Thursday 9 June 2011

Understanding Pediatric Cancer (4): Alleviating Negative Effects

One of the main purposes of my graduate research was to examine the negative effects of cancer (especially fatigue) and how it affects the health-related quality of life (HRQOL) of pediatric cancer patients. HRQOL has been widely studied by researchers and clinicians as an important outcome measure of well-being and chronic illnesses such as cancer. It has also become a consideration for deciding the best course of treatment for a child and when to stop treatment because of poor HRQOL.

Part of my research was to examine factors that could improve quality of life despite the negative effects of cancer and its treatment and I have compiled them here (there are other factors of course but I will not be adressing them in detail as they were not part of my research).

*Note: The following information had been adapted from my own research and was therefore not written by a medical professional. The terms 'child' or 'children' refer to individuals below the age of 21 years old.

Lesson 4: Factors that Alleviate Negative Side Effects

1) Decrease in Fatigue
Fatigue is often described as an extreme tiredness and weakening of physical ability. Fatigue is one of the side effects of treatment that has also been associated with nausea, vomiting, diarrhea and infection.

As many as 60-96% of cancer patients undergoing treatment suffer from fatigue. The degree of fatigue can vary according to the stage of illness and intensity of treatment, i.e. it is usually the greatest when cancer is the most severe and treatment is the most intensive.

Causes of Fatigue
  • Frequent disruption of sleep and rest in the hospital
  • Changes in sleep patterns
  • Effects of the medication
  • Pain from treatment procedures
  • Low blood counts on blood tests
  • Boredom
  • Feeling afraid or worried
  • Overexertion of the body
  • Inadequate nutrition
  • Traveling
  • Depression
  • Feelings of inadequacy
Photo credit: jantoo

 How to improve fatigue?
  • Uninterrupted sleep at night
  • Rest and naps in the day
  • Engaging in quiet activities like reading or listening to music
  • Doing enjoyable things
  • Being optimistic
  • Distraction
  • Participating in physical therapy
  • Taking sleeping medication and having blood transfusion
  • Having adequate nutrition
  • Leaving the hospital
  • Emotional support
  • Interaction with and understanding from others
As one of the most commonly identified sources of fatigue is sleep disruptions, improving the sleep of children with cancer can therefore help to prevent or reduce the likelihood of experiencing fatigue. This is important as my research has found that lower levels of fatigue is related to better quality of life in children with cancer.

2) Good Coping Skills
Coping is generally defined by researchers as "an attempt to manage external or internal demands that are appraised as stressful to an individual". Different individuals often use different strategies to cope with stress.

2 Categories of Coping Strategies
  1. Approach coping = strategies that are directed at dealing with the threat (e.g. problem solving, social support)
  2. Avoidance coping = strategies that are directed at removing oneself from the stressful situation (e.g. distraction, denial)

There is also no one strategy that is more effective than the other.
  • Approach coping >> more beneficial for coping with long-term and controllable stressors such as fatigue 
  • Avoidance coping >> more beneficial for coping with short-term and uncontrollable stressors such as painful treatment procedures

Hence, helping the child use the right strategy for the right type of stressor may help them cope better with their illness and in turn lead to higher quality of life.

3) Increase in Social Support
Social Support = "an exchange of resources between two or more individuals which is intended to provide assistance to and enhance the well-being of the recipient".

3 Types of Social Support
  1. Emotional = provision of trust and expression of concern, understanding and love to the individual receiving the support
  2. Tangible = provision of practical help (e.g. taking care of meals)
  3. Informational = provision of evaluative feedback and giving of advice

Photo Credit: samsungtomorrow

Social support is more relevant for older children and adolescents due to their increasing need for the approval and acceptance of others whereas younger children do not cognitively understand the concept of social support. Hence, social support is usually only examined in children above 10 years old.

Adequate support is necessary as it enhances the child's self-esteem, sense of control over any situation, school performance and overall health. Children with cancer who reported increased social support also reported less psychological distress, anxiety and depressive symptoms. Better social support may also mean better coping and adjustment as well as better quality of life.

4) Understanding older children and adolescents

Photo Credit: teenslivingwithcancer

Generally, children who are diagnosed with cancer at a younger age are less vulnerable to psychosocial difficulties than those who are diagnosed in adolescence. This is due to the greater disruption of developmental tasks in adolescence as compared to infancy and childhood.

School-going children and adolescents are more aware of the physical side effects of treatment like hair loss as compared to younger children due to their increased need for the approval of their peers. They therefore become more vulnerable to problems with their self-image and self-esteem. In contrast, preschool children are not subject to peer approval and thus generally do not mind how they look.

Although younger children do showed more distress over treatment procedures than older children, they still generally have better quality of life throughout treatment.

Aldridge, A. A. & Roesch, S. C. (2007). Coping and Adjustment in Children with Cancer: A Meta-Analytic Study. Journal of Behavioral Medicine, 30(2), 115-129.

Brown, R. T. (2006). Comprehensive handbook of childhood cancer and sickle cell disease: a biopsychosocial approach. Oxford University Press: New York, United States of America.

De Bolle, M., De Clercq, B., De Fruyt, F. & Benoit, Y. (2008). Self- and parental perspectives on quality of life in children with cancer.Journal of Psychosocial Oncology, 26(2), 35-47.

Derevensky, J. L., Tsanos, A. P. & Handman, M. (1998). Children with cancer: An examination of their coping and adaptive behavior.Journal of Psychosocial Oncology, 16(1), 37-61.

Dixon-Woods, M., Young, B. & Heney, D. (2005). Rethinking experiences of childhood cancer: A multidisciplinary approach to chronic childhood illness. Open University Press: Maidenhead.

Eiser, C. (2004). Children with Cancer: The Quality of Life. Lawrence Erlbaum Associates: United States of America.

Hinds, P. S. & Hockenberry-Eaton, M. (2001). Developing a research program on fatigue in children and adolescents diagnosed with cancer. Journal of Pediatric Oncology Nursing, 18(2), 3-12.

Hockenberry-Eaton, M. & Hinds, P. S. (2000).Fatigue in children and adolescents with cancer: evolution of a program of study. Seminars in Oncology Nursing, 16(4), 261-272.

Jackson, A. C., Enderby, K., O'Toole, M., Thomas, S. A., Ashley, D., Rosenfeld, J. V., Simos, E., Tokatlian, N. & Gedye, R. (2009). The role of social support in families coping with childhood brain tumor. Journal of Psychosocial Oncology, 27(1), 1-24.

Ritchie, M. A. (2001). Sources of emotional support for adolescents with cancer. Journal of Pediatric Oncology Nursing, 18 (3), 105-110.

Wallander, J. L. & Varni, J. W. (1989). Social Support and Adjustment in Chronically Ill and Handicapped Children. American Journal of Community Psychology, 17(2), 185-201.

Continue to Understanding Pediatric Cancer (5): Personal Experience
<< Back to Understanding Pediatric Cancer (3): Side Effects of Treatment

UPDATE: If you'll like to find out the results of my research, my complete thesis can be found on the NUS Scholar Bank (Part 1 & Part 2) =)

This post is part of my series on My Pediatric Cancer Research
Read on to learn more about childhood cancer and its impact.
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