Background: When a child is diagnosed with cancer, parents are very affected. This requires nurses to consider the needs of the entire family. A good understanding of parents’ experiences in this situation can help nurses support them through this tough period. Aim: The purpose of this study was to describe parents’ experiences when their child was diagnosed with cancer. Method: The method used is an integrated summary of qualitative research inspired by metasynthesis (Friberg, 2022a). The analysis of ten scientific articles resulted in three themes and eleven subthemes. Results: The three themes were; An emotional roller coaster, A new reality, The significance of support. The result indicates that parents are significantly affected when their child is diagnosed with cancer. The emotions that arose were many and varied, which made support from others necessary. Conclusion: The nurse have a crucial role for the parents and can contribute in a variety of ways to ease the situation and enhance well-being. It is important to involve the parents and see the family as a unit through family-centered care. A strong relationship between the nurse, child and parents contributes to ease the parents' experience during their child's time of illness. / Cancer omfattar olika sjukdomar som orsakats av okontrollerad celldelning- och tillväxt. Barncancer är en cancerform som drabbar cirka 350 barn om året i Sverige. Examensarbetet beskriver föräldrars erfarenheter när barnet drabbats av cancer. Det framkom att föräldrarna påverkades i stor utsträckning och att känslorna var många och varierande.  I resultatet framkom att det kan kännas svårt att se ljuset i livet och att påträngande känslor av oro ständigt existerade. Den känsla som beskrevs mest utmanande var rädslan att förlora sitt barn. Lidande i olika former var framträdande genom hela sjukdomstiden och yttrade sig genom att föräldrar kände hjälplöshet, otillräcklighet och känslor av skuld. Föräldrarna poängterade vikten av att få individualiserad och adekvat information från vårdpersonalen då brist på information bidrog till ökad osäkerhet. Att som sjuksköterska kunna möta både barn och föräldrar var något som framkom som en viktig aspekt. Vikten av ett gott bemötande och stöd genomsyrade resultatet vilket styrker vikten av att tillgodose hela familjens behov. Det framkom att engagerade sjuksköterskor som visade empati var värdefullt och kontinuitet av samma sjuksköterska var uppskattat. Barnets sjukdomstid var en stor påfrestning och kunde ses som ett hot för familjens trygga vardag. Detta kunde upplevas som en splittring av familjen då de många gånger var tvungna att leva åtskilda. Den psykiska påfrestningen hos föräldrarna kunde också medföra olika aspekter som påverkade familjens vardag. Vissa familjer kunde uppleva stärkta relationer och tiden tillsammans sågs som värdefull. Det framkom även nya prioriteringar och värderingar om vad som ansågs vara viktigast i livet, liksom upprätthållande av hälsa. Det blev lättare att se lyckan i små saker i livet. Slutsatser som kan dras är att sjuksköterskan har en viktig roll och kan göra mycket för att öka välbefinnandet hos föräldrarna under den tuffa tiden. Familjecentrerad vård kan vara en god grund för att involvera hela familjen i vårdprocessen.

Introduktion: Varje år insjuknar ungefär 350 barn i cancer i Sverige. När ett barn får cancer väntar en intensiv tid med tuffa behandlingar. Vardagen ändras drastiskt, inte bara för barnet som drabbats utan för hela familjen. För föräldrarna är det en påfrestande situation och sjuksköterskan har en viktig roll för att lugna osäkerheten och oron hos dem. Syfte: Syftet med litteraturöversikten var att undersöka föräldrars upplevelser av att leva med ett cancersjukt barn. Metod: En litteraturöversikt med deskriptiv design användes. Resultatet baserades på kvalitativa originalartiklar. Kvalitetsgranskning av studierna utfördes med SBU:s granskningsmall för kvalitativ metodik och resultatet analyserades sedan med hjälp av Fribergs analysmodell. Resultat: Resultatet mynnade ut i tre huvudkategorier; emotionell påverkan, förändringar i vardagen och stöd med totalt åtta underkategorier. Föräldrarna upplevde många olika känslor som oro, stress, hopplöshet och skuldkänslor, och även fysiska symtom uppkom. Många upplevde att sjukdomen även medförde ekonomiska svårigheter. Sjukdomen gav föräldrarna nya perspektiv samt en förändrad syn på livet och relationerna inom familjen förändrades på olika sätt. Praktiskt och socialt stöd från både anhöriga och vårdpersonal var betydande för att underlätta de svårigheter som barnets cancersjukdom medförde. Slutsats: Föräldrar till barn med cancer beskrev främst negativa, men även några positiva, upplevelser till följd av sjukdomen. De genomgick emotionella, sociala och vardagliga påfrestningar och stöd från sjukvårdspersonalen var viktigt för att minska stress och oro som sjukdomen medförde. Bemötandet från sjuksköterskan är därmed en viktig faktor för föräldrarnas upplevelser av barncancer. / Introduction: Every year around 350 children are diagnosed with cancer in Sweden. After the diagnosis, a difficult time with severe treatments awaits. The everyday life drastically changes, not only for the affected child, but for the whole family. It's a stressful situation for the parents' and the nurses have an important role in order to calm them. Aim: The aim of this literature review was to study parents' experiences of living with a child affected by cancer. Method: A literature review with a descriptive design was used. The results were based on original qualitative articles. The articles were qualitatively reviewed using the SBU's review template for qualitative methodology and thereafter analyzed using Friberg's analysis model. Results: The result was condensed into three main categories; emotional impact, changes in everyday life and support with a total of eight subcategories. The parents experienced many different emotions such as worry, stress, hopelessness and guilt, and physical symtoms also appeared. Many felt that the disease also brought financial difficulties. The illness gave the parents new perspectives and a changed outlook on life, and the relationships within the family changed in different ways. Practical and social support from both relatives and healthcare professionals was significant in easing the difficulties caused by the child's cancer. Conclusion: Parents of children with cancer had mainly negative, but also some positive, experiences as a result of the disease. They experienced emotional, social and everyday stresses and support from the healthcare staff was important to reduce the stress and anxiety that the disease brings. The reception from the nurse is therefore an important factor for the parents' experiences of childhood cancer.

Bakgrund Varje år dör mer än 80 000 barn över hela världen av sin cancer. Föräldrarnas tillvaro vänds upp och ner efter förlusten där ett flertal faktorer påverkar. Sorg och lidande blir en stor del av deras liv. Livssituationen utmanas och föräldrarnas behov av stöd både från familj och vänner samt vårdpersonal blir omfattande. Syfte Syftet var att belysa föräldrars upplevelse av att förlora ett barn i cancersjukdom. Metod En icke-systematisk litteraturöversikt valdes som design för detta arbete och baserades på 15 artiklar med kvalitativ, kvantitativ och mixad ansats. Artiklarna söktes fram i databaserna PubMed och CINAHL. En kvalitetsgranskning enligt Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet utfördes på artiklarna. En integrerad dataanalys användes för att sammanställa och analysera resultatet. Resultat Dataanalysen resulterade i tre kategorier: Förlusten av ett barn, Faktorer som påverkar sorgearbetet och Upplevelser av vården. Resultatet visade att upplevelsen av att förlora ett barn i cancer innebär en tung sorg. Att få stöd från sociala nätverk, stödgrupper och minnet av barnet hjälpte sorgearbetet, samt att engagera sig i aktiviteter och religiösa sammanhang. En god relation till vårdpersonal var viktig för att lindra sorgen. Andra viktiga faktorer var att vårdpersonalens kommunikation var av hög kvalitet och att deras information var ärlig och utförlig. Slutsats Denna litteraturöversikt visar att föräldrarna upplever en svår sorg efter deras barns bortgång, som yttrar sig genom psykosociala svårigheter. Ett flertal omständigheter påverkade sorgearbetet positivt och vårdpersonalens relation till föräldrarna var viktig. Genom en ökad kunskap om föräldrarnas behov av utförlig och ärlig kommunikation, samt värdet av att informera om de olika faktorerna som kan hjälpa sorgearbetet, kan vården förbättras och de negativa påföljder som föräldrarna upplever kan mildras. / Background Every year, more than 80,000 children worldwide pass away from cancer. The lives of the parents are turned upside down after the loss, influenced by various factors. Grief and suffering become a large part of their lives. The life situation becomes challenging, and the parents’ need for support from family, friends, and healthcare professionals, becomes extensive. Aim The aim was to illustrate parents’ experience of being bereaved of a child to cancer. Method A non-systematic literature review was chosen as the design for this study, based on 15 articles with qualitative, quantitative, and mixed approaches. The articles were identified in the databases PubMed and CINAHL. A quality review, following the assessment criteria for scientific classification and quality at Sophiahemmet University, was conducted. An integrated data analysis approach was used to compile and analyse the results. Results The data analysis resulted in three categories: The loss of a child, Factors influencing the grieving process and Experiences of healthcare. The results indicated that the experience of losing a child to cancer entails heavy grief. Receiving support from social networks, support groups, and cherishing memories of the child aided the grief process. Engagement in activities and religious contexts also played a role. A positive relationship with healthcare professionals was crucial for alleviating grief, with high-quality communication and honest, detailed information being important. Conclusions This literature review revealed that parents experience profound grief following the loss of their child, manifested through psychosocial challenges. Several circumstances positively influenced the grieving process, and the healthcare professionals’ relationship with the parents was crucial. Through increased understanding of the parents’ need for comprehensive and honest communication, as well as the value of informing about the factors that can aid the grieving process, healthcare can be improved, and the negative consequences experienced by the parents can be alleviated.

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The number of children and young adolescents diagnosed with cancer is increasing, leading to a need for new therapeutic strategies with diminished neurodegenerative side- effects. This report presents preliminary observations on glioma-initiating cells (GICs) in the way to develop a strategy that induces cell-cycle arrest or quiescence in neural stem cells (NSCs). To test how changes in membrane potential due to pharmacological treatments have effects on localization and levels of REV-ERBα protein, proneural (PN) and mesenchymal (MES) cells were treated with varying concentrations of REV-ERBα agonist SR9009 drug and T-type calcium channel blocker mibefradil. Treatments showed that both drugs do not relocalize REV-ERBα to the nucleus. However, SR9009 decreases the levels of REV-ERBα protein, whereas mibefradil does not have a similar effect.  Our preliminary data on mouse NSCs showed they engage with REV-ERBα protein while going into contact inhibition. Therefore, we investigated whether high confluency put PN and MES GICs into quiescence and the role of the main molecular clock protein REV-ERBα in this process. Cells were grown up to certain confluency, and following qPCR gene expression analysis revealed PN cells go into contact inhibition whereas MES cells continue proliferating even after they are grown to confluency. Moreover, REV-ERBα protein does not have any role in both outcomes.

<p>Traditionally, measures have been developed using Classical Test Theory (CTT). Modern psychometric methods (e.g. Rasch analysis) are being applied to increase understanding of item-level statistics and to aid in interpreting rating scale scores. This thesis aims to compare and contrast psychometric findings for the PedsQL^TM 4.0 Generic Core Scales using CTT and Rasch analysis to determine if a Rasch approach provides information that furthers our understanding of scale scores. The assumptions, advantages and limitations of each psychometric paradigm are presented.</p> <p>Issues that arise when measuring quality of life are discussed to set the stage for a psychometric analysis of the PedsQL^TM in a childhood cancer sample. The PedsQL^TM measures child health in terms of physical, social, emotional and school function. The parent-report version was used in a Canadian study of 385 parents of children aged 2 to 17 years on active cancer treatment and data was re-analyzed for this thesis. CTT analysis was performed using PASW Statistics and Rasch analysis was performed using Rumm2030.</p> <p>Internal consistency reliability was higher using CTT (a = 0.93) than Rasch analysis (Person Separation Index = 0.78). Rasch analysis item curves showed respondents did not discriminate between response categories and a 3 point scale (vs. 5) was preferred. Item curves also indicated most items were free of bias. There are no equivalent visual representations in CTT of how respondents use response categories or of whether items display bias. Both approaches indicate a large ceiling effect associated with the overall score.</p> <p>Results challenge internal consistency reliability of the PedsQL^TM 4.0. Rasch analysis permits detailed and visually pleasing examination of item-level statistics more effectively than CTT. Research is needed to determine which testing circumstances render Rasch analysis useful and justify time and resources to use both paradigms as complementary tools to maximize understanding of rating scale scores.</p> / Master of Science Rehabilitation Science (MSc)

Childhood cancer is a life-threatening disease with a profound impact on the family. Treatment side-effects and accompanied dietary difficulties are for example severe stressors, as appropriate nutrition is important for the treatment success and quality of life. In addition, (unhealthy) dietary patterns established in childhood tend to maintain in survivors. Parents are key players in feeding and establishing these pat-terns, though, systematic research on how parents experience these dietary difficulties is limited. This study aimed at exploring parental experiences of children’s dietary changes and difficulties during cancer treatment and after completion: what feelings do parents experience regarding their child’s dietary changes and difficulties, what feeding strategies to they apply to handle these difficulties, and how did they experience professional support and what are parental support needs. A systematic literature review was conducted and resulted in 21 suitable articles. The children were 0-21 years old, had various types of cancer, and received various types of therapy. Findings showed that parents reported many dietary changes (e.g. increase or decrease in food intake) and associated symptoms (e.g. nausea, changed tastes) during and after the cancer treatment course. Parents reported mainly negative feelings towards these dietary difficulties (e.g. distress and anxiety) and applied a wide range of behavioural feeding strategies, both negative (e.g. pressure to eat) and positive (e.g. provide healthy food) strategies. Parents also used complementary and alternative medicine. A high need for informational support regarding eating and feeding was expressed by parents during treatment, a need for emotional and practical support to a lower extent. These results showed how frequent and profound eating and feeding difficulties are in the childhood cancer and survivor population, and their (negative) impact on parents. Parents consequently need more support: they need oral and written information to set realistic expectations and install appropriate feeding strategies. This is important for the child’s nutritional status and general health both during and after cancer.

Studiens syfte var att undersöka hur musikterapeuters arbete fungerar inom barncancersjukvård. Hur kan musikterapi påverka cancersjuka barn och vilka resultat man kan se. Undersökningen genomfördes med intervjuer med tre verksamma musikterapeuter. I metoden tillämpades en hermeneutisk tolkningsansats med kvalitativa forskningsintervjuer och med en narrativ forskningsmetod. Musikterapi är evidensbaserad inom forskning, ett akademiskt ämne och ett professionellt yrke. Kan även definieras som en konstnärlig terapiform, som bygger på musikupplevelse, musikaliskt skapande och uttryck, kommunikation och samspel som erbjuds i relation mellan patient och terapeut. Resultatet belyser musikterapeuters uppdrag, vilket är ett mycket varierande och flexibelt arbete. Via musikens verktyg och redskap; skapa kontakt, bygga relation, utveckla kommunikation, icke-verbalt, improvisera, se och bekräfta, stärka och dela tillsammans. Musikterapi grundar sig på den psykodynamiska inriktningen inom utvecklingspsykologin, att observera och forska om ett barn i relation till dess omgivning. Musikterapiuppdraget fungerar som en kompletterande behandlingsform inom barncancersjukvård. Musikens förmåga och egenskaper kan bidra till att förstärka en patients egna personliga resurser, skapa utrymme och ge möjlighet till känslomässiga uttryck, hantering och bearbetning av ett barns svåra cancersjukdom och dess sjukhusvistelse. Utifrån intervjuerna av musikterapeuterna och deras berättelser har både signifikanta och positiva resultat har kunnat belysas i denna studie. / The purpose of this study was to examine how music therapists work with children who have cancer. How does music therapy affect the children, and what are the results. The study was made by interviewing three active music therapists. The method I used was a hermeneutic interpretation with qualitative research interviews and with a narrative method. Music therapy is evidence based in research, an academic major and profession. It can also be defined as an artistic form of therapy, where music is used as a mean for experience, creativity, expression and communication between patient and therapist. The result highlights the mission for the therapist, which is very flexible and varying, where flexibility and responsiveness is of great importance; by the tools of music create a sense of contact and communication, nonverbal, improvise, watch and confirm, strengthen and sharing. Music therapy is based on the psychodynamic alignment within developmental psychology, to observe and do research about a child relation to his or her environment. Music therapy also works as an addition to regular medical treatment within cancer care for children. The ability and characteristics of music contributes to strengthen a patient own resources, opens up ways for emotional expression in the process of working with a child with cancer disease and his or her hospitalization. Based on the interviews of the music therapists and their stories, both significant and positive results are illustrated in this study.

<b><u>Introduction:</b></u> Some cancer survivors are known to have an elevated risk of morbidity and mortality from cardiovascular disease. An important cause of this elevated risk is recognised to be irradiation of normal tissues during radiotherapy received as part of cancer therapy. There are substantial difficulties in studying radiation-related cardiovascular disease (RRCD). The reasons for this include the complexities of measuring radiation normal tissue doses retrospectively and the prolonged latencies of many of the cardiovascular endpoints. A variety of complimentary research methodologies can help provide additional knowledge to guide the appropriate management of patients treated in the past and of new patients in the future. <b><u>Methods:</b></u> 1) A cohort study of mortality from circulatory disease in the nationwide British Childhood Cancer Survivor Study (BCCSS). 2) A case-control study of valvular heart disease (VHD) in Dutch Hodgkin lymphoma (HL) survivors, including retrospective radiation dosimetry to estimate the radiation dose to heart valves. 3) A dosimetric study of cardiovascular radiation doses in patients entered into the UK NCRI Lymphoma Study Group RAPID trial, including predictions of 15-year cardiac mortality using innovative methods. 4) A modelling study to predict mean whole heart dose (MWHD) from involved field radiotherapy (IFRT) for HL using anatomical measures. 5) A prospective study using cardiovascular magnetic resonance (CMR) imaging to characterise the heart in women receiving radiotherapy for breast cancer. <b><u>Results:</b></u> 1) The risks of all types of circulatory mortality are elevated in survivors of childhood cancer. The absolute excess risks continue to increase 40+ years following diagnosis. The risk of death from cardiomyopathy and heart failure increased substantially with the introduction of anthracycline chemotherapy. There is no evidence of a reduction in risk of circulatory mortality in more recent eras of diagnosis. 2) There is a strong relationship between estimated radiation dose to the affected heart valve and the risk of subsequent VHD (p<0.001). This effect was modelled to allow prediction of the risk of VHD. 3) A proportion of patients treated with IFRT received a substantial cardiac radiation dose (MWHD = 8.8 Gy, SD = 5.6) but, on average, the predicted 15-year cardiac mortality following treatment is low (absolute risk 0.2%, range 0.0 to 2.7%). 4) It is possible to estimate the mean whole heart dose from IFRT prior to detailed radiotherapy planning based on pre-treatment diagnostic imaging to an accuracy of 5-6% of the prescribed dose. 5) Although women received low cardiac doses (MWHD = 1.5 Gy, SD = 0.8) and have a low predicted risk of cardiac radiation-related morbidity and mortality, there is some evidence of subclinical effects on strain and strain rate imaging of the anterior portions of the left ventricle that receive the highest radiation dose. <b><u>Conclusions:</b></u> Using a variety of methods these studies have all succeeded in adding to knowledge about the nature, magnitude and timing of RRCD. This knowledge can be used to help the future management of cancer patients. In addition, each of the studies has natural and planned extensions and will continue to contribute further knowledge into the future.