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Considerations for Cancer-Directed Therapy in Advanced Childhood Cancer

  • Angela M. FeracoEmail author
  • Luca Manfredini
  • Momcilo Jankovic
  • Joanne Wolfe
Chapter
  • 893 Downloads
Part of the Pediatric Oncology book series (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.

Keywords

Cancer-directed Therapy Childhood Cancer Prognostic Discussions Illness Trajectory Time-limited Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Angela M. Feraco
    • 1
    Email author
  • Luca Manfredini
    • 2
  • Momcilo Jankovic
    • 3
  • Joanne Wolfe
    • 4
  1. 1.Department of Pediatric OncologyDana-Farber Cancer Institute and Boston Children’s HospitalBostonUSA
  2. 2.Department of NeurosciencesPaediatric Chronic Pain and Palliative Care Service, Rehabilitation and Continuity of Care, Institute G. GasliniGenoaItaly
  3. 3.Department of Paediatric Haemato-OncologyMonza and Brianza Foundation for Children and Mothers, Hospital San GerardoMonzaItaly
  4. 4.Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA

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