Approach to Care, Essay Example

Diagnosis Staging of Cancers

All cancers are classified according to specific stages and require an understanding of these stages in order to identify the most effective forms of care and treatment for patients. For pediatric cancers, there are a number of classifications to consider when a diagnosis of childhood leukemia, for example, has been made. The determination of the type of leukemia is present requires various levels of testing that include blood sampling, bone marrow, and lymph nodes or cerebrospinal fluid in some cases; furthermore, staging is based upon the nature and size of the tumor and the extent to which the cancer has spread to other organs or systems; therefore, this requires an effective understanding of the dimensions of staging and what is required to make these determinations (American Cancer Society, 2015). With leukemia, the disease originates in the bone marrow and spreads to the blood rapidly; therefore, it is a different type of issue that requires a unique approach since the cancer is spread throughout the body through the blood (American Cancer Society, 2015).

Classifying different forms of the leukemia type known as acute lymphoblastic leukemia (ALL) is based upon the following parameters: 1) morphology of the cells in order to determine whether the cancer is classified as L1, L2, or L3; and 2)immunophenotype of the cells, which includes the type of lymphocyte from which the cells originate (T or B), and maturity level of these cells (American Cancer Society, 2015). It is important to make this determination before any forms of treatment are considered in order to attack the cancer cells in a proactive manner with the intent to reduce its spread. There are a number of different types of ALL, based upon these factors, and B-cell ALL impacts approximately 80-85 percent of children with the disease (American Cancer Society, 2015). Therefore, the availability of treatments is contingent upon the type of diagnosis that has been made, the timeliness of the diagnosis, and access to the appropriate treatment resources for pediatric patients.

Complications of Cancer and Available Treatments

The incidence of leukemia in children has continued to increase over the past few decades, along with an expanded need to understand the nature of its complications and treatments. There must be a greater emphasis on the development of new perspectives to improve the health and wellbeing of this population through the identification of specific treatments to address the disease in an aggressive manner. It is necessary to obtain a comprehensive and multidisciplinary approach to leukemia treatment that involves a group of specialists from a variety of areas, including primary care, radiation oncology, pediatrics, rehabilitation, and hematology, among others (National Cancer Institute, 2015). Pediatric cancers are complex in nature and affect patient health in a dramatic manner; therefore, many factors must be taken into consideration when addressing the disease state and its overall impact on patient health.

For the purposes of this discussion, a form of ALL known as Precursor B-cell ALL will be considered, also known as WHO B lymphoblastic leukemia, and accounts for up to 85 percent of all childhood ALL cases (Dana-Farber Cancer Institute, 2015). It is important to determine the definitive diagnosis of the condition prior to determining which treatment methods are most appropriate, along with an understanding of the disease state so that patients will experience greater quality of life at a young age. The American Academy of Pediatrics has identified the treatment path for this patient population and has established parameters for consideration that will impact their lives significantly; to be specific, “Because treatment of children with ALL entails complicated risk assignment and therapies and the need for intensive supportive care (e.g., transfusions; management of infectious complications; and emotional, financial, and developmental support), evaluation and treatment are best coordinated by pediatric oncologists in cancer centers or hospitals with all of the necessary pediatric supportive care facilities” (Dana-Farber Cancer Institute, 2015). This strategy reflects the importance of developing a strategic approach that will have a lasting impact on patients and will address their needs in a comprehensive manner.

Patients with the disease are typically categorized into different risk groups, which supports a specific course of treatment to address the disease in a safe manner (Dana-Farber Cancer Institute, 2015). Aggressive treatments with higher risks of toxicity are typically used with patients who have a lower chance of survival, while those with less severe cases who respond to treatment well may receive treatments that are less intensive in nature (Dana-Farber Cancer Institute, 2015). Patients who are at standard risk have a WBC count of less than 50,000 and are between the ages of one and ten, while patients at high risk have a WBC count of over 50,000 and are over the age of ten years (Dana-Farber Cancer Institute, 2015).

Common treatment methods for patients with different forms of ALL include the following steps: 1) Induction, which is used to kill cancer cells in the blood and bone marrow and aims to restore WBC counts to normal levels and promote disease remission; 2) consolidation/intensification, which are used to remove cells that may serve as precursors to the additional formation of cancer cells in the future; 3) maintenance, whereby patients receive treatments to eradicate any additional cancer cells that exist (St. Jude Children’s Research Hospital, 2015). Specific treatment methods may include 1)chemotherapy to kill cancer cells, which is used via injection, by mouth, or a combination of both methods; 2)stem cell transplant to replace cells in the bone marrow that have been eradicated by cancer and to expand the formation of new and healthy blood cells; 3)radiation therapy to kill cancer cells or minimize their level of growth; and 4) targeted therapy to target cancer cells but to refrain from targeting healthy cells (St. Jude Children’s Research Hospital, 2015). These therapies are essential to ensure that children with ALL have a greater chance for survival, in spite of the side effects and potential complications that may be associated with these treatments. It is expected that over time when cancer cells are eradicated, it is likely that patients will experience improved health and quality of life.

Recommendations to Address Physiological and Psychological Effects of Care

For patients with pediatric ALL, there is a significant risk of depression and anxiety among this population group as a result of their health statuses, the need for continuous treatment, and a lack of acceptance and/or understanding by peers regarding the disease state (Myers et.al, 2014). Therefore, it is important to address these findings and to consider the different challenges associated with the disease state and its overall impact on patient health and wellbeing. In many cases, the use of corticosteroids may impact emotional functionality in children, which is a common course of therapy for this group; therefore, these issues must be taken into consideration when treating patients with the disease (Myers et.al, 2014). Furthermore, it is known that “Although symptoms of anxiety and depression may lessen throughout therapy, it is important to recognize the distress they cause and provide appropriate psychosocial interventions… A wealth of psychosocial interventions exists for children with cancer, including cognitive behavioral therapy, social and recreational activities, and psychoeducational interventions” (Myers et.al, 2014). These conclusions reflect the importance of developing strategies that will address the specific psychosocial needs of pediatric patients with ALL and what is required to provide them with a comprehensive plan of care to improve quality of life moving forward (Myers et.al, 2014).

Finally, different forms of pediatric cancer introduce a host of problems for patients; therefore, it is necessary to address these concerns by using a psychological approach, coupled with traditional treatment methods (Kazak & Noll, 2015). From this perspective, it is believed that pediatric patients will be affected in many ways by their cancer diagnosis and the required course of treatment; therefore, they must receive the appropriate psychosocial attention and focus in order to better manage the outcomes of the disease (Kazak & Noll, 2015). This will demonstrate a commitment to restoring the patient’s quality of life and overall physical and psychological wellbeing with an emphasis on developing a strategy for care and treatment that will have lasting benefits (Kazak & Noll, 2015). Areas of need including improved symptom management using such therapies as relaxation, distraction, and cognitive-behavioral therapies as appropriate (Kazak & Noll, 2015). Furthermore, it is important to evaluate the conditions under which patients are able to manage any neurocognitive concerns that may emerge that impact academic performance and socialization (Kazak & Noll, 2015). It is expected that the use of different therapies that are proven to aid cancer patients will be considered on a case-by-case basis and will emphasize the importance of understanding the disease state of each patient in order to draw conclusions regarding the therapies that will be most effective for patients (Kazak & Noll, 2015). Although traditional therapies to eradicate the disease are of critical importance, the psychosocial interventions that are conducted must also serve in a capacity to enhance quality of life for children who face different forms of ALL. This will encourage a multidisciplinary approach to care and treatment that will have lasting benefits for the patient population moving forward.

References

American Cancer Society (2015). How is childhood leukemia classified? Retrieved from http://www.cancer.org/cancer/leukemiainchildren/detailedguide/childhood-leukemia-how-classified

Dana-Farber Cancer Institute (2015). Childhood acute lymphoblastic leukemia treatment (PDQ).                      Retrieved from http://www.dana-farber.org/Health-Library/Childhood-Acute-Lymphoblastic-Leukemia-Treatment-(PDQ%C2%AE).aspx

Kazak, A. E., & Noll, R. B. (2015). The integration of psychology in pediatric oncology research and practice: Collaboration to improve care and outcomes for children and families. American Psychologist, 70(2), 146.

Myers, R. M., Balsamo, L., Lu, X., Devidas, M., Hunger, S. P., Carroll, W. L., … &

Kadan Lottick, N. S. (2014). A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia. Cancer, 120(9), 1417-1425.

National Cancer Institute (2015). Childhood acute lymphoblastic leukemia treatment-for health                        professionals. Retrieved from http://www.cancer.gov/types/leukemia/hp/child-all-treatment-pdq

St. Jude Children’s Research Hospital (2015). Acute lymphblastic leukemia (ALL). Retrieved from https://www.stjude.org/disease/acute-lymphoblastic-leukemia-all.html