RESUMO
PURPOSE: The primary objective of this study was to examine the relationship between play-based procedural preparation and support intervention and use of sedation in children with central nervous system (CNS) tumors during radiation therapy. The secondary objective was to analyze the cost-effectiveness of the intervention compared to costs associated with daily sedation. METHODS: A retrospective chart review was conducted, and 116 children aged 5-12 years met criteria for inclusion. Outcome measures included the total number of radiation treatments received, the number of treatments received with and without sedation, and the type and duration of interventions, which consisted of developmentally appropriate play, education, preparation, and distraction provided by a certified child life specialist. RESULTS: The results of univariate analyses showed that age, tumor location, and total number and duration of interventions were significantly associated with sedation use during radiation therapy. Multivariate analyses showed that, after adjustment for age, tumor location, and craniospinal radiation, a significant relationship was found between the total number and duration of the interventions and sedation use. The implementation of a play-based procedural preparation and support intervention provided by a certified child life specialist significantly reduced health-care costs by decreasing the necessity of daily sedation. CONCLUSIONS: Support interventions provided by child life specialists significantly decreased both sedation use and the cost associated with daily sedation during cranial radiation therapy in children with CNS tumors. This study supports the value of the child life professional as a play-based developmental specialist and a crucial component of cost-effective healthcare.
Assuntos
Neoplasias do Sistema Nervoso Central/radioterapia , Irradiação Craniana/métodos , Ludoterapia/métodos , Neoplasias do Sistema Nervoso Central/psicologia , Criança , Análise Custo-Benefício , Irradiação Craniana/psicologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos RetrospectivosRESUMO
BACKGROUND AND PURPOSE: Primary central nervous system (1° CNS) tumours represent 2% of cancers. They record the third highest mortality from cancer in the 18-35 age group in the UK today. Despite improving medical treatments, prognosis remains poor, with more patients experiencing residual complex functional deficits. Rehabilitation for these patients is scantily researched. Observational studies demonstrate improved function following inpatient and some outpatient multi-professional rehabilitation. Comparative recovery and functional improvement between patients with 1° CNS tumours and differing oncological and other neurological diagnoses is shown. Qualitative papers explore patient's values of medical treatment, demonstrating themes of hope and improved quality of life (QOL). No studies explore the significance of rehabilitation for these patients. The aim of this study was to discover the meaning of rehabilitation for people with this life-limiting illness through ethnographic enquiry. METHODS: Fieldwork data, primarily written narratives, field notes and interviews, were collected from 10 patients with 1° CNS tumours receiving physiotherapy at a UK specialist cancer hospital. They were asked what they thought the purpose of rehabilitation was in the context of their disease. Thematic analysis explored this data. RESULTS: Patient experience provided insightful perception of the beneficial role of rehabilitation in the context of their incurable disease. Main emergent themes included independence, confidence, 'professional talk' (the broader sense of communication through talk, touch and therapeutic handling) and hope. An analogy presents an analytical model of the themes. Incidental findings identified difficulty accessing services. CONCLUSION: Rehabilitation intervention offers positive contributions to patients with 1° CNS tumours improving QOL irrespective of the stage of their disease. With equal access to cancer services, a key aim advocated in national directives in health-care today, it is essential that patients receiving treatment for this life-limiting disease have timely access to rehabilitation services in conjunction with holistic medical management.
Assuntos
Neoplasias do Sistema Nervoso Central/etnologia , Neoplasias do Sistema Nervoso Central/reabilitação , Pacientes Internados/psicologia , Modalidades de Fisioterapia/psicologia , Adulto , Antropologia Cultural , Neoplasias do Sistema Nervoso Central/psicologia , Gerenciamento Clínico , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Narração , Qualidade de Vida/psicologia , Estudos RetrospectivosRESUMO
1) Pensamos que nuestra experiencia reafirma una vez más la importancia de difundir a todo nivel la existencia de esta patología. 2) Consideramos fundamental que la asistencia de los niños con tumores sea encarada precozmente y por un equipo que agrupe a diversos especialistas, con medios, experiencia y planes preestablecidos, superando todo individualismo. 3) Incluímos en esta casuística muchos tumores histológicamente benignos, pero que por su localización y/o evolución pueden comportarse como malignos. 4) Con respecto a los tumores del SNC, la presentación en uno y otro sexo no mostró diferencias significativas. 5) La edad de los pacientes, revela un franco predominio en la segunda infancia. 6) Como es habitual en estos casos, la localización de los tumores mostró un ligero predominio de los infratentoriales sobre los supratentoriales. 7) Con respecto al diagnóstico histológico, se observó una mayor frecuencia de astroblastomas, craneofaringiomas y meduloblastomas. 8) Dado que este tipo de lesiones suele tener localizaciones inabordables, es importante contar con planes de estudio adecuados, dentro de los cuales, en la actualidad la tomografía computada ocupa un destacadísimo lugar. 9) Considerando el importante papel que juega la competencia inmune en esta patología, consideramos que todo centro oncológico debe contar con un laboratorio de inmunología que permita el estudio y seguimiento adecuado de estos enfermos. 10) La oncología pediátrica debe ser una realidad y el manejo, planes, personal, terapeutas, equipos y medios deben ser pediátricos y no diseñados para adultos y luego adaptados a los niños, hecho que significaría negar a la pediatría como entidad... (TRUNCADO)
Assuntos
Masculino , Feminino , Humanos , Recém-Nascido , Lactente , Criança , Biópsia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Cobalto/uso terapêutico , Diagnóstico por Imagem , Evolução Clínica , Exame Físico , Exame Neurológico , Família/psicologia , Formação de Anticorpos , Imunidade Celular , Imunoterapia , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Neoplasias do Sistema Nervoso Central/cirurgia , Neoplasias do Sistema Nervoso Central/classificação , Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/psicologia , Neoplasias do Sistema Nervoso Central/radioterapia , Neoplasias do Sistema Nervoso Central/terapia , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Pacientes/psicologia , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Quimioterapia Combinada , Reação Enxerto-Hospedeiro , Seguimentos , Sistema Imunitário , Sobrevivência , Testes Imunológicos , Testes Psicológicos , Vincristina/administração & dosagem , Vincristina/efeitos adversos , Vincristina/uso terapêuticoRESUMO
1) Pensamos que nuestra experiencia reafirma una vez más la importancia de difundir a todo nivel la existencia de esta patología. 2) Consideramos fundamental que la asistencia de los niños con tumores sea encarada precozmente y por un equipo que agrupe a diversos especialistas, con medios, experiencia y planes preestablecidos, superando todo individualismo. 3) Incluímos en esta casuística muchos tumores histológicamente benignos, pero que por su localización y/o evolución pueden comportarse como malignos. 4) Con respecto a los tumores del SNC, la presentación en uno y otro sexo no mostró diferencias significativas. 5) La edad de los pacientes, revela un franco predominio en la segunda infancia. 6) Como es habitual en estos casos, la localización de los tumores mostró un ligero predominio de los infratentoriales sobre los supratentoriales. 7) Con respecto al diagnóstico histológico, se observó una mayor frecuencia de astroblastomas, craneofaringiomas y meduloblastomas. 8) Dado que este tipo de lesiones suele tener localizaciones inabordables, es importante contar con planes de estudio adecuados, dentro de los cuales, en la actualidad la tomografía computada ocupa un destacadísimo lugar. 9) Considerando el importante papel que juega la competencia inmune en esta patología, consideramos que todo centro oncológico debe contar con un laboratorio de inmunología que permita el estudio y seguimiento adecuado de estos enfermos. 10) La oncología pediátrica debe ser una realidad y el manejo, planes, personal, terapeutas, equipos y medios deben ser pediátricos y no diseñados para adultos y luego adaptados a los niños, hecho que significaría negar a la pediatría como entidad... (TRUNCADO)(AU)