Bone marrow transplantation (BMT) is the last resort for children with leukemia for whom conventional treatments have failed. The case presented herein is one of an adolescent girl whose parents were unable to cope with the extreme challenge of BMT. Couple- and family-related data collected prior to the BMT showed this family was at risk. Indeed, throughout the ordeal the patient seriously regressed and her parents’ reactions appeared to exacerbate her condition. At discharge, when left alone, the patient manifested somatic symptoms which required her parents to attend to her needs. How family factors may influence BMT outcome is discussed.
Summary:The purpose of the present study was to investigate the hypothesis that family factors, in conjunction with clinical factors, are associated with physical outcomes in pediatric BMT. A prospective study of 68 pediatric patients (mean age = 7.5 years; ranging from 4 months to 18 years) undergoing BMT was carried out over a 6.5 year period. Physicians rated initial prognosis on a (0-5) scale which incorporated the child's diagnosis, known risk factors, and type of donor. Both parents individually completed two psychometrically sound questionnaires assessing family well-being and marital satisfaction. Cox proportional hazards survival analyses were performed to determine predictors of death (44% of the patients died). Potential predictor variables included were: initial prognosis, type of transplant, patient's age, socioeconomic status, marital satisfaction and family status, and family stress. Initial prognosis, as estimated by the physician, (RR = 0.62, 95% CI = 0.40, 0.97) was the best predictor of survival. Initial clinical factors are clearly critical in outcomes for pediatric BMT patients. Bone Marrow Transplantation (2000) 26, 553-558. Keywords: predictors; survival; pediatric; bone marrow transplantation BMT in pediatric patients, while no longer an experimental treatment, is often a procedure used as a last resort. It is complicated, costly (both in human and financial terms), and extremely stressful for all involved (ie patient, family, hospital personnel). Initially, research focused on the medical technology and physical health outcomes. Given the high demands of BMT it is not surprising that a second line of research addressed the psychosocial issues for both patients and family members. Most of this latter work was descriptive, 1 outlining the various challenges incurred during the different phases of the procedure. Studies typically were cross-sectional and included small sample sizes. Attention was paid to the impact of BMT on family memCorrespondence: PL Dobkin,
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