Thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Counselling Psychology at the Zululand University, South Africa, 2012. / When a child is diagnosed with paediatric cancer, the entire family is affected. Relating to the impact of this new family diagnosis, it is often the siblings of the ill child who carry the greatest hidden burden of stress. Although there is a sound and growing body of international research pertaining to the sibling cancer experience, South African research on this topic is almost non-existent, and there is still much to be learnt. As a result, the present study aimed to gain a better understanding of the cancer experience from the perspective of South African siblings. To this end, semi-structured interviews were conducted with 10 healthy siblings who have a brother or sister who was diagnosed with paediatric cancer. The sibling sample comprised of 4 boys and 6 girls (Aged 8-18) who reside in the Western Cape Province of South Africa. Data collected through the sibling interviews was analysed by means of thematic analyses. Five overall themes evolved from the siblings’ narratives. These themes related to the concept of cancer; concerns and worries; emotional experiences; changes; and resources and coping. Within each of these overarching themes, various sub-themes were also noted. In order to gain a holistic understanding of the sibling cancer experience, the five themes were contextualised and discussed in terms of various developmental theories including: Erikson’s psychosocial (socio-emotional) developmental theory; Piaget’s cognitive developmental theory; and Bronfenbrenner’s Bioecological systems theory. Although findings relating to the cancer experience for siblings in the present study did not differ tremendously from those noted in previous research, the results still made a valuable contribution to the existing body of knowledge involving siblings and paediatric cancer. Light was shed on the unique cancer experience for 10 South African siblings, and great insight was gained into their unique emotional worlds. In conclusion the present study’s contributions as well as shortcomings were discussed, and intervention guidelines and recommendations for future research were provided.

Art has the power to bring together communities of people who have suffered from traumatic experiences, and allow them to heal, and overall dismantles the stigma associated with it. My work delves into the emotional side of living with pediatric cancer from the child’s perspective, particularly my own experiences as a brainstem tumor survivor, and the overall concerns of fragility. This paper explores these perspectives that are severely lacking throughout studies, while also taking a closer look at how artists, such as Frida Kahlo and Jamie Bates Slone, have used art to reflect on and express emotions concerning personal traumas. My thesis project demonstrates how art, or in my case clay, can emphasize the resiliency of young children in overcoming pediatric cancer, and fosters a greater understanding, by focusing on the hopeful side of the diagnosis, in those who may only recognize fragility.

Siblings of children with cancer are exposed to significant stress and experience challenges in many aspects of their lives throughout the pediatric cancer trajectory. As a result, siblings are at risk for acute and long-term psychosocial consequences and must be provided with appropriate supportive services during and after cancer treatment. At this time, there are no evidence-based standards to guide the supportive care of siblings of children with cancer. The purpose of this study was to explore and develop an understanding of the different ways in which siblings of children with cancer perceive their psychosocial needs are addressed from formal and informal sources. A qualitative interpretive descriptive methodology was used in the study design. Data were collected from a sample of ten siblings in Ontario whose siblings were diagnosed and treated for pediatric cancer within the past ten years. The data collection methods included semi-structured individual interviews, socio-demographic questionnaires, field notes, and the researcher’s reflexivity journal. A reflexive thematic and inductive approach was used for the analysis of the collected data. The study findings highlight that there are significant gaps in the psychosocial support provided to siblings of children with cancer. Four overarching issues were identified, including: (1) siblings’ isolation from the pediatric cancer experience, (2) limited parental awareness of siblings’ psychosocial needs, (3) needs for consistent academic and school support, and (4) needs for standardized psychosocial support from healthcare professionals and hospital systems. The study findings provide several implications for clinical practice, policy, education, and research for nurses and other healthcare professionals working in pediatric oncology settings. Recommendations include: (1) integration of psychosocial care for siblings into clinical practice, (2) development of evidence-based standards and guidelines for the psychosocial support of siblings, (3) ongoing education and training for healthcare professionals related to siblings’ psychosocial healthcare needs, and (4) additional research on standardized screening tools and interventions for siblings. / Thesis / Master of Science in Nursing (MSN)

Evidence from the pediatric traumatic brain injury and pediatric brain tumor populations suggests that positive family functioning serves as a protective factor for neurocognitive outcomes of children who survive these conditions. However, no research has been found that examines whether positive family functioning similarly moderates the effects of CNS-directed chemotherapy on the neurocognitive functioning of survivors of pediatric ALL. The purpose of this study is to examine the effect of family functioning upon neurocognitive outcome among survivors of pediatric ALL treated with chemotherapy. Based upon a multidimensional model of attention and Anderson’s model of executive function (EF), four subcomponents of attention (selective, divided, sustained, and shifting) and four subcomponents of EF (working memory, planning, inhibition, and processing speed) will be examined. Sequential, or hierarchical, multiple regression analyses will be conducted to examine the relationship between family functioning and neurocognitive functioning among survivors of pediatric ALL as well as a comparison group of healthy children. Data for the ALL group and the comparison group will be examined using separate analyses, with demographic and treatment-related variables entered first, followed by a family functioning variable. For the ALL group, family functioning is expected to explain a significant amount of variance in neurocognitive outcome, even after controlling for demographic and treatment-related variables. It is expected that this relationship will not be found for the comparison group. If so, this would have important implications for the survivors and their families. For example, survivors from families with lower levels of functioning could be identified early through screening measures and their families could receive targeted interventions aimed at improving family functioning and thus survivor outcomes. / text

Low Dose Metronomic (LDM) chemotherapy, combined with VEGF pathway inhibitors, is a highly effective strategy to coordinately inhibit angiogenesis and tumor growth. We have tested the efficacies of daily oral LDM topotecan alone and in combination with pazopanib, in three pediatric extracranial solid tumors mouse models. We also investigated the effect of prolonged combination therapy with the combination on tumor behavior in a neuroblastoma mouse xenograft model. In-vitro dose-response study of topotecan and pazopanib was conducted on several cell lines. In-vivo antitumor efficacies of drugs, as single agents and combination, were tested in immunodeficient mice models. For studying the mechanisms of resistance to our therapy, a time-response study (28, 56 and 80 days) was conducted in SK-N-BE(2) xenografts model, treated in same way as earlier. In vitro, topotecan caused a dose-dependent decrease in viabilities of all cell lines, while pazopanib did not. In vivo, the combination of topotecan and pazopanib demonstrated significant anti-tumor activity compared to the respective single agents in all models. Reductions in the levels of viable Circulating Endothelial Progenitors and/or Circulating Endothelial Cells and tumor microvessel density were correlated with tumor response and therefore confirmed the antiangiogenic activity of the regimens. However, the combination also caused significantly higher myelotoxicity than single agents. Pharmacokinetic study did not reveal any interaction between the two co-administered drugs. In the time-response study, we found that only combination treated animals survived till 80 days. However, tumors in these animals started growing gradually after 50 days. Unlike single agents, all three durations of combination treatment significantly lowered tumor microvessel densities, compared to the control. However, tumors treated with the combination for 56 and 80 days had higher pericyte coverage. The combination increased the hypoxia, angiogenic expression and proliferative index and caused metabolic reprogramming of tumor cells. We conclude that the combination of LDM topotecan and pazopanib has superior efficacy than either single agents, which is attributed to superior antiangiogenic activity. However, prolonged treatment with the combination can have additive myelotoxicity and may encounter adaptive resistance associated with metabolic reprogramming and increased proliferation of the tumor cells.

Low Dose Metronomic (LDM) chemotherapy, combined with VEGF pathway inhibitors, is a highly effective strategy to coordinately inhibit angiogenesis and tumor growth. We have tested the efficacies of daily oral LDM topotecan alone and in combination with pazopanib, in three pediatric extracranial solid tumors mouse models. We also investigated the effect of prolonged combination therapy with the combination on tumor behavior in a neuroblastoma mouse xenograft model. In-vitro dose-response study of topotecan and pazopanib was conducted on several cell lines. In-vivo antitumor efficacies of drugs, as single agents and combination, were tested in immunodeficient mice models. For studying the mechanisms of resistance to our therapy, a time-response study (28, 56 and 80 days) was conducted in SK-N-BE(2) xenografts model, treated in same way as earlier. In vitro, topotecan caused a dose-dependent decrease in viabilities of all cell lines, while pazopanib did not. In vivo, the combination of topotecan and pazopanib demonstrated significant anti-tumor activity compared to the respective single agents in all models. Reductions in the levels of viable Circulating Endothelial Progenitors and/or Circulating Endothelial Cells and tumor microvessel density were correlated with tumor response and therefore confirmed the antiangiogenic activity of the regimens. However, the combination also caused significantly higher myelotoxicity than single agents. Pharmacokinetic study did not reveal any interaction between the two co-administered drugs. In the time-response study, we found that only combination treated animals survived till 80 days. However, tumors in these animals started growing gradually after 50 days. Unlike single agents, all three durations of combination treatment significantly lowered tumor microvessel densities, compared to the control. However, tumors treated with the combination for 56 and 80 days had higher pericyte coverage. The combination increased the hypoxia, angiogenic expression and proliferative index and caused metabolic reprogramming of tumor cells. We conclude that the combination of LDM topotecan and pazopanib has superior efficacy than either single agents, which is attributed to superior antiangiogenic activity. However, prolonged treatment with the combination can have additive myelotoxicity and may encounter adaptive resistance associated with metabolic reprogramming and increased proliferation of the tumor cells.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this paper, we propose a mobile solution to optimize the medical referral process for pediatric patients with presumptive cancer diagnosis. This proposal allows the automation of the process through the identification of the main gaps that are covered by the following functionalities: (1) Registration and interaction of the actors in the process, (2) Support for timely diagnosis with first-hand information, (3) Creation of request tickets and personalized medical appointments, and (4) Creation of reports on the response time and compliance with the process. The proposal is described in three sections: (1) The automation of the medical referral process, (2) The functionalities of the mobile solution, and (3) the designed technology architecture. The validation of the proposal was carried out in a social health insurance in Lima-Peru, with data and information of the process obtained by the institution. The measurement was made through the mobile solution which allowed obtaining the response times of the process with the main actors such as the pediatric doctor, an oncology specialist and a pediatric patient's guardian. The results showed that the time of the referral process is optimized between an interval of [95%-97.5%], which mainly generates a social benefit to the community by assuring a timely treatment of the pediatric cancer patient, based on diagnosis and early care.

No description available.

Although young adult (YA) survivors of child cancer comprise a unique group from a developmental standpoint, in most treatment and research settings either child or general adult measures of quality of life (QL) are used to measure adjustment and functioning. Studies have relied heavily on survey methods, and though many hint at a variety of specific problems that a subset of YAs may experience, most identify YA survivors as relatively well adjusted. Interview studies with survivors and care-providers and interactions in survivor support venues paint a more complex and problematic picture of adjustment. To better understand the QL concerns unique to YAs this study employed grounded theory methodology to build a model of survivorship from participant perceptions. Four focus groups were conducted (N=15) with survivors between the ages of 18 and 30 years recruited from in-person and online support group settings. Themes emerged describing a larger extent of struggles than prior studies have identified. The grounded theory model detailed that having cancer can fundamentally change an individual, and these changes and resulting struggles do not end with remission. Survivors described constantly pursuing normalcy in the context of being fundamentally different, while balancing the dual roles of young adult and survivor. Survivors revealed difficulties in essentially every area of their lives (school, work, friendships, family, romance, self-esteem, outlook and attitudes, etc.), and though many could identify strategies for addressing these problems, maladaptive coping techniques dominated and survivors were left feeling overwhelmed, under-supported, and misunderstood. Results suggest that YAs could benefit from QL measures developed specifically with their unique concerns in mind. While progress has been made in developing YA-specific measures, such measures have not become widespread practice in clinical and research settings. Furthermore, this study suggests that collecting such information in a conversational, semi-structured interview format may elicit a fuller scope of survivors’ concerns than pencil and paper methods, though further research is recommended in this area.

Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Current research has shown pediatric cancer patients to be at greater risk for lowered selfesteem, altered body image, and an overall change in self-concept. Even if patients are only at an increased risk, the development of a tool to identify these problems is necessary. Periodic screening of all patients would be beneficial and when problems are identified, intervention can take place. Research previously conducted with various tools concluded that cancer patients may select answers that allow them to appear "normal" or "supernormal" and therefore defensively deny their cancer (Puuko 1997). Currently there is not a unifonn instrument used to test these factors. To this end, a protocol was devised to evaluate the use of Harter's Self-Perception Manual in the pediatric cancer population and to test the current theories. Dr. Susan Harter's Self-perception Questionnaires have previously been used for prospective research in various pediatric populations and are designed specifically to allow patients to answer truthfully. The questionnaires have been determined to be a valid, reliable instrument to measure a child's self-perception of their self-concept. Further data (to come from the prospective study) is needed to determine if the scale is useful for pediatric cancer patients. In addition, the retrospective use of Harter's scale will be piloted in this protocol in order to determine how children really felt during trea1ment. In an effort to compensate for developmental advances/processes and issues with accurate recall specific limits have been placed on retrospective participants. / 2031-01-01