Aspectos médicos, psicológicos y sociales del cáncer infantil

Sin resume

Bioética clínica: la mujer ante los retos de la bioética clínica actual

Women can contribute to the current challenges of clinical bioethics a humanistic vision in relation to their capacity to welcome, care and give life. A complementary vision to which the man can contribute to which he adds his life experience as a woman.This publication aims to give some keys to face and solve the multiple bioethical questions that in the current clinic are raised at a time in history where relativism also affects human life. Training, cunning, courage and coherence are necessary when defending a bioethic based on the person, it is the dignity that is its own. Various situations are reviewed in clinical practice in which women can not only defend life, but also convince those who do not defend it with a good argument.La mujer puede aportar a los retos actuales de la bioética clínica una visión humanista en relación con su capacidad de acoger, de cuidar y de dar vida. Una visión complementaria a la que puede aportar el hombre a la que suma su experiencia vital como mujer. En la presente publicación se pretende dar unas claves para afrontar y resolver las múltiples cuestiones bioéticas que en la clínica actual se plantean en un momento de la Historia en el relativismo afecta también a la vida humana. Formación, astucia, valentía y coherencia son necesarias a la hora de defender una bioética basada en la persona, es la dignidad que le es propia. Se revisan diversas situaciones en la práctica clínica en las que la mujer puede, no solo defender la vida, sino convencer a los que no la defienden con una buena argumentación

Questions and answers in the management of children with medulloblastoma over the time. How did we get here? A systematic review.

Introduction: Treatment of children with medulloblastoma (MB) includes surgery, radiation therapy (RT) and chemotherapy (CT). Several treatment protocols and clinical trials have been developed over the time to maximize survival and minimize side effects. Methods: We performed a systematic literature search in May 2023 using PubMed. We selected all clinical trials articles and multicenter studies focusing on MB. We excluded studies focusing exclusively on infants, adults, supratentorial PNETs or refractory/relapsed tumors, studies involving different tumors or different types of PNETs without differentiating survival, studies including <10 cases of MB, solely retrospective studies and those without reference to outcome and/or side effects after a defined treatment. Results: 1. The main poor-prognosis factors are: metastatic disease, anaplasia, MYC amplification, age younger than 36 months and some molecular subgroups. The postoperative residual tumor size is controversial. 2. MB is a collection of diseases. 3. MB is a curable disease at diagnosis, but survival is scarce upon relapse. 4. Children should be treated by experienced neurosurgeons and in advanced centers. 5. RT is an essential treatment for MB. It should be administered craniospinal, early and without interruptions. 6. Craniospinal RT dose could be lowered in some low-risk patients, but these reductions should be done with caution to avoid relapses. 7. Irradiation of the tumor area instead of the entire posterior fossa is safe enough. 8. Hyperfractionated RT is not superior to conventional RT 9. Both photon and proton RT are effective. 10. CT increases survival, especially in high-risk patients. 11. There are multiple drugs effective in MB. The combination of different drugs is appropriate management. 12. CT should be administered after RT. 13. The specific benefit of concomitant CT to RT is unknown. 14. Intensified CT with stem cell rescue has no benefit compared to standard CT regimens. 15. The efficacy of intraventricular/intrathecal CT is controversial. 16. We should start to think about incorporating targeted therapies in front-line treatment. 17. Survivors of MB still have significant side effects. Conclusion: Survival rates of MB improved greatly from 1940-1970, but since then the improvement has been smaller. We should consider introducing targeted therapy as front-line therapy. 1 Introductionpost-print5468 K

Cuidados paliativos centrados en la familia en oncología pediátrica

Cancer is a disease that affects one child for every 200 adults. It is the second leading cause of death in children aged 0-14 years after accidents. 80% of children diagnosed with cancer are cured of their disease in our country. However, approximately 20% eventually die from the disease or the side effects of treatment. Once the severity of the disease is known and therefore its consequences, it is essential to try to integrate the disease into the normal life of the child, the family, and the surrounding environment. The aim is to turn the child into a physically, psychologically, socially, and spiritually healthy adult. To achieve this, the child must be the center of our work and should be attended to by a multidisciplinary team. Palliative Care should be started from the time of diagnosis for children with poor or no possibility of cure.&nbsp; For the rest of the children, it should be started in case of relapse. In the last days of life of any child, it is always offered the possibility of receiving this care at home, in the hospital, or in a combined modality (Mixed Palliative Care), where they receive part of the care at home and at the end of their life they move to the hospital to live their last days there.&nbsp; Medicine should not only focus on the patient, but also the family.&nbsp;El cáncer es una enfermedad que afecta a un niño por cada 200 adultos. Es la segunda causa de muerte en el niño de 0-14 años después de los accidentes. Gracias al desarrollo de la oncología pediátrica, el 80% de los niños diagnosticados con cáncer se curan de su enfermedad en nuestro país, sin embargo el 20% aproximadamente fallecen eventualmente de la enfermedad o de las secuelas del tratamiento. Conociendo la gravedad del diagnóstico de una enfermedad oncológica en un niño, con sus posibles consecuencias, es fundamental tratar de integrar la enfermedad en la vida normal del niño, la familia y el entorno que le rodea. El fin es convertir al niño en un adulto sano física, psíquica, social y espiritualmente. Para ello, el niño debe ser el centro de nuestro trabajo y estar rodeado de un equipo multidisciplinar. El inicio de los Cuidados Paliativos debe integrarse desde el momento del diagnóstico en aquellos niños con pocas o nulas posibilidades de curación e iniciarse en el resto en la primera recaída. En los últimos días de vida de cualquier niño, siempre se le ofrece la posibilidad de recibir estos cuidados en casa, en el hospital o en una modalidad combinada (Cuidados Paliativos mixtos), donde reciben parte de los cuidados en su domicilio y al final de su vida se trasladan al hospital para vivir allí sus últimos días. Por ello, deben realizarse desde la óptica de la medicina centrada no sólo en la persona, sino también en la familia.&nbsp

Ten Reasons Why People With Down Syndrome are Protected From the Development of Most Solid Tumors - A Review.

People with Down syndrome have unique characteristics as a result of the presence of an extra chromosome 21. Regarding cancer, they present a unique pattern of tumors, which has not been fully explained to date. Globally, people with Down syndrome have a similar lifetime risk of developing cancer compared to the general population. However, they have a very increased risk of developing certain tumors (e.g., acute leukemia, germ cell tumors, testicular tumors and retinoblastoma) and, on the contrary, there are some other tumors which appear only exceptionally in this syndrome (e.g., breast cancer, prostate cancer, medulloblastoma, neuroblastoma and Wilms tumor). Various hypotheses have been developed to explain this situation. The genetic imbalance secondary to the presence of an extra chromosome 21 has molecular consequences at several levels, not only in chromosome 21 but also throughout the genome. In this review, we discuss the different proposed mechanisms that protect individuals with trisomy 21 from developing solid tumors: genetic dosage effect, tumor suppressor genes overexpression, disturbed metabolism, impaired neurogenesis and angiogenesis, increased apoptosis, immune system dysregulation, epigenetic aberrations and the effect of different microRNAs, among others. More research into the molecular pathways involved in this unique pattern of malignancies is still needed.post-print1107 K

Análisis del uso y funciones del silencio en la comunicación de los profesionales sanitarios en una unidad de oncología pediátrica.

Existen diferentes tipos de silencio, con múltiples funciones, y cada uno puede provocar efectos diversos en la comunicación. En el ámbito sanitario una comunicación eficaz es fundamental para lograr que los pacientes comprendan lo que les sucede y se expresen con claridad y confianza ante los profesionales sanitarios. El silencio juega un papel clave en esta comunicación. Objetivo: Desarrollar un instrumento para conocer la importancia que tiene el silencio para los profesionales sanitarios y analizar de qué manera emplean el silencio en su comunicación con los pacientes. Métodos: En el estudio han participado 43 profesionales del ámbito de la Oncología Pediátrica. Este estudio propone una clasificación de los tipos de silencio en la comunicación sanitaria. Resultados: El silencio es heterogéneo y cumple diferentes funciones. Se comprueba que los profesionales sanitarios emplean distintos tipos de silencio, siendo los Silencios Neutros los más utilizados, a continuación, los Silencios Productivos y los menos empleados los Silencios Obstructivos. Aquel que más se usa es el que favorece la atención, el acompañamiento, la reflexión y la expresión, mientras que el silencio de poder y el de desconexión son los menos empleados. Conclusión: El instrumento de evaluación propuesto (Q-SPS) ha presentado buenos niveles de consistencia interna para esta muestra permitiendo establecer un perfil comparativo entre el uso del silencio por parte de los distintos profesionales del ámbito de la salud por lo que podría valorarse una investigación más exhaustiva con mayor volumen de participantes.post-print482 K

Um colégio em uma Unidade de Oncologia Pediátrica: O papel crucial da educação no contexto de uma doença grave

The Montepríncipe School works in the education of children and teenagers diagnosed with cancer, supporting the continuity of their academic and social scholarship. School attendance permits them to continue with their previous lives, which is an indication of integration and normalization of disease. The school relies on a multidisciplinary team, which includes teachers, psychologists, music therapists, and volunteers working, all together,With the Unit health professionals. This article describes the performance of the Hospital School and the way it permits to integrate and normalize disease in the lives of children. In order to do so, we accomplished an experimental, quantitative, longitudinal study considering daily school attendance of 36 students, as an average, over five school years (2012-2017). The attendance turned out to be 90%, though it was non-compulsory, and it maintained stable through the years. Additionally, we measured academic performance to verify that school attendance was effective. The sample was formed by 14 students, whose Spanish Language and Mathematics marks were compared before and after treatment. The outcomes showed an improvement of one point in each subject in average, which demonstrates that daily attendance to the Hospital School contributes to integrate disease into the lives of the children and, even, to improve their academic results.El Colegio Montepríncipe trabaja en la educación de niños, niñas y adolescentes con diagnóstico de cáncer; apuesta por la no interrupción de su vida escolar en su aspecto académico y, cuando es posible, social. Cuenta, para ello, con un equipo multidisciplinar formado por profesionales de la docencia, psicología y musicoterapia y con personas voluntarias. Este equipo está integrado en el funcionamiento sanitario de la Unidad de Hematología y Oncología Pediátrica del Hospital Universitario Montepríncipe. En este artículo se describe el funcionamiento del colegio en el hospital y cómo este permite integrar la enfermedad en la vida normal de estos grupos afectados por tal diagnóstico. Para valorar dicho objetivo, se ha llevado a cabo un estudio experimental longitudinal cuantitativo, en el que se tuvo en cuenta la asistencia diaria al colegio. Se contó con un promedio de 36 estudiantes a lo largo de cinco cursos académicos (2012-2017) en los que se comprobó que la asistencia diaria al colegio era del 90 % (esta no es obligatoria), y se mantenía constante a lo largo de estos años. Además, se midió el rendimiento académico de una selección de estudiantes para comprobar que la asistencia al colegio era eficaz. En este caso, la muestra real la formaron 14 sujetos y se compararon las notas medias de las asignaturas de Lengua y Matemáticas antes del diagnóstico y después de terminar el curso en el hospital. Los resultados mostraron que el rendimiento aumentaba como promedio un punto por asignatura. De los resultados se podría concluir que la asistencia diaria al colegio en el hospital ayuda a integrar la enfermedad en la vida normal de cada paciente e incluso a mejorar sus resultados académicos.O Colégio Monteprincipe trabalha na educação de crianças e adolescentes com diagnóstico de câncer, orientada a não interromper suas vidas escolares no aspecto acadêmico e, se possível, social. Como recurso, conta com uma equipe multidisciplinar formada por profissionais da área da docência, psicologia, terapia musical e voluntariado integrado no funcionamento sanitário da Unidade de Hematologia e Oncologia Pediátrica do Hospital Universitário Montepríncipe. Este artigo descreve o funcionamento do colégio no hospital e como o mesmo permite integrar a doença na vida normal de estas pessoas afetadas pelo diagnóstico. Para determinar o objetivo, foi realizado um estudo experimental longitudinal quantitativo, considerando a assistência diária ao colégio. Participaram aproximadamente 36 estudantes durante cinco anhos acadêmicos (2012-2017), nos quais foi comprovado que a assistência diária no colégio era de 90% (presença não obrigatória), e se manteve constante durante estes anos. Além disso, foi medido o rendimento acadêmico de uma seleção de estudantes para comprovar se a assistência ao colégio era eficaz. Neste caso, a amostra real foi formada por 14 sujeitos e se compararam a média de notas em idioma e matemáticas antes do diagnóstico e depois de terminado o curso no hospital. Os resultados demostraram que a média de rendimento aumentou um ponto por matéria. Como resultado, pode-se concluir que a assistência diária ao colégio do hospital ajuda a integrar a doença na vida normal de cada paciente como também melhorar o aproveitamento académico

Full breastfeeding and paediatric cancer

Aim: It has been suggested that there is an inverse association between breastfeeding and the risk of childhood cancer. We investigated the association between full breastfeeding and paediatric cancer (PC) in a case control study in Spain. Methods: Maternal reports of full breastfeeding, collected through personal interviews using the Paediatric Environmental History, were compared among 187 children 6 months of age or older who had PC and 187 age-matched control siblings. Results: The mean duration of full breastfeeding for cases were 8.43 and 11.25 weeks for controls. Cases had been significantly more often bottle-fed than controls (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1-2.8). Cases were significantly less breastfed for at least 2 months (OR 0.5; 95% CI 0.3-0.8), for at least 4 months (OR 0.5; 95% CI 0.3-0.8), and for 24 weeks or more (OR 0.5; 95% CI 0.2-0.9). Conclusions: Breastfeeding was inversely associated with PC, the protection increasing with the duration of full breastfeeding. Additional research on possible mechanisms of this association may be warranted. Meanwhile, breastfeeding should be encouraged among mothers

Results of A Phase 1 study of the oncolytic adenovirus DNX-2401 with radiotherapy for newly diagnosed diffuse intrinsic pontine glioma (DIPG)

Background A Phase 1, single center study is ongoing to evaluate the conditionally replicative oncolytic adenovirus, DNX-2401 (tasadenoturev), followed by radiotherapy (RT) in pediatric patients with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Methods Patients 1–18 years with newly diagnosed DIPG with no prior treatment, Lansky/Karnofsky performance score ≥ 70, and adequate organ function were enrolled. A tumor biopsy was performed followed by a single intratumoral injection of 1e10-5e10 virus particles (vp) DNX-2401. Conventional radiotherapy was initiated within 1 month of DNX-2401 administration. Results Enrolled subjects (n=12) had a median age of 9 (range 3–18) and performance scores of 90–100 (n=4; 33%) or 70–80 (n=8; 67%). As part of a dose escalation design, subjects were treated with 1e10 vp (n=4) or 5e10 vp DNX-2401 (n=8), which was then followed by standard RT in 11 of 12 subjects (92%). No dose-limiting toxicities were observed and the treatment regimen was well-tolerated. Adverse events (AEs) have been primarily mild to moderate and consistent with underlying disease. The most commonly reported AEs (≥ 5 subjects), regardless of study drug relationship, include headache, asthenia, vomiting, anemia, leukocytosis, and fever. Two SAEs have been reported including grade 3 lymphopenia and grade 3 abdominal pain. Tumor reductions have been observed and efficacy evaluations are ongoing. As of 09Dec2020, 12-month survival (OS-12) was 71% and 4 of 12 patients had survived > 20 months. Four subjects continue to be followed for survival. Correlative analysis of tumor biopsy and peripheral samples is ongoing. Conclusions DNX-2401 followed by RT can be safely administered to pediatric subjects with newly diagnosed DIPG; clinical activity and preliminary survival are encouraging