The purpose of this essay is to compile interventions for parents of children with cancer in a literature review based on 13 peer-reviewed articles. The objective is twofold: to describe the aim of the interventions, and to investigate their effectiveness. Results indicate that the aim is to reduce stress, prevent the development of posttraumatisk stress, improve problem-solving skills, improve coping behaviour or increase parents’ knowledge of childcancer. Some of the interventions have intended effect, others have effect but not intended effect, and finally some show no effect at all. The main conclusion is that the forthcoming studies need to focus more on developing interventions that are flexible and can satisfy multiple needs.

Syftet med studien var att beskriva friska syskons upplevelser när deras bror eller syster drabbas av cancer som barn. Metoden var en beskrivande litteraturstudie som baserades på elva stycken vetenskapliga artiklar med kvalitativ ansats. Litteratursökningen utfördes i databaserna Cinahl och Medline (PubMed), därefter analyserades artiklarna och sammanställdes i kategorier. Resultatet visade att de friska syskonen behövde få vara delaktiga i sin sjuka broders eller systers omvårdnad. De upplevde ett behov av information om sjukdomen och stöd från omgivningen samtidigt som de upplevde olika känslor som ilska, oro, avundsjuka etc. när deras bror eller syster drabbades av cancer. De friska syskonen upplevde även att relationen till föräldrarna och den sjuka brodern eller systern påverkades av sjukdomen, därför var det vikigt för dem att inte bli separerade från sin familj. Slutsatsen var att friska syskon hade olika behov av information, stöd och delaktighet när deras bror eller syster drabbades av cancer. Friska syskons upplevelse är ett outforskat område varför det finns behov av ytterligare forskning där fokus ligger på gruppen friska syskonen. Detta skulle bidra till ökad kunskap hos sjuksköterskor vilket i sin tur skulle kunna användas till att guida det friska syskonet till att bemästra den svåra situationen. / The purpose of this study was to describe the experience of healthy siblings when their brother or sister gets affected by childhood cancer. The method being used was a describing literature study that was based upon 11 scientific articles with a qualitative approach. The literature search was performed in the databases Cinahl and Medline (PubMed). The articles were analyzed and compiled into categories. The result showed that the healthy siblings needed to be part of their ill brother’s or sister’s care. They experienced a need to get information about the illness and support from their family and friends all while they were experiencing different emotions like anger, concern, jealousy etc. when their brother or sister got affected by cancer. The healthy siblings also experienced that the relation towards the parents and the sick brother or sister was affected by the illness which made it very important not to get separated from their family. The conclusion was that healthy siblings had different needs of information, support and participation, when their brother or sister got affected by cancer. Healthy sibling’s experience is an unexplored area why there is a need for additional research where the focus is on the group of healthy siblings. This would contribute to an increased knowledge among nurses which in turn could be used to guide the healthy sibling to overcome the difficult situation.

In the present study, a grounded theory approach was employed with the purpose of developing a substantive theoretical model to identify and illustrate changes in sibling relationships after pediatric bone marrow transplantation (BMT). Further investigation of the impact of sibling relationship quality on children's adaptation following this life-threatening medical procedure was examined. Two families, each consisting of a sibling dyad that included a child who received a BMT and a well sibling that ranged in age from 10-14 and a parent, participated in the study. Siblings were interviewed individually, and in the dyad, to capture an insider's view of the sibling relationship after BMT and factors that impact child adaptation to pediatric BMT. Child observational and parent survey data provided a multiple-informant and multiple-method approach which helped to foster a more complete picture of the broader family context. Findings suggest that children's sibling relationships improved after BMT, as evidenced by their building a close relationship, establishing intimacy and gaining trust, and learning to get along and settle differences better. Positive coping strategies included identifying and utilizing supports and resources, praying/prayer, making life easier for the sibling, and redefining what is important in life. Children's individual adaptation outcomes included accepting the illness, recognizing the longevity of the relationship, reducing worry/stress, and moving beyond the illness. Analyses that were grounded in the data from the present study suggest four theoretical propositions. First,children's sibling relationships have the potential for positive change after BMT. Second, close sibling relationships can serve as a buffer, or protective factor, to the adverse conditions and extremely stressful situations encountered after BMT. Third, positive changes in children's sibling relationships after BMT can positively influence children's coping strategies which may have a direct influence on children's adaptation to BMT. The fourth, and primary hypothesis, suggests that positive changes in children's sibling relationships after BMT potentiate new coping strategies in the dyad that are more facilitative to child adaptation than managing stress on one's own. Findings add to the general knowledge on sibling relationships and shed light on the complexities of children's sibling relationships when one child is severely ill.

Survivors of childhood cancer are a relatively new phenomenon in the medical world. The introduction of treatment protocols in the 1970s started a trend in curing children of cancer that historically had been a death sentence. Under these treatment protocols children were given different treatment regimens based on past research that helped remove cancerous cells from their bodies, but were later found to be the cause of treatment related morbidities years into the future; for most survivors roughly ten to 20 years post treatment. These morbidities, commonly called late-effects, are the prime reason that survivors of childhood cancer need to participate in survivorship care. Survivors of childhood cancer are particularly vulnerable to late-effects because the majority of them receive their treatment at a time when their bodies are still growing and developing. Survivorship care services vary by site, but all maintain the common goals of providing long-term follow up for the survivor and education about the ways in which treatments may affect a survivors’ health as they age. Similar to many other facets of healthcare and medicine, there are many populations who do not participate in survivorship care. The purpose of this research is to identify possible barriers to care, assess the level of impact these barriers have upon the survivor’s potential for participation and provide suggestions as to how these barriers can be mitigated. Additionally, this research highlights areas that need further research and analysis.

La tesi esamina le principali rappresentazioni della sofferenza infantile nella società contemporanea, con un affondo sul tema della malattia oncologica che coinvolge un bambino e la sua famiglia. L’indagine si propone di offrire ai genitori la possibilità di esprimersi in merito alle modificazioni dei propri stili educativi che la malattia e l’ospedalizzazione comportano. L’idea consiste nel dedicare ai genitori del tempo per offrire loro uno spazio di pensiero in merito alle modificazioni avvenute negli equilibri familiari e supportarli nell’individuare una nuova progettualità familiare. Accompagnare i genitori ad assumere consapevolezza del cambiamento personale e della coppia genitoriale verificatosi durante la degenza ospedaliera del figlio significa anche aiutarli a identificare nuove modalità di interazione con i figli, sulla scorta dei significati dell’esperienza attraversata. Significa inoltre aiutare gli operatori sanitari a percepire i genitori come persone competenti nella gestione educativa del figlio e pertanto a migliorare costantemente la presa in carico non solo del bambino, ma anche della sua famiglia. L’indagine in generale, la flessibilità degli strumenti in particolare, ha permesso di raggiungere gli obiettivi prefissati. / The purpose of this research is to examine the nature of the experiences of parents of children with cancer. In fact, childhood cancer is a potentially life-changing experience for mothers and fathers. Overall, the research move in terms of theoretical reflection and empirical research. The study explore the main representations of the suffering of children in contemporary society, with special attention to the suffering due to oncological disease. Also, the research explore the influences of the hospital context on the members of the family, intending only not the physical environment, but also the figures of various kind that are daily reported with their. The investigation in general, the flexibility of the tools in particular, has allowed the parents to comment on the changes of their educational styles that illness and hospitalization cause.

The main purpose of the study was to investigate whether illness-related factors predict marital adjustment in parents of children with cancer. The sample consisted of parents of hospitalized children, parents of children receiving outpatient treatment, and parents who brought their children for their routine controls ith a total of 105 mothers and fathers. The data were gathered by administering the Dyadic Adjustment Scale and Demographic, Illness- and Caregiver- Related Information form. Findings suggested that number of previous hospitalizations and support from spouse predict marital adjustment in parents of children with cancer. However, when the subscales were analyzed seperately, different predictors emerged. Number of previous hospitalizations predicted Dyadic Consensus, relapse and support from spouse predicted Dyadic Satisfaction, and currently receiving treatment and support from spouse predicted Dyadic Cohesion. No predictors for affectional Expression could be found. When only the parents of children currently receiving treatment are selected for analysis, the predictors do not change for Dyadic Satisfaction. However for Dyadic Cohesion, both parents as caregivers emerges as a predictor along with support from spouse. Single variables correlate significantly with the DAS Score, Dyadic Consensus and Affectional Expression. They are support from spouse for the DAS Score and Dyadic Consensus, and length of marriage for Affectional Expression.

In Australia, up to 80% of individuals diagnosed with childhood cancer are now expected to survive for more than five years after their initial diagnosis. However, survivors of childhood cancer are at risk of developing late sequelae as a consequence of therapies received during childhood. The aim of this study was to determine the incidence of selected late sequelae in a cohort of Australian childhood cancer survivors and identify treatment and genetic factors that may modify the risk of late sequelae in survivors. Our study included 1150 individuals treated for childhood cancer at the Sydney Children??s Hospital between 1962 and 1999, who had remained in remission >3 years and were confirmed to be alive. Rates of mortality and second cancers among survivors were compared against population rates to determine standardised mortality and incidence ratios. Survivors completed a questionnaire on the incidence of adverse health conditions and provided a buccal specimen. Real time PCR was used to detect polymorphisms in genes involved in drug detoxification and transport. Rates of mortality and secondary cancers were found to be 7.5-fold (95%CI 5.4-10.1) and 4.9-fold (95%CI 2.9-8.0) higher among survivors of childhood cancer relative to the general population, respectively, with the highest risks observed for those survivors previously treated for Hodgkin??s disease. Over 60% of survivors reported at least one cardiopulmonary, endocrine or sensory-motor condition following diagnosis of childhood cancer; the most frequently observed conditions included growth hormone deficiency, hypothyroidism, and hypertension. Late sequelae were most frequently reported by females and survivors of brain tumours. Genetic investigations showed that an increased risk of growth hormone deficiency was associated with homozygosity for the GSTM1 null polymorphism, while no gene associations were observed to influence the risk of second cancers among survivors. Our study demonstrates that survivors of childhood cancer are at risk of developing a variety of health conditions as a result of anti-cancer therapies received during childhood. Determining risk factors for late sequelae based on therapy type, lifestyle and genetic predisposition will enable the optimisation of treatment protocols and promote the future well-being of childhood cancer survivors.

In Australia, up to 80% of individuals diagnosed with childhood cancer are now expected to survive for more than five years after their initial diagnosis. However, survivors of childhood cancer are at risk of developing late sequelae as a consequence of therapies received during childhood. The aim of this study was to determine the incidence of selected late sequelae in a cohort of Australian childhood cancer survivors and identify treatment and genetic factors that may modify the risk of late sequelae in survivors. Our study included 1150 individuals treated for childhood cancer at the Sydney Children??s Hospital between 1962 and 1999, who had remained in remission >3 years and were confirmed to be alive. Rates of mortality and second cancers among survivors were compared against population rates to determine standardised mortality and incidence ratios. Survivors completed a questionnaire on the incidence of adverse health conditions and provided a buccal specimen. Real time PCR was used to detect polymorphisms in genes involved in drug detoxification and transport. Rates of mortality and secondary cancers were found to be 7.5-fold (95%CI 5.4-10.1) and 4.9-fold (95%CI 2.9-8.0) higher among survivors of childhood cancer relative to the general population, respectively, with the highest risks observed for those survivors previously treated for Hodgkin??s disease. Over 60% of survivors reported at least one cardiopulmonary, endocrine or sensory-motor condition following diagnosis of childhood cancer; the most frequently observed conditions included growth hormone deficiency, hypothyroidism, and hypertension. Late sequelae were most frequently reported by females and survivors of brain tumours. Genetic investigations showed that an increased risk of growth hormone deficiency was associated with homozygosity for the GSTM1 null polymorphism, while no gene associations were observed to influence the risk of second cancers among survivors. Our study demonstrates that survivors of childhood cancer are at risk of developing a variety of health conditions as a result of anti-cancer therapies received during childhood. Determining risk factors for late sequelae based on therapy type, lifestyle and genetic predisposition will enable the optimisation of treatment protocols and promote the future well-being of childhood cancer survivors.

Meduloblastoma é o tumor maligno intracranial mais comum em crianças. A desregulação da sinalização BDNF/TrkB tem sido associada a aumento da proliferação, invasão e resistência a quimioterapia, em diversos tipos de câncer, incluindo tumores de sistema nervoso. No entanto, seus efeitos biológicos e relevância clínica em meduloblastoma não estão compreendidos. Neste estudo foram analisados os efeitos do inibidor seletivo de TrkB, ANA-12, na viabilidade, sobrevivência e ciclo celular de linhagens de meduloblastoma humano. Este estudo demonstrou que o bloqueio seletivo de TrkB reduziu significativamente a viabilidade e sobrevivência de linhagens celulares representativas de diferentes subgrupos moleculares de meduloblastoma. Estes resultados fornecem uma base racional para investigar a inibição de TrkB como uma nova e potencial estratégia para o tratamento de meduloblastoma. / Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Deregulation of BDNF/TrkB signaling has been associated with increased proliferative capabilities, invasiveness and chemo-resistance in several types of cancer. However, the relevance of this pathway in MB remains unknown. Here, we show that the selective TrkB inhibitor ANA-12 markedly reduced the viability and survival of human cell lines representative of different MB molecular subgroups. These findings provide a rationale to further investigate TrkB inhibition as a potential novel strategy for MB treatment.

Meduloblastoma é o tumor maligno intracranial mais comum em crianças. A desregulação da sinalização BDNF/TrkB tem sido associada a aumento da proliferação, invasão e resistência a quimioterapia, em diversos tipos de câncer, incluindo tumores de sistema nervoso. No entanto, seus efeitos biológicos e relevância clínica em meduloblastoma não estão compreendidos. Neste estudo foram analisados os efeitos do inibidor seletivo de TrkB, ANA-12, na viabilidade, sobrevivência e ciclo celular de linhagens de meduloblastoma humano. Este estudo demonstrou que o bloqueio seletivo de TrkB reduziu significativamente a viabilidade e sobrevivência de linhagens celulares representativas de diferentes subgrupos moleculares de meduloblastoma. Estes resultados fornecem uma base racional para investigar a inibição de TrkB como uma nova e potencial estratégia para o tratamento de meduloblastoma. / Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Deregulation of BDNF/TrkB signaling has been associated with increased proliferative capabilities, invasiveness and chemo-resistance in several types of cancer. However, the relevance of this pathway in MB remains unknown. Here, we show that the selective TrkB inhibitor ANA-12 markedly reduced the viability and survival of human cell lines representative of different MB molecular subgroups. These findings provide a rationale to further investigate TrkB inhibition as a potential novel strategy for MB treatment.