatment in low-income countries may be impacted by parents' and health-care providers' perspectives on chemotherapy-related side-effects. This study explores prevalence and severity of side-effects in childhood cancer, and compares health beliefs about side-effects between parents and health-care providers, and between nurses and doctors in Indonesia. Materials and Methods: Semi-structured questionnaires were filled in by 40 parents and 207 health-care providers in an academic hospital. Results: Parents exporessed a desire to receive more information about side-effects (98%) and worried about this aspect of treatment (90%), although side-effects were less severe than expected (66%). The most frequent was behavior alteration (98%) and the most severe was hair loss. Only 26% of parents consulted doctors about side-effects. More parents, compared to health-care providers, believed that medicines work better when side-effects are more severe (p<0.001), and accepted severe side-effects (p=0.021). More health-care providers, compared to parents, believed that chemotherapy can be stopped or the dosage altered when there are side-effects (p=0.011). More nurses, compared to doctors, stated that side-effects were unbearable (p=0.004) and made them doubt efficacy of treatment (p<0.001). Conclusions: Behavior alteration is the most frequent and hair loss the most severe side-effect. Apparent discrepancies in health beliefs about side-effects exist between parents and health-care providers. A sustainable parental education program about side-effects is recommended. Health-care providers need to update and improve their knowledge and communication skills in order to give appropriate information. Suchmeasures may improve outcome of childhood cancer treatment in low-income countries, where adherence to therapy is a major issue.

Content Analysis on Psychosocial Adjustment of Adolescent Survivors of Leukemia (백혈병 생존 청소년의 심리사회적 적응에 대한 내용분석)

  • You, Mi-Ae
    • Child Health Nursing Research
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    • v.12 no.3
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    • pp.304-313
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    • 2006
  • Purpose: This study was done to describe psychosocial adjustment of adolescents who have survived childhood acute lymphocytic leukemia (ALL). Method: Out of a total of 16 adolescents ($11{\sim}20$ years old) registered at the Pediatric Oncology Clinic at one university affiliated hospital, 13 adolescents agreed to participate in this study. The data were collected through in-depth interviews using a semi-structured questionnaire. The contents of the interviews were analyzed using the inductive content analysis method. Result: Three main categories were identified 'personal characteristics', 'coping patterns', and 'interpersonal relationship'. Personal characteristics included self-praise, self-confidence, altruism, being worrisome, and being difficult. Coping patterns included positive thinking, activeness, and avoidance. Interpersonal relationship included appreciation, intimacy, burdened by over protectiveness, and feelings of regret and equality as peers. Conclusion: The results indicate that adolescents who have survived childhood cancer have both positive and negative experiences. It is suggested that care providers identify and support the strengths of the adolescents in order to help them to adjust more positively after the experience of childhood cancer.

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Perceived Stress and Quality of Life in the Parents of Children with Cancer (소아암 환아 부모의 스트레스와 삶의 질)

  • Lee, Sang-Hyuk;Kim, Ji-Eun;Lyu, Chuhl-Joo;Byen, Kyoung-Min;Choi, Tae-Kyou
    • Korean Journal of Psychosomatic Medicine
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    • v.11 no.2
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    • pp.159-169
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    • 2003
  • Objectives: The object of this study was to compare between perceived stress, coping strategies and quality of life between parents of childhood cancer and normal controls. Methods: Global assessment of recent stress(GARS) scale and symptom checklist-90-revised (SCL-90-R) were used to measure perception for stressors and stress responses(psychopathology). Coping scale and Smithklein Beecham quality of life scale were used to measure coping strategies and quality of life. Results: Scores of perceived stress related to interpersonal, changes in relationship, sickness or illness, financial, unusual happenings on the GARS scale were significantly higher in parents of childhood cancer than normal controls. Scores of the SCL-90-R, somatization, depression, anxiety, hostility subscale were also significantly higher in parents of childhood cancer than normal controls. Scores of self control and positive reappraisal were significantly higher in parents of childhood cancer than normal controls. Parents of childhood cancer scored significantly lower in quality of life than normal controls. Scores of depression were also significantly higher in parents of children diagnosed as acute lymphocytic leukemia(ALL) than those as acute nonlymphocytic leukemia(ANLL). Conclusions: The results suggest that patients with parents of childhood cancer were likely to have higher levels of perceived stressor and psychopathology and lower quality of life than normal controls.

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Development of Nursing Intervention Protocol for Childhood Cancer at Early Diagnosis Stage (소아암 환자의 초기 진단단계의 간호중재 프로토콜 개발)

  • Choi Ja-Yun;Yoo Il-Young
    • Child Health Nursing Research
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    • v.8 no.1
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    • pp.44-54
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    • 2002
  • The main purpose of this methodological study was to develop an assessment tool and intervention protocol for child and family with childhood cancer at early diagnosis stage. The assessment tool and intervention protocol was developed by extensive literature review and consultation with experts. Review of nine domestic and sixty-six international journal articles were done to identify stress, interventions, coping strategies and adjustment of children with cancer and their family. Results were as follows; First, assessment at the early diagnosis stage need to include information on patient, family, and patient/family attitude toward diagnosis and treatment. Second, intervention protocol for children with cancer includes control physical symptoms, manage the side effects of chemotherapy and diagnostic or therapeutic procedures, control emotional responses, provide support and information, assist decision-making and adjust to environment. Third, intervention protocol for family includes controlling emotional responses, provision of informations, inducing family support to patient, improving family cohesion, supporting siblings and supporting spiritual growth. In conclusion, the early diagnosis stage in cancer treatment is important for child and family since this stage greatly affects the overall adjustment of child and family to live with cancer. Therefore, pediatric nurses need to be sensitive to the need of patient/family and systematically manage their needs at this stage.

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Role of Electromagnetic Field Exposure in Childhood Acute Lymphoblastic Leukemia and No Impact of Urinary Alpha-Amylase - a Case Control Study in Tehran, Iran

  • Tabrizi, Maral Mazloomi;Hosseini, Seyed Ahmad
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7613-7618
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    • 2015
  • Childhood acute lymphoblastic leukemia (ALL) is one of the most common hematologic malignancies which accounts for one fourth of all childhood cancer cases. Exposure to environmental factors around the time of conception or pregnancy can increase the risk of ALL in the offspring. This study aimed to evaluate the influence of prenatal and postnatal exposure to high voltage power lines on the incidence of childhood ALL. It also examines the role of various factors such as environmental factors and alpha-amylase as a marker in the development of leukemia.This cross-sectional case control study was carried out on 22 cases and 100 controls who born and lived in low socioeconomic families in Tehran and were hospitalized for therapeutic purposes in different hospitals ofrom 2013-2014. With regard to the underlying risk factors; familial history and parental factors were detected as risk factors of ALL but in this age, socioeonomic and zonal matched case control study, prenatal and childhood exposure to high voltage power lines was considered as the most important environmental risk factor (p=0.006, OR=3.651, CI 95% 1.692-7.878). As the population study was from low socioeconomic state, use of mobiles, computers and microwaves was negligible. Moreover prenatal and postnatal exposure to all indoor electrically charged objects were not detected as significant environmental factors in the present study. This work defined the risk of environmental especially continuous pre and postnatal exposure to high voltage power lines and living in pollutant regions through the parents or children as well as the previously described risk factors of ALL for the first time in low socioeconomic status Iranian population.

Colon Cancer with Appendiceal Perforation in a 13-year-old Boy (충수염으로 오인된 소아의 대장암)

  • Choi, Myung-Min;Lee, Un-Gi;Jeon, In-Sang;Kim, Hyun-Young
    • Advances in pediatric surgery
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    • v.14 no.2
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    • pp.189-195
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    • 2008
  • Colorectal cancer is extremely rare in children. Unlike adult colorectal cancer, the overall prognosis of colorectal cancer in children is poor. Delayed diagnosis, advanced stages of the disease at presentation, and mucinous type of histology are the major determinants of poor outcome in childhood. A 13-year-old boy with abdominal pain visited our hospital. Physical examination andabdominal ultrasonography identified acute appendicitis with perforation. He underwent appendectomy and then the pathologic findings revealed mucinous adenocarcinoma. The cancer was located at the transverse colon and had metastases on peritoneal wall at $2^{nd}$ laparotomy. Extended right hemicolectomy was performed. He underwent palliative chemotherapy. After 4 months later, hepatic metastasis and aggravated peritoneal seedings developed. He died of renal failure and pneumonia 13 months after operation. We need to have a high index of suspicion for the possibility of a malignant colorectal tumor in any childhood case with nonspecific signs and symptoms.

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No Association between Traffic Density and Risk of Childhood Leukemia: a Meta-analysis

  • Sun, Xiao-Xi;Zhang, Shan-Shan;Ma, Xiao-Ling
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.13
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    • pp.5229-5232
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    • 2014
  • Background: While many studies have concluded that local traffic density is positively associated with childhood leukemia, the results are inconsistent. We therefore performed a meta-analysis to assess the relationship between traffic density and the risk of childhood leukemia. Methods: A systematic literature review was carried out using PubMed, EMBASE, and the Cochrane Library from January 1979 to December 2013. We selected and assessed journal articles evaluating the relationship between local traffic density and the risk of leukemia in children. The analysis was carried out using STATA version 12.0. Results: A total of 11 articles, including 12 estimates of effect, were included in our meta-analysis. The summary effect size from the random-effects model, expressed as an odds ratio, was 1.03 (95% CI: 0.98-1.09, p=0.002). No significant association between traffic density and the risk of childhood leukemia was found. Similar conclusions were found on subgroup analysis. Conclusions: The results of our meta-analysis suggested no association between traffic density and the risk of childhood leukemia. This implies that living in close proximity to roads with heavy traffic may not increase the risk of childhood leukemia. However, further high-quality prospective trials are needed to support these results.

Factors Affecting Social Adjustment of Childhood Cancer Survivors (소아암 치료 종료 아동의 사회적응에 영향을 미치는 요인)

  • Oh, Su-Mi;Lee, Hye-Jung;Kim, Gwang-Suk;Park, Kyung-Duk
    • Child Health Nursing Research
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    • v.19 no.3
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    • pp.238-245
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    • 2013
  • Purpose: The purposes of this study were to assess social adjustment of childhood cancer survivors and to identify factors affecting social adjustment. Methods: Data were collected from 79 childhood cancer survivors and his/her parents. The survey consisted of questions related to characteristics, physical functioning, depression, self-esteem and coping strategies. The Social Competence Inventory was used to measure social adjustment in the children. Results: The level of social adjustment of childhood cancer survivors was 83.5 out of a possible 155. Physical functioning, depression, self-esteem, and aggressive or proactive coping strategies were associated with social adjustment. Only physical functioning independently affected social adjustment. Conclusion: The results of this study indicate that there are several factors influencing social adjustment of childhood cancer survivors, and therefore there is a need for programs that deal with all aspects of children's physical as well as emotional health in order to enhance their social adjustment.