Palliative care and pediatric surgical oncology

Abstract

Survival rate for childhood cancer has increased in recent years, reaching as high as 70% in developed countries compared with 54% for all cancers diagnosed in the 1980s. In the remaining 30%, progression or metastatic disease leads to death and in this framework palliative care has an outstanding role though not well settled in all its facets. In this landscape, surgery has a supportive actor role integrated with other welfare aspects from which are not severable. The definition of surgical palliation has moved from the ancient definition of noncurative surgery to a group of practices performed not to cure but to alleviate an organ dysfunction offering the best quality of life possible in all the aspects of life (pain, dysfunctions, caregivers, psychosocial, etc.). To emphasize this aspect a more modern definition has been introduced: palliative therapy in whose context is comprised not only the care assistance but also the plans of care since the onset of illness, teaching the matter to surgeons in training and share paths. Literature is very poor regarding surgical aspects specifically dedicated and all researches (PubMed, Google Scholar, and Cochrane) with various meshing terms result in a more oncologic and psychosocial effort.

Pediatrik Onkolojide Palyatif Bakım Alan Çocuklara Psikolojik Destek Uygulamalarının Etkisi

“…Sessizliği sağlayarak aktif dinleme tekniklerini kullanmak, terapötik iletişimin yanı sıra, hastayı ve aileyi tam olarak anlamanın anahtarıdır (Crozier ve Hancock, 2012). Inserra ve diğerleri (2016), pediyatrik onkolojide palyatif bakımda çocuğun gelişim evresine uygun açık ve net iletişimin gerekli olduğunu belirterek, çocuğun duygusal sorunlarla başa çıkmasına yardımcı olmak için sürekli duygusal destek sağlanmasının, kabullenilmesinin, güven ve sevgiye dayalı olumlu bir dil kullanılmasının önemli olduğunu belirtmiştir (Inserra, Narciso, Paolantonio, Messina, ve Crocoli, 2016). 2009) ile Hinds ve diğerlerinin (2000), kanserli çocuk ve ergenlerde terapötik bir müzik video müdahalesinin etkinliğini inceledikleri çalışmalarda; uygulama sonrasında stres düzeylerinin deney grubunda daha düşük olduğunu belirtmişlerdir.Bu tür uygulamaların kliniklerde tedavi gören pediyatrik onkoloji hastalarında hemşirelik girişimlerine eklenmesinin faydalı olabileceği düşünülmektedir.…”

Palliative care: A surgical perspective

“…Indeed, surgical palliation should not be considered as a single step but as a structured path through different stages over the course of the disease—at diagnosis, during treatment, and, of course, at the end of life when the goal is optimal symptom control aimed at achieving the most significant quality of life possible . In this context, surgeons may face different clinical situations, including the following: Pain control : Surgical treatment for refractory forms of pain may include implant of devices for neuromodulation, peripheral nerve block using computed tomography‐guided injection of neurolytic agents (ie, ethanol), and implant of ventricular access devices (VADs) as Ommaya/Rickham reservoirs. These devices are easy to access and can also be used in outpatient and home‐care settings. Intracranial hypertension : Intracranial hypertension is one of the most aggressive and debilitating aspect of central nervous system tumors, both primary and metastatic.…”

“…Similarly, for digestive obstruction, intestinal decompression may be considered to relieve both symptoms and related complications (dyselectrolytemia, bacterial overgrowth, and perforation). Palliative gastrostomy tube placement can also be considered when there is a lack of adequate access for administration of medication and nutrition Surgical interventions with limited potential of cure : As reported by Shelton and Jackson, there are some situations where surgeons perform procedures that can be helpful from a palliative standpoint even when there is only a small possibility of cure.…”

“…Indeed, surgical palliation should not be considered as a single step but as a structured path through different stages over the course of the disease-at diagnosis, during treatment, and, of course, at the end of life when the goal is optimal symptom control aimed at achieving the most significant quality of life possible. 8 In this context, surgeons may face different clinical situations, including the following:…”

“…Indeed, surgical palliation should not be considered as a single step but as a structured path through different stages over the course of the disease-at diagnosis, during treatment, and, of course, at the end of life when the goal is optimal symptom control aimed at achieving the most significant quality of life possible. 8 In this context, surgeons may face different clinical situations, including the following: • Airway obstruction: Up to 11% of advanced stage pediatric solid may lead to upper respiratory tract compression. 7 Even if there are no established criteria for children, tracheostomy could be performed to improve quality of life, including in a home-care setting.…”