RESUMEN
The most significant oncologic concern with finding new pulmonary nodules on imaging in a pediatric patient who has anaplastic Wilms tumor is progressive disease with new pulmonary metastases. This case emphasizes the importance of employing a creative clinical differential diagnosis, even for patients with known underlying oncologic disease.
Asunto(s)
Neoplasias Renales/complicaciones , Pulmón/diagnóstico por imagen , Neumonía/complicaciones , Neumonía/diagnóstico , Toxocariasis/complicaciones , Toxocariasis/diagnóstico , Tumor de Wilms/complicaciones , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Preescolar , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Pulmonares/secundario , Neumonía/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Toxocariasis/tratamiento farmacológico , Tumor de Wilms/secundarioAsunto(s)
Planificación Anticipada de Atención , Pesar , Oncología Médica/normas , Resiliencia Psicológica , Enfermo Terminal/psicología , Comunicación , Humanos , Masculino , Oncología Médica/métodos , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Medical providers are trained to investigate, diagnose, and treat cancer. Their primary goal is to maximize the chances of curing the patient, with less training provided on palliative care concepts and the unique developmental needs inherent in this population. Early, systematic integration of palliative care into standard oncology practice represents a valuable, imperative approach to improving the overall cancer experience for adolescents and young adults (AYAs). The importance of competent, confident, and compassionate providers for AYAs warrants the development of effective educational strategies for teaching AYA palliative care. Just as palliative care should be integrated early in the disease trajectory of AYA patients, palliative care training should be integrated early in professional development of trainees. As the AYA age spectrum represents sequential transitions through developmental stages, trainees experience changes in their learning needs during their progression through sequential phases of training. This article reviews unique epidemiologic, developmental, and psychosocial factors that make the provision of palliative care especially challenging in AYAs. A conceptual framework is provided for AYA palliative care education. Critical instructional strategies including experiential learning, group didactic opportunity, shared learning among care disciplines, bereaved family members as educators, and online learning are reviewed. Educational issues for provider training are addressed from the perspective of the trainer, trainee, and AYA. Goals and objectives for an AYA palliative care cancer rotation are presented. Guidance is also provided on ways to support an AYA's quality of life as end of life nears.