Presentation Description: For many, the image of end-of-life care includes a patient in a hospital bed receiving medication. While this may be one possible scenario, it is by no means the only one, nor should it be the model. At end-of-life, support for the child, family and care providers is imperative, in order to meaningfully affect the dying process, legacy of the child and coping strategies after death for all included.
This presentation provided an overview of pitfalls, tools and strategies in supporting children, their families and their care providers at the end of life.
Speaker:
Kevin Weingarten, MD, MHSc, FRCPC
Staff Haematology/Oncology & Palliative care
The Hospital for Sick Children
Presentation Description: Despite improvements in survival rates, cancer remains the leading cause of disease-related death in childhood. Research indicates significant symptom burden and suffering among children who die of cancer, as well as barriers to the provision of pediatric palliative care. In these cases, communication and decision making are vitally important to families and healthcare providers when a child cannot be cured. Novel approaches to working with families regarding advanced directives and decision-making are highlighted.
This presentation provided an overview of some of the challenges experienced by healthcare providers and families of children near the end of life.
Speaker: Cynthia A. Gerhardt, PhD
Director, Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital,
Associate Professor of Pediatrics and Psychology, The Ohio State University, Columbus, OH
Presentation Description: Children and adolescents with cancer may present with challenging behavior that can interfere with medical care, adherence to treatment, and quality of life. There are a wide variety of strategies that may decrease distress, allow for optimal medical care, and enhance quality of life for both children and their families.
This presentation reviewed a range of multi-disciplinary interventions including psycho-education, procedural support, cognitive behavioral therapy, and parent problem-solving therapy, as well as psychopharmacology approaches to behavioural problems.
Speaker:
Anna C. Muriel, MD, MPH
Chief, Division of Pediatirc Psychosocial Oncology,
Department of Psychosocial Oncology and Palliative Care
Dana Farber Cancer Institute, Boston MA
Presentation Description: Survivors of CNS impacting cancers diagnosed in childhood are at significant risk for cognitive impairments. As survival rates improve, efforts to optimize cognitive outcomes take on added importance. Historically, there have been few empirically supported interventions for cancer survivors. Findings from pharmacologic interventions, largely using methylphenidate, have revealed an intervention that is safe and efficacious. However, there remain children for whom stimulant medications are not a viable option due to medical contraindication, parental preference or poor medication response.
Findings from nonpharmacologic, therapist-delivered interventions offer initial encouragement, particularly for improving academic skills; yet, time and financial requirements are high for relatively modest benefits, and individuals must reside in close proximity to providers. Computerized cognitive training offers added advantages of remote administration, decreased personnel resources and standardized implementation. Studies have demonstrated the feasibility, acceptability and efficacy of this approach, with neuroimaging findings suggestive of training-related neuroplasticity. Generalization of benefits to non-trained skills and maintenance of benefits over time are being investigated. Future directions include the use of genetics and neuroimaging to identify cognitive risk early in treatment as well as individualize intervention approaches.
This presentation provided an overview of pharmacologic and nonpharmacologic interventions for cognitive late effects experienced by childhood cancer survivors, including novel interventions currently under investigation.
Speaker: Heather M. Conklin, PhD
Chief, Neuropsychology Section
Associate Member, Department of Psychology
St. Jude Children’s Research Hospital, Memphis, TN
