Unresolved grief and its consequences. A nationwide follow-up of teenage loss of a parent to cancer 6-9 years earlier.

PURPOSE: The early loss of a parent is a tragedy and a serious life event. This study investigated grief resolution and morbidity in cancer-bereaved teenagers 6 to 9 years after the loss of a parent to cancer. METHODS: In a nationwide population-based study of 622 of 851 (73 %) youths who as teenagers 6 to 9 years earlier had lost a parent to cancer, we explored the magnitude of unresolved grief and its association with psychological and physiological morbidity. Participants answered a study-specific anonymous questionnaire including questions about if they had worked through their grief and about their current health. RESULTS: Six to nine years post-loss 49 % reported unresolved grief (8 % no and 41 % a little grief resolution). They had, in comparison with youths reporting resolved grief, statistically significantly elevated risks, e.g. for insomnia (sons' relative risk (RR) 2.3, 95 % CI 1.3-4.0; daughters' RR 1.7, 95 % CI 1.1-2.7), fatigue (sons' RR 1.8, 95 % CI 1.3-2.5; daughters' RR 1.4, 95 % CI 1.1-1.7) and moderate to severe depression, i.e. score >9, PHQ-9 (sons' RR 3.6, 95 % CI 1.4-8.8; daughters' RR 1.8, 95 % CI 1.1-3.1). Associations remained for insomnia in sons, exhaustion in daughters and fatigue in both sons and daughters when depression, negative intrusive thoughts and avoiding reminders of the parents' disease or death were included in a model. CONCLUSIONS: Approximately half of cancer-bereaved youth report no or little grief resolution 6 to 9 years post-loss, which is associated with fatigue, sleeping problems and depressive symptoms

Valor de la Resonancia Nuclear Magnética en Ortopedia Oncológica

Presentamos nuestra experiencia preliminar sobre la utilidad diagnóstica de la Resonancia Nuclear Magnética (RM) en la evaluación pre- y postoperatoria de pacientes con tumores musculoesqueléticos. Se han revisado 21 pacientes con tumores caracterizados histológicamente. Del total, 10 casos eran sarcomas de partes blandas, 7 correspondían a tumores óseos y 4 eran metástasis óseas o recidivas locales. Las imágenes se obtuvieron mediante un sistema de RM de campo medio provisto de un imán superconductor operando a 0.5 Teslas. En todos los casos se obtuvieron imágenes T1 y T2, en los planos axial y coronal. Como norma se objetivó un excelente contraste entre la señal de la lesión y la de las estructuras normales adyacentes. Sólo en un caso, un osteosarcoma del extremo proximal del peroné, las imágenes de extensión a partes blandas vecinas resultaron ser negativas en la exploración quirúrgica. El análisis de los cambios de intensidad de la señal no permitieron distinguir la especificidad tisular del tumor, ni diferenciar lesiones benignas y malignas. En nuestra experiencia, la RM nos ha permitido un mejor diagnóstico anatómico de la extensión tumoral, facilitándonos la planificación quirúrgica que requieren las modernas técnicas reconstructivas en ortopedia oncológica.The preliminary experience using Magnetic Resonance imaging for pre- and post-operative assessment of orthopaedic oncologic patients is hereby reported. Twenty-one patients with histologically characterized bone and soft tissue tumors have been reviewed. Seventeen patients had primary musculoskeletal neoplasia: 10 had soft tissue sarcomas and 7 bone tumors. The remained 4 patients consisted of bone metastasis or local racidive. Magnetic resonance images were acquired using a superconductive magnet operating at 0.5 Tesla. T1- and T2-weighted transaxial and coronal images were obtained in all cases. An excellent contrast between the signal of the lesion and the normal adjacent structures was usually obtained. Only in one osteosarcoma of the proximal fibula, an extraosseous extension was presumed but not found during surgical resection. Changes in image intensity did not permit to identify tumor tissue specificity neither distinguish between benign and malignat lesions. In our experience, Magnetic Resonance shows a great advantage in order to determine tumor anatomical extension, providing a useful information for the surgical planning required by current reconstructive techniques in orthopaedic oncology

The needs of professionals in the palliative care of children and adolescents

The main objectives of this qualitative study were to describe the perceptions and needs of pediatric health care professionals (HCPs) taking care of children with palliative care needs and to develop a concept for the first Center of Competence for Pediatric Palliative Care (PPC) in Switzerland. Within two parts of the study, 76 HCPs were interviewed. The main interview topics were: (1) definition of and attitude toward PPC; (2) current provision of PPC; (3) the support needs of HCPs in the provision of PPC; and (4) the role of specialized PPC teams. HCPs expressed openness to PPC and reported distinctive needs for support in the care of these patients. The main tasks of specialized PPC teams in Switzerland would encompass the coaching of attending teams, coordination of care, symptom control, and direct support of affected families during and beyond the illness of their child. Conclusion: This study indicates the need for specialized PPC in Switzerland both inside and outside of centers providing top quality medical care (Spitzenmedizin). Specialized PPC teams could have a significant impact on the care of children and families with PPC needs. Whether hospices are an option in Switzerland remains unanswered; however, a place to meet other families with similar destinies was emphasized

Professional caregivers' perceptions of providing information to parents of children with cancer

Information has been described as a critical part of the care for parents of children with cancer, but not much is known about how caregivers makes decisions about informing parents. This study aims to illuminate professional caregivers' perceptions of providing information to parents of children with cancer. Twenty caregivers at a Swedish pediatric oncology ward participated in four focus group interviews. The interviews were transcribed verbatim and subjected to qualitative content analysis. Two themes were found: Matching the amount of information to the parents' needs concerned situations where the amount of information provided according to the caregivers' assessment is deemed too small, appropriate, or too large. Navigating through a vague structure dealt with a disrupted setting, unclear responsibilities within the team, difficult timing, unintelligible information, and underused tools for communication. Implications for intervention development are discussed