Achieving balance: a case study examination of an adolescent coping with life-limiting cancer.

A single-case study approach was used to provide an in-depth examination of the special events that take place in an early adolescent's family as the adolescent attempts to adapt to living with life-limiting cancer. Through symptom control, hope, denial, and the achievement of developmental tasks such as peer group identification, independence, and autonomy, the early adolescent was able to demonstrate positive coping and adaptation. In the context of the Calgary Family Systems Model, the adolescent achieved individual system balance, which in turn enabled his family's systems to balance. The health care professional played an integral role in enabling the adolescent to accomplish his developmental tasks, which translated into facilitating adaptation.

Improving outcomes in difficult bone cancers using multimodality therapy, including radiation: physician and nursing perspectives.

Principles of therapy are similar for Ewing's sarcoma and osteosarcoma. Chemotherapy or surgery alone cures few patients. Multimodality measures are needed for durable response. Quality of life and function are very important short- and long-term considerations. The spine, sacrum, pelvis, ankle, hand, mediastinum, pulmonary hilum, and chest wall are examples of bone cancer locations for which surgery is difficult. Patients with positive margins may need radiation and may experience systemic therapy delay, recurrence, loss of function, or any combination of these. When radiation is used as a means of local control, concomitant chemotherapy can increase its effectiveness. Options for difficult Ewing's sarcoma and osteosarcoma situations and multimodality solutions, including 1 mCi/kg of samarium and proton therapy, are discussed. Combination radiation and chemotherapy regimens are summarized, and organization of patients, caregivers, and medical teams for multimodality therapy is described, along with tools used in our institution that aid in this process.

Treatment approaches for metastatic Ewing's sarcoma: a review of the literature.

The Ewing's sarcoma family of tumors (ESFT) is an aggressive group of neoplasms that represent approximately 3% of all pediatric malignancies. The overall survival rates in patients with localized disease are approaching 75%. The outcome for the 25% of patients who present with metastatic disease, however, remains poor, with long-term survival rates of less than 30%. This review will explore the natural history of ESFT including clinical presentation, molecular pathology, and high-risk features of the disease. Outcomes of metastatic treatment protocols to date will be examined as well as the rationale for current and future therapies. Nursing considerations in caring for patients with metastatic ESFT will be discussed. A case scenario will be reviewed to highlight treatment and supportive care issues in the management of the disease. Cancer therapy in general is becoming more complex; treatment approaches involve different ways of targeting tumor cells. It is crucial that nurses caring for these patients understand the rationale behind treatment strategies so that appropriate patient education and support may be given.

Looking for guarantees.

The article attempts to capture some of the author's experience with the diagnosis and subsequent treatment of her son's cancer. David was 15 when he was diagnosed with Ewing's sarcoma of the left femur. He underwent chemotherapy within 3 weeks of the diagnosis, having undergone port insertion, a needle biopsy of the tumor, and numerous other diagnostic procedures. After four chemotherapy treatments and a series of radiation treatments, David underwent an 8-hour operation to reconstruct the left femur. Bank bone was used as well as the fibula from his lower leg and iliac crest bone from the same side. David continued to be on chemotherapy treatments for just under 2 more years. As a result of this experience, the author's priorities, ways of being with clients, relationships with family members and friends, and outlook on life have all been affected. She has a new appreciation of all that a family goes through when a loved one is in crisis and how it affects the entire family and network of friends.