Approach to the children with cancer in the terminal phase and their families

Abstract

Although 70% of children with cancer survive, about 30% will experience recurrence, progression and death. Palliative care, is the symptomatic care that is given to patients in whom survival is no longer expected. It includes physical, emotional, social and spiritual elements. It should aim to obtain a good quality of life for the child and relief pain. Other measures are also taken to relief symptoms. Although the decision to go on with palliative therapy is similar in the whole world; geographical, social and cultural differences should be regarded when communicating with the child and family. Terminal care is a team work, and is a hard time emotionally for both the child, family and medical staff. The development of hospices and palliative care units are very important for both the patients and the medical staff involved.

Keywords

• Attitude to Death,Bereavement,Terminally Ill,Truth Disclosure,Terminal Care,Palliative Care,Home Care Services,Hospice Care,Neoplasms,Child,Pain

Terminal dönemde kanserli çocuk ve ailesine yaklaşım

Öz

Günümüzde kanser tanısı almış çocukların %70'i iyileşmektedir; ancak %30 kadarında ise hastalığın tekrarlanması, tedaviye yanıt vermemesi ve ölüm yaşanmaktadır. Palyatif tedavi, şifanın olası olmadığı dönemde hastayı rahatlatacak, hayat kalitesini en yüksek düzeyde tutacak tedavidir. Palyatif tedaviye geçiş prensipleri bütün dünyada benzerdir, ancak aile ve hastayla iletişimde ülkeye, yöreye özgü sosyal ve kültürel özelliklere de önem verilmelidir. Bu dönemde en rahatsız edici semptomlardan olan ağrı giderilmelidir. Hastanın bulgularına göre diğer semptomatik ve destek tedaviler yapılır. Terminal dönem bakımı bir ekip işi olup, hasta ve ailesi kadar, sağlık ekibi için de duygusal olarak çok zor bir dönemdir. Hospislerin, palyatif bakım ünitelerinin kurulması, bu konuyla ilgilenen tıbbi ekip için de, bu hastalar için de çok önemlidir.

Anahtar Kelimeler

• Ölüme tavır, yas, çocuk, ev bakımı, misafirhanede bakım, neoplazi/hemşirelik/psikoloji, ağrı/terapi, palyatif bakım, terminal bakım, doğruyu açıklama

Kaynakça

1. 1. Wolfe J, Grier HE. Care of the dying child. In: Pizzo PA, Poplack DG, editors. Principles and pratice of pediatric oncology. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 1477-94.
2. 2. Hain RDW, Hardy J. Palliative care in pediatric oncology. In: Pinkerton R, Plowman PN, Pieters R, editors. Pediatric oncology. London: Arnold; 2004. p. 684-70.
3. 3. Hilden JM, Emanvek EJ, Fairclough DL, Link MP, Foley KM, Clarridge BC, et al. Attitudes and practices among pediatric oncologists regarding end-of–life care: Results of the 1998 American Society of Clinical Oncology Survey. J Clin Oncol 2001;19(1):205-12.
4. 4. Whittam EH. Terminal care of the dying child. Psychosocial implications of care. Cancer 1993;71(10 Suppl):3450-62.
5. 5. [No authors listed] American Academy of Pediatrics Committee on Bioethics: Guidelines on foregoing life-sustaining medical treatment. Pediatrics 1994;93(3):532-6.
6. 6. Goldman A, Christie D. Children with cancer talk about their own death with their families. Pediatr Hematol Oncol 1993;10(3):223-31.
7. 7. Wolfe J, Grier HE, Klar N, Levin SB, Ellenbogen JM, Salem-Schatz S, et al. Symptoms and suffering at the end of life in children with cancer. N Engl J Med 2000;342(5):326-33.
8. 8. Foley GV, Whittam EH. Care of the child dying of cancer: Part I. CA Cancer J Clin 1990;40(6):327-54.

9. 9. Levy MH. Doctor-patient communication: the lifeline to comprehensive cancer care. ASCO Educational Book. 1998;195–202.
10. 10. World Health Organization and International Association for the Study of Pain: Cancer Pain: Relief and Palliative Care in Children. Geneva: Switzerland, World Health Organization. 1998.
11. 11. Contro NA, Larson J, Scofield S, Sourkes B, Cohen HJ. Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics 2004;114(5):1248-52.
12. 12. Himelstein BP, Hilden JM, Boldt AM, Weissman D. Pediatric palliative care. N Engl J Med 2004;350(17):1752-62.