Guided Imagery and Relaxation Audio for Children with Cancer: Development and Evaluation

The study aims to develop, validate and evaluate a Guided Imagery and Relaxation (GIR) audio in Bahasa Malaysia, serving as one of the coping tools for children with cancer. Based on extensive review, GIR script was developed by a clinical psychologist. Panels of experts including pediatric oncologists and psychiatrists conducted initial assessment at multiple stages of hearing sessions. The final version of the audio was pre-recorded in MP3 player for evaluation. Face and content validation of 3 × approximately 5 minutes duration of GIR audio series were obtained via experts’ reports. Twenty-three participants (5 adults, 18 children with cancer) listened to the audio and completed evaluation form. All adult evaluators gave positive remarks on the script, narration and recording quality. As for the children, 100% completed audio-hearing and majority (66.7% - 88.9%) were able to imagine well without falling asleep and in some way were positively affected by the imagery-induced relaxation audio. Majority was not disturbed during the hearing sessions (66.7%), will hear it again (83.3%) and found it enjoyable (88.8%). This is the first known study developing GIR audio in Bahasa Malaysia which is feasible, enjoyable and beneficial for children that warrants efficacy study.

Prevalence of Infectious Complications in Children with Cancer

Background:?Infections are the most common complications during chemotherapy. The trends have been changing over time due to use of multi-agent intensive chemotherapy.?Procedure:?We looked?over?our data to see what complications we get in our patients. The data was collected on patients treated in King Fahad Medical City from July 2009 to Dec 2015.?Results:?We?found that 86 patients had one episode only while 92 had 2 or more episodes reaching up to 11 episodes in 1 patient. We found positive cultures in 17.3% of episodes with staphylococcus as common gram positive and Klebsiella pneumoniae as common gram negative bacteria, respiratory viral infections in 13.8% and GI infections in 9%. We found Candida albicans as the most common fungus while other yeasts followed. Acute lymphoblastic leukaemia was the most common diagnosis. The episodes were associated with neutropenia of 7 days in 1st?episode and 56.8% in cases with repeated episodes. We had 2 deaths one from recurrent infections with CNS (Central Nervous System) damage and one from Pulmonary infections causing pulmonary haemorrhage. We had one with persistent neurological sequele from prolonged fungal infection.?Conclusions:Neutropenia of 7 days came out to be significant risk factors for infection across all diseases. We have an acceptable level of morbidity and mortality due to good supportive services.?We need prospective studies to get an up-to-date picture of our practice.?We need prophylactic antibiotics and antifungals for high-risk patients like AML.

Process of Patients Telling Children about Newly Diagnosed Breast Cancer

Objective: This study aims to determine the process of patients with newly diagnosed breast cancer in Japan telling their children about the disease, and how they have thought about it after the diagnosis. Methods: Semi-structured interviews were conducted with 15 patients with newly diagnosed breast cancer who had 3- to 14-year-old children. Narratives of participants about how they told their children about the disease were analysed by a qualitative and descriptive study design using the Modified Grounded Theory Approach (M-GTA). Results: In the process by which patients with newly diagnosed breast cancer tell their children about the disease, participants were [Maintaining mental balance in the face of the threat of the cancer] after the breast cancer diagnosis, and used the “Facing the cancer through the relationship with the children” as the core category in the process. The participants had [Determined to tell the children about the disease], while [Being worried about the influence of cancer on the children], [Thinking about the benefits of not hiding the cancer], and [Feeling difficulty in communicating the diagnosis of cancer to their children]. They were [Encouraged to tell about the disease to the children] by people around them, and did tell the children that they had a “disease” or “cancer”. The participants who told the children that they had the disease while [Determining the impact on the children] repeated the [Making herself look unconcerned] in the process. Those who told the children that they had cancer while [Determining the impact on the children] repeated [Talking openly about cancer and death] between parents and children. Conclusions: The participants came to face their own cancer by maintaining mental balance in the face of the threat of the cancer and telling their children about the disease. Nurses need to assist these patients to be able to deal openly with their children from the early stage of the diagnosis and solve problems by family members.

Factors Affecting Maternal Coping in Korean Mothers of Children with Cancer

Background: The childhood cancer is increasing throughout the world. The incidence of children and adolescent (1 - 19 years old) mortality by cancer was 4.49 by 2006 (Korea Statistics, 2014). Mothers of children experienced a difficult situation in coping when their children were diagnosed with cancer. Based on Mishel’s Uncertainty in Illness Theory, maternal uncertainty and perceived social support are important factors that may have an impact on maternal coping in mothers of children with cancer. Therefore, it was worth to investigate this phenomenon in the context of Korea where no such study was conducted. Objective: To identify the factors affecting maternal coping in mothers of children with cancer. Methods: The study was conducted by using a descriptive design. This study was approved by the Institutional Review Board, Yonsei Health System, Severance Hospital, Seoul, Korea and informed consent forms were obtained from the participants. Fifty-nine mothers completed three questionnaires: 1) Parent’s Perception of Uncertainty Scale, 2) Multidimensional Scale of Perceived Social Support, and 3) Coping Health Inventory for Parents. The internal consistency of these instruments was satisfactory, all with alpha coefficients over 0.86. Results: Hierarchical multiple regression analysis revealed that perceived social support and maternal uncertainty together explained 35% of the variance in the maternal coping in mothers of children with cancer (R2 = 0.353, F = 15.255, p = 0.000). Perceived social support and maternal uncertainty had an impact on maternal coping. Conclusions: The findings provided information that could be used in a further intervention study to increase maternal coping in mothers of children with cancer.

Quality of Life in Egyptian Children with Cancer

Background and Objectives: Cancer treatments leading to increased survival rates are reported to participate in the creation of debilitating physical and psychosocial deficits for cancer survivors. Measures of health-related quality of life (HRQOL) are designed to tap such consequences of cancer treatment together with the impact of the disease itself. Methods: Parents of 67 included patients aged 8 - 12 years, were asked to complete the parent proxy report of PedsQLTM 3.0 Cancer Module (Arabic version), as well as a separate sheet for socio-demographic data. Results: The ratio of Males to females was 1.8:1 among study patients with a median age of 8 years at diagnosis. Hematological malignancies represented 70.1% of the sample, with the highest proportion for ALL (52.2%). Total QOL showed to be relatively low with mean value of 62.29 for the whole group. Subscales with least scores were for;worry (44.11), perceived physical appearance (50.6), and procedural anxiety (55.34). On the other hand, the best score was 75.98 for communication, followed by 72.63 for cognitive problems. The impacts of some medical and socio-demographic variables on QOL and its subscales were elicited in our results. Conclusion: Increased treatment intensity, long duration of hospital admission, higher frequency of hospital visits, female sex, younger age at diagnosis, and large family size were all associated with a poorer total QOL and/or its subscales among Egyptian pediatric cancer patients.

CCCG-ALL-2015方案治疗儿童急性淋巴细胞白血病复发的危险因素分析

目的分析儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)经中国儿童肿瘤协作组急性淋巴细胞白血病2015方案(Chinese Children's Cancer Group ALL-2015 protocol,CCCG-ALL-2015)治疗后的累积复发率(cumulative incidence of relapse,CIR),并探讨影响复发的危险因素。方法回顾性分析2015年1月—2019年12月接受CCCG-ALL-2015方案治疗的852例患儿的临床资料,计算CIR并分析影响儿童急性B淋巴细胞白血病(B-ALL)复发的危险因素。结果852例ALL患儿中,146例(17.1%)发生复发,8年CIR为(19.8±1.6)%。B-ALL与急性T淋巴细胞白血病患儿的8年CIR比较差异无统计学意义(P>0.05)。146例复发患儿中,复发时间主要集中于极早期(62例,42.5%)和早期(46例,31.5%),极早期单纯骨髓复发42例(28.8%),早期单纯骨髓复发27例(18.5%)。Cox比例风险回归模型分析显示,融合基因MLLr阳性(HR=4.177,95%CI:2.086~8.364,P<0.001)和第46天微小残留病≥0.01%(HR=2.013,95%CI:1.163~3.483,P=0.012)是B-ALL患儿经CCCG-ALL-2015方案治疗后复发的危险因素。结论儿童ALL经CCCG-ALL-2015方案治疗后仍有较高的复发率,以极早期和早期单纯骨髓复发常见;第46天微小残留病≥0.01%、融合基因MLLr阳性与B-ALL复发密切相关。

舒适护理理念下改良体位固定法在癌症患儿腰椎穿刺术中的应用

目的探讨舒适护理理念下改良体位固定法在患儿腰椎穿刺术中的应用效果。方法回顾性分析2020年1月—2023年12月在福建医科大学肿瘤临床医学院/福建省肿瘤医院进行腰椎穿刺术并鞘内注射化疗药的100例肿瘤患儿,根据所在病区不同分为对照组与观察组,各50例。对照组采用传统腰椎穿刺术体位固定模式,观察组采取基于舒适护理下改良体位固定法,即在体位固定带辅助下腰椎穿刺术体位固定模式;2组其余护理方式一致。比较2组患儿术前体位摆放时间、术中调整体位、重复穿刺、术后并发症及体位满意度情况的差异。结果观察组术前体位摆放时间为(102.76±12.09)s,短于对照组的(118.72±23.41)s,差异有统计学意义(P<0.05)。观察组术中调整体位、重复穿刺发生率分别为12.00%、18.00%,低于对照组的82.00%、66.00%,差异有统计学意义(P<0.05)。2组并发症总发生率比较,差异无统计学意义(P>0.05)。观察组对体位的稳定性、舒适性、固定效果、体位(带)的美观、术后恢复情况及整体满意度均优于对照组,差异有统计学意义(P<0.05)。结论在舒适护理理念下,腰椎穿刺术改良体位固定法不但提高腰椎穿刺术患儿的满意度,且缩短患儿腰椎穿刺术术前体位摆放时间,降低术中再次调整体位、重复穿刺率。

不同口腔护理对癌症患儿化疗后口腔黏膜炎防治的网状Meta分析

目的:评价6种口腔护理方法对于癌症患儿化疗后口腔黏膜炎防治效果,为防治癌症患儿化疗后口腔黏膜炎及提升其远期生存质量提供依据。方法:检索中英文数据库中关于防治癌症患儿化疗后口腔黏膜炎的随机对照试验,检索时间为建库至2023年5月31日,由2名研究者独立进行检索及资料提取。采用ADDIS1.16.1软件进行网状Meta分析。结果:共纳入文献21篇。Meta分析结果显示,使用醋酸氯己定溶液漱口为降低癌症患儿化疗后口腔黏膜炎发生率的最佳选择;低剂量激光疗法对于降低癌症患儿化疗后口腔黏膜炎发生率、严重口腔黏膜炎发生率,缩短口腔黏膜炎愈合时间三者综合效果最好;涂抹蜂蜜在缩短癌症患儿化疗后口腔黏膜炎愈合时间方面效果最优。结论:不同的口腔护理方法在防治口腔黏膜炎上各具优势,临床上应针对癌症患儿化疗后口腔黏膜炎的不同分期有针对性地选择防治方案,以期有效地预防和快速地治愈其口腔黏膜炎。

家族聚集性肝癌患者子女心理体验的现象学研究

目的 了解家族聚集性肝癌患者子女的心理体验,为提供针对性护理干预提供理论依据。方法 运用质性研究中的现象学研究方法,2023年1月至2024年4月以目的抽样法选取天津某三级甲等专科医院家族聚集性肝癌患者的子女16名为研究对象,并对其进行深入访谈,采用主题分析法进行归纳分析并提炼主题。结果 共提炼出多源负性心理体验、预防家族聚集性肝癌的策略、综合支持需求等3个主题和12个亚主题。结论 家族聚集性肝癌患者子女心理负担较重,存在多种需求;医护人员应关注其心理体验与需求,采取多渠道、多途径的综合干预策略及措施,帮助其缓解心理压力。

超声诊断儿童膀胱低度恶性潜能乳头状尿路上皮肿瘤1例

患儿男,12岁,血尿1周就诊。首次超声检查显示膀胱三角区一约3.6cm×2.7cm×2.3cm的中等回声肿块,边缘不规则呈“珊瑚状”,向膀胱腔内凸起(图1),CDFI显示肿块内丰富血流信号,RI:0.52。术中见膀胱三角区于右侧输尿管开口外上方一菜花状(或水草样)肿物,大小约4cm×3cm×2cm,蒂宽约1.0cm,肿物来自膀胱粘膜层,完全剔除膀胱肿瘤,肌层未见明显受侵。病理诊断:膀胱低度恶性潜能乳头状尿路上皮肿瘤。患儿术后1年6个月后再次出现血尿症状1周就诊,二维超声显示膀胱后壁两个分别约0.8cm×0.6cm×0.5cm、0.6cm×0.5cm×0.5cm的高回声结节(图2),三维超声显示膀胱内多发散在分布的结节样回声肿块向膀胱腔内凸起,形态不规则,呈“菜花”状,局部呈索条状隆起(图3),周围粘膜面粗糙;膀胱镜检查可见膀胱后壁、右侧壁见多发散在分布的“菜花样”肿物凸于膀胱内,恰似“漂浮的水草”(图4)。

肿瘤患儿照护者对选择长期静脉导管置管决策体验的质性研究

目的探讨肿瘤患儿照护者对选择中心静脉置管的决策体验,为制定决策辅助策略提供依据。方法采用现象学质性研究方法,以目的抽样法选取肿瘤患儿照护者17人进行半结构式访谈,采用Colaizzi资料分析法对访谈资料进行分析。结果共提炼出3个主题和6个亚主题,分别为决策前积极准备与消极应对共存(迷茫无助、积极应对)、决策中医生主导与共享决策共存(医生主导决策、共享决策)、决策后获益庆幸与反思后悔共存(获益庆幸、后悔担心)。结论肿瘤患儿照护者在选择静脉导管置入时的决策体验复杂、决策参与度不高;医护人员应关注其参与共享决策意愿及影响因素,并予以针对性干预,提升其共享决策参与意愿。

抚养未成年子女的乳腺癌患者育儿干预研究的范围综述

目的归纳和总结抚养未成年子女的乳腺癌患者育儿干预的基本内容及干预效果。方法以JBI发布的范围综述指南为方法学框架,检索中国知网、万方数据、维普网、中国生物医学文献服务系统、PubMed、Embase、Cochrane Library、CINAHL、PsycINFO、Web of Science等数据库,检索时限为建库至2023年11月30日。对纳入文献进行归类和分析。结果共纳入14篇文献,抚养未成年子女的乳腺癌患者育儿干预研究涉及针对乳腺癌患者、未成年子女及其配偶的干预,干预内容包括亲子交流指导、情绪管理指导、加强社会支持、自我效能感培训、健康知识教育及亲子相处指导等;育儿干预的频次、时间存在较大差异;育儿干预可改善患者的育儿能力、亲子沟通能力以及其未成年子女的情绪行为问题等。结论针对乳腺癌患者及其未成年子女开展的育儿干预内容、干预形式仍有待完善和优化,需重视以家庭为中心,并进一步探索基于互联网及针对特殊患者群体个性化的干预方案,以提升育儿干预效果。

儿童癌症幸存者体力活动研究进展

文章系统回顾了儿童癌症幸存者体力活动的相关研究,对儿童癌症幸存者体力活动的现状、影响因素和干预措施等进行综述,以期为儿童癌症幸存者体力活动的干预研究和护理实践提供参考。

癌症儿童多症状测评工具的范围综述

目的 比较国内外用于癌症患儿的多症状测评工具,为癌症患儿症状管理提供参考。方法 计算机检索PubMed、Web of Science、EMbase、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,查找用于测评癌症患儿多症状评估的工具,检索时限为从建库至2022年9月。提取各工具的条目数、信效度、评分方法、适用对象等信息,对纳入工具进行描述。结果 最终纳入9个持续性评估工具,共28篇全文文献,其中9篇关于评估工具的开发、19篇关于评估工具的运用。结论 目前癌症患儿的多症状测评工具良莠不齐,有必要开发针对不同群体的多症状群测评工具,以保证动态追踪患儿的症状变化,拟订干预措施,促进癌症患儿的症状管理。

儿童肿瘤患者营养筛查量表的应用和筛选

营养不良降低儿童肿瘤患者的生命质量,增加其术后医院感染的风险。针对这一问题,尽早对儿童肿瘤患者进行营养筛查,并对存有营养不良风险的患儿采取干预措施,对预防营养不良及相关并发症极为重要。在我国,儿童肿瘤患者营养不良率相对较高,而肿瘤的类型、分期及治疗方案的个体差异性等多重因素,增加了评估儿童肿瘤患者是否营养不良的复杂性。目前,多数研究采用国外的营养风险评估量表,不同量表之间的结果难以统一和比较。因此,制订一套针对性强、适用于我国国情的临床营养筛查量表成为迫切需求。本文通过对比国内外当前儿童营养筛查量表的筛查目标、适用人群、评估内容、评分标准、实际应用、使用限制及效果评估方面的异同,归纳总结各自的优缺点,提出对现有量表的改进建议及制订适用于我国儿童肿瘤患者营养筛查量表的意见,旨在推进我国儿童肿瘤患者营养筛查量表的制订和应用。

心理韧性在肿瘤患儿父母疾病不确定感和医学应对方式间的中介效应分析

目的探讨心理韧性在肿瘤患儿父母疾病不确定感和医学应对方式间的中介效应。方法选取2020年9月至2021年8月在重庆大学附属肿瘤医院住院治疗的228例肿瘤患儿父母为研究对象;采用一般情况调查问卷、10条目心理韧性量表(CD-RISC-10)、修订版中文版父母用疾病不确定感量表(PPUS)和中文版父母用应对方式量表(CHIP)收集和评估肿瘤患儿父母一般资料、心理韧性、疾病不确定感及医学应对情况。采用Pearson相关分析肿瘤患儿父母CD-RISC-10得分与PPUS得分、CHIP得分的相关性;根据Baron和Kenny的中介及调节效应分析心理韧性在肿瘤患儿父母疾病不确定感和医学应对方式间的中介效应。结果共发放调查问卷228份,回收有效问卷218份,有效率为95.61%。家庭月收入<5000元、医疗费用自费肿瘤患儿父母的CD-RISC-10得分和CHIP得分均低于家庭月收入≥5000元、医疗费用非自费的肿瘤患儿父母,差异均有统计学意义(P<0.05);独生子女、家庭月收入<5000元、医疗费用自费肿瘤患儿父母PPUS得分高于非独生子女、家庭月收入≥5000元及医疗费用非自费的肿瘤患儿父母,差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,肿瘤患儿父母CD-RISC-10得分与PPUS得分呈负相关(r=-0.420,P<0.05),与CHIP得分呈正相关(r=0.776;P<0.05)。中介效应分析结果显示,心理韧性在肿瘤患儿父母疾病不确定感与医学应对方式间的中介效应为37.78%。结论心理韧性与肿瘤患儿父母疾病不确定感和医学应对方式均具显著相关,疾病不确定感可通过影响肿瘤患儿父母心理韧性进而影响瘤患儿父母的医学应对方式。

癌症患者对未成年子女养育忧虑的现状及影响因素分析

目的了解癌症患者对未成年子女养育忧虑的现状并分析其影响因素,为改善癌症患者养育忧虑提供参考。方法便利抽取372例癌症患者为研究对象,使用一般资料调查表、养育忧虑问卷、痛苦表露指数量表、感知伴侣回应性量表和育儿胜任感量表进行调查。结果癌症患者对未成年子女的养育忧虑总分为32.00(24.00,41.00)分。广义线性回归分析结果显示,文化程度、最小未成年子女的年龄、子女健康状况、是否出现转移或复发、痛苦表露、感知伴侣回应性和育儿胜任感是癌症患者对未成年子女养育忧虑水平的影响因素(均P<0.05)。结论癌症患者对未成年子女的养育忧虑处于中等偏低水平,医护人员应根据影响因素制定针对性的干预措施,缓解癌症患者养育忧虑。

癌症患儿疾病不同阶段主要照顾者心理危机轨迹的质性研究

目的:探讨癌症患儿疾病不同阶段主要照顾者心理危机发生状况,为制定针对性干预策略提供参考依据。方法:采用现象学研究方法,对15例癌症患儿的主要照顾者分别在患儿疾病确诊初期、治疗中期、治疗结束3个阶段进行半结构式深入访谈,并采用Colaizzi 7步分析法提炼主题进行分析。结果:主要照顾者在患儿疾病不同阶段的心理危机表现不一致。在患儿疾病确诊初期,主要照顾者在情感方面以愤怒、敌对的表现形式为主;在认知方面以威胁感为主;行为方面以接近行为为主要表现,甚至出现攻击行为等极端情况。在患儿疾病治疗中期,主要照顾者在情感方面以焦虑、恐惧为主;在认知方面以丧失感为主;行为方面以回避行为为主要表现。在患儿治疗结束阶段,主要照顾者在情感方面以抑郁为主;在认知方面以侵犯感为主;行为方面以失去能动感为主要表现。结论:改变传统的心理干预方式,分阶段制定针对性的心理干预策略,提供精准化医疗服务,提高照顾者的心理弹性,有助于改善癌症患儿及家庭的生活质量。

Keep on Striving: The Impact of Psychosocial Support on Jordanian Adolescents with Cancer

Having cancer during adolescence stage causes stressors in patients’ lives. They are responsible for dealing with many new situations and stressors. Coping with such stressors can be influenced by psychosocial factors. This study aimed to explore the impact of psychosocial support on adolescents with cancer. A qualitative exploratory design was used to understand the experience of psychosocial support from the perspectives of the patients. Twenty adolescents with cancer were selected purposefully from two major cancer treatment centers in Jordan. Semi-structured face-to-face interviews were used to obtain the participants’ perspectives. Data were analyzed using thematic analysis approach. Findings revealed three major themes: “supportive structure”, “precious aspects of psychosocial support”, and “cancer could be defeated”. Participants expressed their satisfaction with the psychosocial support provided to them. However, they asked for further improvement in hospital facilities, playrooms and leisure activities. In conclusion, having a strong psychosocial support system will help adolescents to cope with cancer. Family, friends, and the surrounding environment are the key elements in installing hope and helping adolescents to go through cancer experience. Nurses are advised to adopt these psychosocial keys in order to create age-related activities that would improve the patients’ coping with cancer.

Healthy Children Arizona: Early Intervention for Prevention

The Healthy Children Arizona (HCA) program was developed to promote early, positive exposure to cancer-preventive diet, physical activity and sun safety behaviors. Five lessons delivered weekly were evaluated by classroom teachers while pre- and post-curriculum surveys examined increases in students’ understanding of concepts and self-reported behavior. The first and second graders and their teachers in ethnically diverse elementary schools (including Title 1) in Tucson and Phoenix, Arizona participated in the curriculum assessment. All 5 interactive lessons were highly rated by teachers in qualitative assessments. Aggregated analyses of pre- (n = 582) and post- (n = 588) comparison tests indicated that the HCA curriculum significantly increased students’ knowledge of each of six measured concepts (p < 0.0001), although correct choice of muscle-building foods (25%), whole grain items (78%) and target time for daily exercise (61%) were lower than desired. Mean self-reported fruit and vegetable servings eaten in the previous day increased from 3.1 ± 1.8 to 3.8 ± 1.6 (p < 0.0001). The HCA curriculum significantly improved cancer prevention knowledge among primary school children.