Julia Challinor

Behavioral Adjustment of Children and Adolescents With Cancer: Teacher, Parent, and Self-Report

PURPOSE/OBJECTIVES To describe behavioral adjustment in children and adolescents with acute lymphoblastic leukemia (ALL) and to determine whether behavioral adjustment is correlated with cognitive and academic abilities. DESIGN Descriptive, cross-sectional design. SETTING Two pediatric oncology treatment centers. SAMPLE 47 children and adolescents who had been receiving ALL therapy for at least one year or who were off therapy for no more than three years and their parents and teachers. Wechsler Intelligence Scale for Children-Revised (WISC-R) and Wide Range Achievement Test-Revised (WRAT-R) data were available on a subset of 17 subjects. METHODS Parent, teacher, and self-report Behavioral Assessment System for Children (BASC) ratings were used to measure behavioral adjustment. WISC-R measured cognitive abilities, and WRAT-R measured academic abilities. Demographic, family, and treatment-related data also were collected. MAIN RESEARCH VARIABLES Behavioral adjustment and cognitive and academic abilities. FINDINGS At least 20% of teacher ratings for somatization, learning problems, leadership, and study skills; parent ratings for somatization, adaptability, attention problems, withdrawal, anxiety, social skills, and depression; and self-report ratings for anxiety and attitude to school were in the at-risk range (i.e., presence of significant problems that require treatment). The majority of teacher BASC ratings were correlated significantly with WISC-R and WRAT-R scores. Self-report depression and social stress ratings were correlated significantly with some WISC-R and WRAT-R scores. Treatment-related experiences such as body image alterations and mental and emotional problems were associated with problematic behaviors, including depression, somatization, withdrawal, and social stress. CONCLUSIONS Youth with ALL are at risk for some behavioral adjustment problems, particularly anxiety, somatization, adaptability, attention, and withdrawal. Cognitive and academic abilities are associated with some dimensions of behavioral adjustment. IMPLICATIONS FOR NURSING Findings suggest the need for ongoing assessment of behavioral adjustment and cognitive and academic abilities of children with ALL. Behavioral interventions that target at-risk mannerisms, such as somatization, depression, anxiety, and social stress, are needed. Central nervous system treatment may contribute to behavioral adjustment problems, as well as to cognitive and academic problems. Strategies to improve academic abilities also may have a positive effect on behavioral adjustment.

Baseline standards for paediatric oncology nursing care in low to middle income countries: position statement of the SIOP PODC Nursing Working Group

www.thelancet.com/oncology Vol 15 June 2014 681 Antoine Brouquet, Bernard Nordlinger* Department of Surgical Oncology and Digestive Surgery, Hôpital Bicêtre, Assistance Publique–Hôpitaux de Paris, Le KremlinBicêtre, Université Paris-Sud INSERM 986, France (AB); and Department of General Surgery and Surgical Oncology, Hôpital Ambroise Paré, Assistance Publique–Hôpitaux de Paris, 92100 Boulogne-Billancourt, France (BN) bernard.nordlinger@apr.aphp.fr

Educational needs and strategies of pediatric oncology nurses in low- and middle-income countries. An International Society of Pediatric Oncology- Pediatric Oncology in Developing Countries Nursing Working Group Initiative.

Background: There is no existing pediatric oncology nursing curriculum written specifically for low- and middle-income countries (LMICs), where 80% of children with cancer reside. In 2012, the International Society of Pediatric Oncology Nursing Working Group sought to address this gap with a 3-phase study. Objective: Phase 1: identify educational priorities of LMIC nurses providing oncology care. Phase 2: solicit educational strategies from expert pediatric oncology nurses. Phase 3: develop a culturally adaptable modular curriculum framework based on LMIC nurses’ priorities. Methods: A cross-sectional sample of LMIC nurses were surveyed (including Africa, Latin America, Asia). Next, 2 rounds of a Delphi survey were sent to expert pediatric oncology nurses from high-income countries with experience working in LMICs. A 2-day workshop was conducted to develop the framework. Results: Low- and middle-income country nurses’ survey responses indicated a similar need for specialty training (eg, chemotherapy and psychosocial support). Delphi survey participants agreed on educational strategies (eg, group discussions and peer teaching). Finally, 5 LMIC nurses committed to creating curriculum modules. Conclusions: There is an urgent need for a curriculum framework created and field tested in LMICs. The International Society of Pediatric Oncology 3-phase project was a successful strategy for initiating this ongoing process. Implications for Practice: Translating or modifying existing oncology nursing curricula from high-income countries for use in LMICs is no longer adequate. Engaging LMIC nurses who care for children and adolescents with cancer in curriculum development, recognizing local cultures, traditions, and priorities and harnessing the LMIC nurses’ knowledge, experience, and resources are the logical solution for a relevant curriculum.

Nutritional issues in pediatric oncology: an international collaboration between the Central American nurses cooperative group and U.S.-based dietary and nursing experts.

Pediatric oncology patients are at risk for malnutrition due to cancer cachexia and anticancer treatment [1]. At the time of diagnosis, malnutrition is observed in 6–50% of children [2–5], and ensuring that children undergoing anticancer treatment receive adequate nutrition is challenging. It is even more challenging in developing countries where such patients may be chronically malnourished before their diagnosis. This problem was a main topic at the nursing session of the 10th Annual Meeting of the Asociación de Hemato-Oncologı́a Pediátrica Centroamericana (AHOPCA), which was held in the Dominican Republic in February 2007. Malnutrition in children is characterized by weight (or weight for height) less than 2 standard deviations below the mean for sex and age and/or a weight curve that falls more than 2 percentile lines on the National Center for Health Statistics growth charts after achieving a stable pattern [6]. Inadequate food intake causes weight loss or ‘‘wasting,’’ and long-term inadequate food intake leads to poor growth or ‘‘stunting’’ and decreased head circumference. The small stature of children in developing countries was originally considered an evolutionary adaptation to the limited availability of food. Today we know that small stature reflects growth failure due to the lack of food during the growing years (i.e., infancy-puberty) [7]. Among Central American children, 12.4% are underweight [8], and 20.4% experience stunting [9]. Undernourished children are at risk for several deleterious conditions such as brain underdevelopment, muscle wasting, infection, anemia, and impaired learning. Undernutrition associated with diarrhea, pneumonia, malaria, or measles contributes greatly to childhood death worldwide [10]. Proper nutrition during anticancer treatment is important for the well being of pediatric patients, and patients who receive proper nutrition tolerate anticancer treatments better [11] and experience fewer infections [12].

Treating Children With Cancer Worldwide--Challenges and Interventions.

* Abbreviations: ALL — : acute lymphoblastic leukemia HICs — : high-income countries LMICs — : low- and middle-income countries > Although morbidity from childhood cancer is second only to unintentional injuries in high-income countries, in low-income countries, it hardly hits the radar screen compared with death from pneumonia, diarrhea, malaria, neonatal sepsis, preterm birth, and neonatal asphyxia. Nevertheless, the extraordinary progress made in treating childhood cancer in high-income countries brings into harsh focus the mammoth disparities that exist in impoverished areas of the world. As the capacity to diagnose and treat childhood cancer improves in low- and middle-income countries, the ability to improve outcomes for the more common diseases benefits as well. The authors have summarized the issues related to childhood cancer care with thoughtful attention to how children everywhere can gain from the advances in medical science in high-income nations. > > Jay E. Berkelhamer > > Column Editor Childhood cancer is a relatively rare disease, and most cases occur in the low- and middle-income countries (LMICs) where nearly 90% of the world’s children live.1,2 In low-income countries, childhood cancer mortality is low compared with childhood mortality from other causes (eg, infectious disease). However, as mortality rates from other causes decreased by 49% worldwide from 1990 to 2013 for children aged under 5 years, so the relative importance of childhood cancer has increased.2,3 Although no etiologic agent or trigger is identifiable for most childhood cancers, there are some well-described associations with infectious diseases. The incidence of Burkitt lymphoma is much higher in malaria-endemic regions, Kaposi sarcoma is almost always associated with HIV infection, and hepatocellular carcinoma is more frequent in areas with a high prevalence of hepatitis B infection.1,2 Public health measures to reduce these infectious diseases will also lower childhood cancer mortality. There are 3 standard modalities … Address correspondence to Trijn Israels, MD, PhD, Pediatric Oncology, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands 1081 HV. E-mail: t.isreals{at}vumc.nl

Strengthening the oncology nurse workforce in low-income and middle-income countries

The burden of cancer is increasing worldwide. Cancer has become a priority on the agendas of WHO, the UN, and other international organisations. Health-care professionals are needed to provide care across the entire cancer continuum, from prevention and detection, to treatment and end-of-life care or survivorship. Unfortunately, such health-care professionsals are seriously lacking in low-income and middle-income countries (LMICs). Initiatives have been made to address cancer care in these countries with the restricted healthcare workforce available. Such initiatives include support and training from twinning programmes, short-term in-country training, and online teaching programmes. However, until there is a serious commitment from governments in LMICs to fund and support the development of health-care infrastructure, including personnel (physicians, surgeons, nurses, pharmacists, and radiotherapists) and to address the material and

Addressing Childhood Cancer in Low-Resource Countries: Current Challenges, Strategies, and Recommendations

Children and adolescents represent a small, but critically important, number of patients with cancer worldwide (14.1 million newly diagnosed adults versus 160,000 children annually). The life years saved when a child is cured of cancer are about 71 compared to 15 years for an adult in most high-income countries (HICs). In HICs, about 80% of children survive cancer. Unfortunately, in low- and middle-income countries (LMICs), the survival rates are generally 50% or less. In these resource-limited settings, only 15%-37% of children and adolescents have access to cancer treatment, and most are diagnosed with advanced-stage disease, making cure impossible.

Development and testing of the school competency assessment scale

et al., 1996; Challinor, Miaskowski, Moore, Slaughter & Franck, 2000; Copeland, Moore, Francis, Jaffe, & Culbert, 1996; McCarthy, Williams, & Plumer, 1998; Moore, et al., 2000; Raymond-Speden, Tripp, Lawrence, & Holdaway, 2000; Smibert, Anderson, Godber, Ekert, 1996; Waber, et al., 1995). Despite numerous reports of school problems experienced by long-term survivors of childhood cancer, information of a comprehensive assessment of a child’s risk and protective factors for school problems is lacking. This information is essential to the development of intervention strategies designed to improve academic abilities and school competency among children with can-

A one-day pilot course in data collection and entry for pediatric oncology nurses in Central America

Oncologia Pedidtrica de Centro America (AHOPCA), the pediatric oncology cooperative group in Central America. In recent years, South American oncology nurses have published results of their participation in research. The opportunity for Central American pediatric oncology nurses to participate in organized clinical trials has just begun. This project was an initial effort, using a non-clinical trial database, to train a cohort of pediatric oncology nurses about data documentation, collection, and entry. Target audience: 12 (total) Central America