Palliative Care

As discussed in previous sections of this chapter, the treatment given in pursuit of cure for childhood cancer is extremely toxic, with many acute and long-term physical and emotional sequelae. Concern about the comfort of the pediatric cancer patient is always a part of treatment for oncologists, but comfort becomes the primary concern when cure is no longer an option. For parents, symptom-related care is an essential part of all cancer-directed therapy; this is a frequent reason parents give for seeking complementary or alternative care for their chil dren. The American Academy of Pediatrics has established guidelines for the use of complementary and alternative care with children and adolescents (Kemper et al. 2008).

Use of complementary and alternative medicine is common among children who are in active treatment or are survivors of cancer. Small clinical trials have supported the utility of acupuncture or ginger for nausea and vomiting, or hypnosis and guided imagery for pain or anxiety (Ladas et al. 2006). Although some interventions have been found to be safe and effective when used in conjunction with cancer treatment protocols, others present interaction risks. Therefore, open communication must be maintained regarding any additional treatment modalities pursued by the child or teen and family (Quimby 2007).

Seeking agreement between parents about end-of-life care is important on many levels. It is good for the couple and their ability to live with themselves and each other after the child's death (Edwards et al. 2008). Also, if the parents cannot agree on a primary goal of lessening suffering, they are more likely to report that the child suffered significantly from cancer-related treatment (Bluebond-Langner et al. 2007). Although the prognosis is much better than in the past, staff working with pediatric oncology patients must deal with a great deal of suffering and fear in the patients and families and frequently must watch their young patients die. Despite these stressors, burnout does not appear to be greater among staff in pediatric oncology than among staff in other pediatric specialties (Liakopoulou et al. 2008). Nurses who are able to avoid "compassion fatigue" appear to be able to focus on "moments of connection, making moments matter, and energizing moments" (Perry 2008, p. 87). Despite the extensive research into posttraumatic stress response in childhood cancer survivors and their families, very little has been done to examine "vicarious traumatiza-tion" of oncology nursing staff (Sinclair and Hamill 2007). The reader is referred to Chapter 16 for further discussion of issues related to palliative care.

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