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Considerations for Cancer-Directed Therapy in Advanced Childhood Cancer

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Palliative Care in Pediatric Oncology

Part of the book series: Pediatric Oncology ((PEDIATRICO))

Abstract

Cancer-directed therapy encompasses any modality utilized with the goal of controlling cancer. Research among adults with advanced cancer suggests that adults who understand that their cancer is incurable are less likely to continue cytotoxic cancer-directed therapy. However, novel classes of targeted and immunologic therapies are rapidly changing treatment paradigms in advanced malignancies. These agents may alter previously accepted prognostic estimates for some advanced cancers by facilitating life extension through cancer control without achieving cancer eradication. Similarly, our understanding of illness trajectories in advanced childhood cancers is increasingly complex and necessitates nuanced and serial prognostic discussions. Research among families of children with advanced cancer suggests that preferences and priorities vary and that cancer-directed therapy may convey benefits as well as burdens. In summary, detailed understanding of tumor biology, available therapies and healthcare system constraints, careful symptom monitoring, and repeated assessments of patient and parent understanding, preferences, and goals should guide decision-making with regard to selecting, continuing, or discontinuing cancer-directed therapy.

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Author information

Authors and Affiliations

  1. Department of Pediatric Oncology, Dana-Farber Cancer Institute and Boston Children’s Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA

    Angela M. Feraco M.D., M.M.Sc.

  2. Department of Neurosciences, Paediatric Chronic Pain and Palliative Care Service, Rehabilitation and Continuity of Care, Institute G. Gaslini, Genoa, Italy

    Luca Manfredini M.D.

  3. Department of Paediatric Haemato-Oncology, Monza and Brianza Foundation for Children and Mothers, Hospital San Gerardo, Monza, Italy

    Momcilo Jankovic M.D.

  4. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Joanne Wolfe M.D., M.P.H.

Authors
  1. Angela M. Feraco M.D., M.M.Sc.
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  2. Luca Manfredini M.D.
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  3. Momcilo Jankovic M.D.
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  4. Joanne Wolfe M.D., M.P.H.
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Corresponding author

Correspondence to Angela M. Feraco M.D., M.M.Sc. .

Editor information

Editors and Affiliations

  1. Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA

    Joanne Wolfe

  2. School of Social Work, The University of Texas, Austin, Texas, USA

    Barbara L. Jones

  3. Department of Caring Sciences, Palliative Research Centre, Stockholm, Sweden

    Ulrika Kreicbergs

  4. Hospital san Gerardo, University of Milano, Monza, Italy

    Momcilo Jankovic

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Feraco, A.M., Manfredini, L., Jankovic, M., Wolfe, J. (2018). Considerations for Cancer-Directed Therapy in Advanced Childhood Cancer. In: Wolfe, J., Jones, B., Kreicbergs, U., Jankovic, M. (eds) Palliative Care in Pediatric Oncology. Pediatric Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-61391-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-61391-8_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61390-1

  • Online ISBN: 978-3-319-61391-8

  • eBook Packages: MedicineMedicine (R0)

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