The Complicated Legacy of Cassandra Callender

DALHOUSIE MEDICAL JOURNAL

It is crucial to obtain a competent individual’s informed consent in any medical process, including cancer treatments. However, when it comes to incompetent children, it seems to be favourable, but not necessary, to obtain their assent in medical practice.1 This paper considers Christine Harrison’s example of Samantha, an eleven-year-old girl that was treated for osteosarcoma in her left arm. Samantha had previously been treated by amputation and a course of chemotherapy. This cancer later metastasized to her lungs, decreasing her chances of remission with aggressive treatment to 20%. Although she wanted to refuse treatment, she was deemed incompetent to make decisions about her cancer care, and her parents adamantly wanted her to continue treatment.7 This paper considers physicians’ moral obligations in pediatric cancer cases such as Samantha’s. I will define assent, the principles of autonomy, beneficence, and competence as it pertains to children. I consider arguments of two oppo...

Illness, Crisis & Loss, 2017

The study utilized a highly qualitative, narrative, and free associative methodological approach to give a mother’s perspective of her teenage daughter’s 9-month journey from diagnosis of cancer to her death. Cancer is a unique chronic illness that impacts both physically and psychologically. The key findings of this study show that medical treatment alone is not enough and that professionals must understand the impact that cancer and the treatment have on the quality of life for the child and how the phrase surviving cancer has different meanings. It highlights the importance that family, friends, beliefs, and education have on supporting a teenager and the consequences of denying that access to all stakeholders.

Journal of the Royal College of Physicians of London

M alignancy affects an estim ated 1 in 800 people in the age group 13-18. The m ost com m on diagnoses affecting teenagers and young adults in the UK are leukaem ia/lym phom a, prim ary brain tum our s and bone tum our s © The diagnosis and treatm ent of a life-threatening illness is likely to distur b and possibly arrest nor m al progress from dep endence to independence. Hence, the goal of all oncologists m ust be to cure the patient w ith m inim al mor bidity © Treatm ent in a specialist oncology unit w ill overcom e m any problem s, particularly in the early stages of treatm ent w hen the patient is com ing to term s w ith the diagnosis © There can be no definite cut-off for the patient to be best treated in an adult or paediatric hospital © Structured follow -up is essential to identify the tr ue effects of treatm ent, w hich m ay become fully apparent only later in life. In particular, the neuropsychological im pact of malignancy m ay be severely underest im ated K ey P oints

Cambridge Quarterly of Healthcare Ethics, 2020

When talking about decisionmaking for children with a life-threatening condition, the death of children with brain tumors deserves special attention. The last days of the lives of these children can be particularly harsh for bystanders, and raise questions about the suffering of these children themselves. In the Netherlands, these children are part of the group for whom a wide range of end-of-life decisions are discussed, and questions raised. What does the end-of-life for these children look like, and what motivates physicians and parents to make decisions that may affect the life and death of these children? This article highlights the story of the parents of the sisters Roos and Noor. When both their daughters were diagnosed with a hereditary brain tumor, they had to make similar decisions twice. Their story sheds light on the suffering of children in the terminal phase, and how this suffering may motivate parents and physicians to make decisions that influence the end of life of...

Cancer Nursing, 2019

Background: The experiences of teenagers with cancer are related to falling ill, receiving treatment, and the way they exist in the world. The understanding of the meaning of teenagers coexisting with cancer must be placed in the social context with the teenagers at the core. Objective: By using an interpretive ethnographic research method, this study applied the body perception view of Merleau-Ponty to how teenagers with cancer understand self through the body in a social and cultural context. Methods: Participant observation and individual semistructured interviews of 18 teenagers diagnosed with cancer were conducted over a 20-month period. Results: The illness experience of teenagers undergoing chemotherapy was described as self-integration. Five themes emerged: boundary ambiguity of body, medical equipment as part of the body, confined body space, from self-dissociation toward self-integration, and healing power formed by self and others. Conclusion: In the face of the adjustments of body disorder, the teenagers with cancer initiated motility of the body, self-displacement, and integration in order to regain control of the body. Implications for Practice: The provision of correct disease knowledge to strengthen teenagers' understanding and their sense of mastery of their bodies throughout the participation in their cancer treatment is essential. Discussions on making decisions, self-management, and social identification are related to the relationship between body and self as well as between healthcare and otherness. Providing culture and social sensitivity support systems and resources to teenagers and families can strengthen them to face the disease and promote positive healing. T he experience of teenagers with cancer related to falling ill, the subsequent treatment process, and the associated changes to their bodies all effect the self-image of these teenagers and the way they exist in the world. 1-4 The exploration of cultural and psychological phenomenon of the disease includes the significance of the symptoms and diseases at an individual

Supportive Care in Cancer, 2008

Introduction Almost all pediatric lymphomas are malignant, high-grade tumors. The combined incidence of Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) reaches 10 to 12 new cases a year per million children under the age of 16 years, representing about 10% of all pediatric cancers. HD makes up to 40% and NHL 60% of pediatric lymphomas. During the last 20 years, cure rates raised dramatically so that currently over 90% of children and adolescents with HD and about 80% of those with NHL can be cured. As cure can be achieved in a large majority of patients, long-term effects and quality of life of the survivors are nowadays the principal challenges to pediatric oncologists. Discussion Like survivors from acute lymphoblastic leukemia, young adults cured from NHL may present with neurocognitive deficits, especially if treated at a young age and with cranial irradiation. Intrathecal or high-dose intravenous chemotherapy with methotrexate may induce the same problems, although in a lesser extent and severity. Large enough prospective cohort studies like the CCSS in the USA were able to show an increased risk of second malignant neoplasms, especially brain tumors in patients formerly treated with cranial irradiation. Reduced fertility can follow exposure to cyclophosphamide, especially in the

Online Journal of Health Ethics, 2019

Journal of the National Comprehensive Cancer Network

Historically, adolescent and young adult (AYA) patients with cancer, diagnosed for the first time at age 15 through 39 years, have often been identified as a “lost tribe” without a medical “home”; neither pediatric nor adult oncology services were able to provide age-appropriate care to this specific group. Internationally, AYA care programs are being established to bridge the gap between the age-defined healthcare worlds and to address the specific needs of AYAs with cancer. However, AYA care programs mostly focus on improving cure rates and addressing survivorship issues, and direct less attention to the unique needs of those living with an uncertain and/or poor cancer prognosis. Additionally, palliative care services are typically poorly equipped to address the age-specific needs of this group. Given that increasingly more AYAs with an uncertain and/or poor cancer prognosis are gaining life years because of novel treatments, and sometimes even face the prospect of long-term disea...

Cancer, 2006

2012