Understanding Pediatric Cancer (5): Personal Experience

If you have been diligently following my series of posts on pediatric cancer for the past week, thank you so much for your support! After all that information-heavy posts, I thought it would be good to end off with a post on my reflections and experiences as a researcher in the field.

My Personal Research Experience at NUH

I started sending out emails asking the Head of Department of Paediatrics of NUH and the Head of Pediatric Haematology/Oncology for permission and they gave it to me readily. However, getting Ethics approval to actually start data collection was much harder. The ethics people were understandably concerned as this was a vulnerable population. After waiting for a year, DSRB finally gave me the go-ahead to start my project.



Credits: nuh.com.sg


I was introduced to the oncologist, nurses and adminstrators who were tasked to work with me in collecting the data. I love them! Without them, I would not have been able to do anything in the clinic so kudos to them =)

A typical day of data collection begins with me in the clinic at 8.30am in the morning. I was already pregnant with baby girl so people treated me with less suspicion (ah the benefits of relating to other mothers/fathers). Nurse N would pass me a list of the patients coming in for the day and I will approach them and invite them to take part in my research. It's just filling out a couple of survey questions and was voluntary, so they really don't have to do it if they don't want to.

But many of them do! Whether it's because they are really interested or just couldn't reject a very pregnant researcher, I don't know. But I was very glad that they did. They are real heroes =)

The atmosphere in the clinic is generally very optimistic. Some parents have been in and out of the clinic for many years so they know the drill with the back of their hands. Others have just been introduced to it so they looked very overwhelmed. But still, they try their best to be strong for their children. They hold their young children's hands and try not to wince when the needle goes in. They comfort their kids even though they themselves need comforting. I admire them greatly for their strength.

The children too have incredible spirit. They triumph against incredible odds. Although some younger ones will cry in great distress because of the blood test, many others bravely endure it week after week. Even though they may be tired and weak, they still try their best to answer my questions. They are real champions.

The NUH staff at the clinic greets every child by name when they arrive. The children love the nurses there and the nurses love them. Staff from the Children's Cancer Foundation speak with the parents and offer them support. Contrary to what most people think, the cancer clinic is not a dreary place. It is alive with hopes, dreams, and most of all love.

I thank God for the incredible privilege to be able to work with this population of fighters. I have learnt much and hope I would one day be back to work with them again =)


<< Back to Understanding Pediatric Cancer (4): Alleviating Negative Effects

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.

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.



References:
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.

Understanding Pediatric Cancer (3): Side Effects of Treatment

With advancements in medical treatment for cancer, the mortality rates have declined over the past 15 years. However, it is still challenging for pediatric cancer patients to adjust to painful procedures and numerous side effects. These side effects will also vary depending on the stages of treatment.

*Note: The following information has 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 3: Side Effects of Treatment

1) Diagnosis & Early Treatment (1st 4-12 weeks)

Children with cancer and their parents have often identified the time just after diagnosis as the most stressful period in the course of their illness and treatment. The child may react to the diagnosis by expressing shock, denial, grief, anger and depression.

Physical Side Effects

• Pain (from intrusive procedures such as blood tests, lumbar punctures & venipunctures)
• Nausea & vomitting
• Lack of appetite
• Drowsiness
• Fatigue
• Cough and fever
• Hair loss
• Weight gain or loss due to medication

The creator of these dolls asked Mattel to manufacture Bald Barbies to be given to children with cancer. They did!
Photo Credit: Beautiful and Bald Barbie

Measures have been taken to reduce the procedural distress of children with cancer by introducing a topical analgesic ointment (which numbs the area where the child is pricked) and the surgical placement of central venous lines so that the child would not have to be pricked repeatedly.

Nevertheless, many children with cancer continue to show signs of procedural distress and pain. The pain and side effects of treatment experienced by the child can sometimes be more unpleasant than the cancer itself.

Psychological Effects

• Loss of control
• Fear of relapse and dying
• Lack of self-esteem as a result of the disfiguring physical changes (this affects an adolescent more than a younger child)
• Sibling problems (parents may pay more attention to the child who's sick and neglect the healthy sibling)
• Reliance on family members
• Feeling miserable and/or lethargic
• Feeling depressed and/or anxious

Photo credit: healthshire.com

Social Effects

• Prolonged separation and isolation from family and friends due to their compromised immune system and frequent hospitalization
• Inability to play with friends due to reduced physical abilities

In Singapore, children with cancer have to cease going to school during the course of their treatment, which can lead to changes in their relationships with their peers. In particular, older children and adolescents are more affected than pre-schoolers by the changes in friendships with their classmates.

2) Middle of Treatment

As treatment continues, patients and their parents learn how to adapt to the various changes to life and routines. The anxiety faced by parents immediately after diagnosis is now less apparent as their child’s illness and treatment progresses. Children also learn how to cope with their illness and the treatment side effects. However, they are still burdened by treatment adherence and uncertainty of the future.

3) End of Treatment & Survival

The child continues to visit their oncologist at least once a year for follow up after their treatment is completed. He or she is considered to have survived cancer after they have been in remission for 3-5 years.

After surviving cancer, children have to adjust back to functioning like they did before they had cancer. They have to return to school and their primary caregiver may have to return to part- or full-time employment.

Even after treatment has ended, the child continues to face treatment late effects and other complications as a result of their illness and treatment.

Physical Late Effects

• Complications include organ dysfunction, growth delay, infertility, and second malignancies
• Changes in physical appearance such as amputation
• Child has to be conscious of their health choices (for example, smoking would have a disastrous effect on their already weakened immune system)
• Cognitive late effects such as problems with learning, attention and memory (especially for survivors of brain tumor)
• Neurocognitive impairment in survivors of brain tumors

Psychological Late Effects

• Fear of relapse
• Stress as a result of difficulties in adjusting back to school

School Readjustment Problems

• In Singapore, survivors of cancer are told to rejoin their peers in the same class and educational level that they are at even though they had missed the years of school in between.
• For example, if a girl was diagnosed with cancer at 8 years old, she'll stop her primary 2 schooling and start her treatment, which lasts for let's say 3 years. At the end of treatment, she'd be 11 years old  and is thus expected to rejoin her peers at primary 5.
• As you can imagine, there are many problems with this arrangement. Although it may help the child to readjust to their lives before cancer, the years of school that they had missed may make it difficult for them to catch up to their peers in their school work.
• This may result in poorer academic performance and greater stress.
• Return to school may also be emotionally difficult for a school-age child or adolescent if there were significant changes in their physical appearance.

Effects of Cancer & Treatment on the Family

A diagnosis of cancer does not only affect the child but also their families.
Researchers have identified FOUR dimensions of impact on the family:

I. Financial Burden (extent to which illness changes the family’s economic status)
Families are burdened by the cost of treatment, loss of a parent’s income and other additional costs such as travel and meals at the hospital.

II. Social Impact (with others outside the immediate family)

III. Familial Impact (interaction within the immediate family)
All the members of the family are required to adapt to changes made to accommodate the increasing visits to the hospital, and frequent hospitalizations.

IV. Distress Experienced by Primary Caregiver
Parents often have to make adjustments to their work schedules to accommodate their sick child.


References:
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.

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.

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.


Continue to >> Understanding Pediatric Cancer (4): Alleviating Negative Effects
<< Back to Understanding Pediatric Cancer (2): 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.

Understanding Pediatric Cancer (2): Treatment

Now that you have learnt about the types of childhood cancers, we shall move on to the types of medical treatment for cancer.

*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 2: Treatment for Childhood Cancer

Delivered by a complex team of medical professionals, who looks after the needs of the child and their families, treatment for pediatric cancer include chemotherapy, radiotherapy, bone-marrow or stem-cell transplantation and surgery. Depending on the type of cancer and its severity, treatment may entail a combination of two or more of the above therapies that are administered either concurrently or one after another.

1) CHEMOTHERAPY

Chemotherapy, the most common form of cancer treatment, is the administration of cytotoxic drugs that kill cancer cells and interfere with their growth. The aim of chemotherapy is to completely destroy all the cancer cells; hence, the patient is given the maximum dosage of drugs that is tolerated by the body.

The drug is administered through a central venous line, which is inserted into a large vein under the collarbone. This thin plastic tube stays in the patient’s body for many months so that subsequent blood tests and drug administrations can be done without repeatedly pricking the child and causing him/her distress.


Photo credit: curesearch.org

Chemotherapy requires the patient to spend significant amounts of time in the hospital. There are also many side effects associated with the drugs and complications like infections and bleeding may occur.

Chemotherapy is also the main form of treatment used to treat lymphomas as the tumor is very responsive to it.

2) RADIOTHERAPY

Photo credit: interview with the illustrator

Radiotherapy uses ionizing radiation to target and cause cell damage to the cancer. The treatment requires that the patient be hospitalized daily for 4-6 weeks and common side effects of treatment include hair loss and soreness of the mouth and skin.

Recent research has shown that children are generally more responsive to chemotherapy than radiotherapy, which is why the former is used more frequently. The only exception is brain tumors, which require both chemotherapy and radiotherapy (and sometimes surgery).

3) SURGERY


Photo credit: kaahe.org

There are two purposes for conducting surgery on a child with cancer:
A) to obtain tissue sample for analysis and diagnosis;
B) to remove all or part of the tumor from the affected site.

Although surgery is risky, the level of surgical risks can be reduced if the medical team is skilled and able to make sound decisions.

Surgery, together with chemotherapy, is often used to treat bone tumors such as osteosarcoma and Ewing’s sarcoma. In more severe cases, the limb may be amputated and an artificial prosthesis inserted.

4) BONE MARROW or STEM-CELL TRANSPLANTATION

Photo credit: placidway

Transplantation is performed when oncologists deem it necessary to administer a high and potentially lethal dosage of drugs to the patient, which could overly suppress the bone marrow. Bone marrow or stem cells are then transplanted to counter this suppression.

As with any surgical procedure, transplantation procedures are very risky. There are also many acute and chronic complications that are associated with this form of treatment. Hence, transplants are only performed in patients who have a high-risk type of cancer and are unresponsive to regular chemotherapy.


Treatment for Acute Lymphoblastic Leukemia (ALL)

The treatment of the most common form of childhood cancer, ALL, consists of a combination of chemotherapy and radiotherapy with the aim of achieving complete remission as soon as possible. Treatment targets all parts of the body and is more intensive than that of adults. The initial period is the most intensive where hospitalization is required, after which subsequent treatment is administered in the outpatient clinic. Treatment then continues for about 24 to 36 months.

Children with ALL are usually placed on clinical trial protocols where treatment is commonly divided into 4 main phases:

I. Remission induction = aims to eradicate leukemia cells rapidly from the bone marrow and circulatory system
II. CNS preventive therapy
III. Consolidation = phase where therapy is intensified following induction
IV. Maintenance = as presence of undetectable levels of leukemia still have the capacity to be fatal, maintenance is necessary to ensure complete eradication of leukemia cells.

A child is considered to be in remission when the signs and symptoms of cancer has disappeared but as the cancer may return, the child is not declared a survivor until he/she is three to five years in remission.


References:
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.


Continue to >> Understanding Pediatric Cancer (3): Side Effects of Treatment
<< Back to Understanding Pediatric Cancer (1): Types of Childhood Cancers

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.

Understanding Pediatric Cancer (1): Types of Childhood Cancers

I recently received terrible news from my sister that her friend's niece had been diagnosed with Acute Lymphoblastic Leukemia. As this is the population of children that I had worked with for the last 3 years and whose data I had toiled many nights trying to understand and write for my thesis, I had vested interest in understanding more.

My sister had a lot of questions about childhood cancer, which I thought would be best answered with a series of posts based on my research, which is in no way exhaustive. I hope what I have learnt in my graduate training will be of help to you :)

*Note: The following information has 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 1: Types of Childhood Cancers

Cancer in childhood is relatively rare. Children with cancer often present with symptoms of fever, fatigue, pain, bruising, etc and the severity of the symptoms is dependent on the type of cancer.

These symptoms are also non-specific and can easily be mistaken for a less serious illness, thus making it hard for doctors to recognize and diagnose the disease.

Despite extensive research, the cause of childhood cancer is still not well established. Although it is common for parents (especially mothers) of children with cancer to blame themselves for not taking care of their children, in actual fact they are not the cause of their child's illness. There was one study that found no genetic or environmental factors that were related to cancer (even as far as to say it seemed to happen randomly). It is hoped that further research and greater medical advancement would give us an answer in future.

There are many types of cancer in children and its classification is often done by histology or type of cells involved rather than by organs as is used in adults. The most common type of cancer in children is leukemia (40.8% in Singapore), followed by other solid tumors such as neuroblastoma, lymphoma, etc.

1) LEUKEMIA

Leukemia is an increase in malignant cells occurring in the bone marrow. These malignant cells replace normal bone marrow cells and then subsequently enter the blood stream. Leukemia later leads to a reduction in the number of white blood cells and platelets in the blood, which lowers the immunity.

The child may therefore show infection-like symptoms such as fatigue, bleeding, bone pain, bruising or irritability. As these symptoms are non-specific, a blood test is required to make a diagnosis of leukemia.

The most common type of leukemia in children is Acute Lymphocytic Leukemia (ALL) (80% of all leukemia cases) while Acute Myeloid Leukemia (AML) and Chronic Myeloid Leukemia constitutes the rest. Prognosis is generally good as the 5-year survival rate for ALL is approximately 80%.

2) BRAIN TUMORS

Photo credit: hopkinsmedicine.org

Brain tumors are the most common form of Central Nervous System tumors, and its severity ranges from relatively benign to those that are highly malignant with poor prognosis.

Tumors in the brain can affect the balance and eye movements of pediatric patients. They can also cause a blockage in the flow of fluid between the brain and spinal cord resulting in a rise in intracranial pressure, which may cause severe headaches and vomiting.

The most common type of brain tumor in Singapore is medulloblastoma, which are malignant tumors derived from primitive embryonal tissue. The survival rate for medulloblastoma is approximately 60-70%, which is less than that of children with ALL. This is because treatment for brain tumors is generally more challenging and the brain is more susceptible to late treatment effects like brain damage and learning disabilities.

3) NEUROBLASTOMA


Credits: biota.utoronto.ca

Neuroblastoma originates from 2 sources: i) neural crest tissue in the adrenal gland, ii) sympathetic nervous tissue in the chest and abdomen.

The most characteristic symptom of neuroblastoma is the presence of a mass at the abdomen of the patient. Patients often complain of abdominal pain, vomiting, constipation and loss of appetite.
Due to the nature of the disease, prognosis is better in children younger than 12 months and significantly poorer in children older than 12 months. Even with intensive treatment, the survival rate is approximately 20-30%.

(Remember the girl with Neuroblastoma that I blogged about earlier? It is nothing short of a miracle that she is in remission after much prayer and the medical care of her doctors.)

4) LYMPHOMAS

Photo credit: India Cancer Hospital

There are 2 main types of lymphomas: i) Hodgkin’s disease and ii) non-Hodgkin lymphoma.

Lymphomas are tumors that arise from the lymphoid tissue, which is part of the body’s immune system. Typically, the tumor leads to enlargement of the lymph glands and may also spread to other organs like the liver, spleen or bone marrow. There may be pain at the site of the cancer.

In order to make a diagnosis of lymphoma, diagnostic imaging tests and biopsy of the affected tissue are required. Prognosis is also generally good.

5) MALIGNANT BONE TUMORS

Photo credit: Danis Foundation

The most common malignant bone tumors are Osteosarcoma and Ewing’s sarcoma. Sarcomas are cancers that develop in the supporting structures of the body like bone or soft tissue.

Both are most commonly presented in children ages 10-15 years, which is a period when rapid bone development occurs (although tumors can appear in young children as well). The characteristic symptom of malignant bone tumors is persistent and localized bone pain that is typically at the leg or arm, after which a mass at the affected site is detected.

6) OTHER TUMORS

Other tumors include: i) Kidney tumors (e.g. Wilms’ tumor), ii) Rhabdomyosarcoma, iii) Retinoblastoma (tumor of the eye in infants), iv) germ-cell tumors and v) liver tumors.


References:
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.

Health Promotion Board. (n.d.). First Report of the Singapore Childhood Cancer Registry 1997 – 2005. Retrived August 5, 2009, from www.hpb.gov.sg/data/hpb.home/files/Monograph v1.06.pdf.



Continue to >> Understanding Pediatric Cancer (2): 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.

The Psychology of Children with Cancer

This post is dedicated to my research work with children and adolescents with cancer at the Viva University Children's Cancer Centre, National University Hospital (NUH).

Viva University Children's Cancer Centre

According to Singapore's Health Promotion Board, an average of 120 Singaporean children and adolescents are diagnosed with cancer each year, with about half of all childhood cancers occurring in children age 5 and below. NUH treats a number of different types of childhood cancers with the most common being Acute Lymphoblastic Leukemia (ALL). They also see children from all over Asia including Malaysia, Indonesia, Phillippines, Brunei, Vietnam, India, Bangladesh and Sri Lanka as well as the United Arab Emirates.

So what business does psychology have with pediatric cancer?

Firstly, I want to clarify that psychology is not about mind-reading. That's a psychic's job! Neither is it only about crazy people. Unless by crazy people you mean us psychologists, who go mad trying to explain to people that we can't read their minds! For the uninformed, psychology is the study of the mind and behavior. Much like astronomers who 'read' the stars and predict when the next eclipse is going to happen, psychologists 'read' people and predict what they are likely to do in a particular situation.

A few of us are qualified, after vigorous clinical training, to see patients with mental health issues (they are called clinical psychologists or psychotherapists) but the rest of us are mostly researchers conducting human experiments (sounds worst than it is really). Don't worry we are governed by a very strict code of ethics, so you don't have to be afraid that we will hurt you in any way when you participate in one of our studies.

Which brings me back to our study with pediatric cancer patients. As we all know, cancer treatment (such as chemotherapy) is necessary to cure the illness but it also results in many physical, cognitive and social side effects in children and adolescents. Doctors and medicine can only do so much for the patients physically but what about the effects of treatment on their psychosocial well-being? That's where we step in. My supervisor and I want to know how cancer treatment is affecting the children's quality of life and how their coping strategies are helping/not helping them to overcome the challenges that they face.

So we got permission from various authorities (i.e. the university, the hospital & the ethics board), joined forces with the pediatric oncologists at NUH and handed out surveys to parents and children asking them a bunch of psychology-related questions. Our participants were real heroes who, despite being ill, were happy to help us. Most people don't give two hoots about research so we're glad for their kind and generous participation =)

Along the corridors of the clinic where I patrol regularly to invite people to participate in our study

So far, our results are optimistic. Although treatment is not a pleasant thing to go through, both the children and their parents are finding ways to cope with it and most are doing well. I really admire the parents especially for their tenacity, determination and strength to fight alongside their children for as long as it takes. When we see the children walk out of there cancer-free, we rejoice with them and their families.

So other than writing/correcting my thesis, which can sometimes be such a big pain in the behind, I do love what I do. And for those of you who are wondering what that is, well now you know.


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 and 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.