ENG 101 Sample Final Paper
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101
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Jan 9, 2024
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1 Research Paper: Pediatric Leukemia Student Name English 101 Carolinas College of Health Sciences December, 2019
2 Childhood leukemia, unfortunately, is a common problem that is faced in this generation. The process of diagnosis and treatment is often studied extensively but what is often times overlooked is how the life of the child is affected during treatment and after they have gone into remission. When children are diagnosed with leukemia, the treatment can be aggressive with side effects going into their adult life. It can be easy to think that once a person goes into remission it is the end of that story, but children that have had leukemia treatments often suffer from side effects long after they have completed treatments. In order to receive a better understanding of the relationship between side effects during leukemia treatment and side effects present after treatment it is important to first look at symptom trajectories. A study was performed to observe these trajectories in order to see how symptoms affect different children, if these symptoms occur alone, and how they increase or decrease over time (Hockenberry, M., Hooke, M., Rodgers, C., Taylor, O., Koerner, K., Mitby, P., Moore, I., Scheurer, M., Pan, W., 2018). The main symptoms that were observed were nausea/vomiting, pain, interrupted sleep and associated fatigue, and mental symptoms (such as depression and anxiety). Symptom clustering refers to when more than one symptom is seen and together the symptoms cause the side effects to look a little different. According to Hockenberry et al (2018), this has been seen more commonly in adults but “symptom clustering is just emerging in children’s cancer” (pg. 2). In order to perform a study to better understand this subject, an organized plan had to be established. Two-hundred and forty-one children were chosen at random. While being observed there were certain demographic characteristics that were taken into consideration: age, sex, and race/ethnicity. The chance of survival and chance of relapse are divided as low risk, average risk, high risk, and very high risk and these are all taken into consideration. Symptoms being seen or
3 felt are observed in intervals depending on how the patient was recovering from low platelet counts caused by treatment. When a pattern of symptoms can be detected it is easier to determine ways to make treatment easier for the children and to try to eliminate any lasting symptoms. Leukemia risk level, age, and sex have no significant and consistent impact on childhood symptoms and severity (Hockenberry et al, 2018). However, race and ethnicity does have an impact on severity so more research is needed before determining the reason for this. Children are not only suffering from symptoms of decreased sleep, nausea, and mental health issues, but they are also experiencing long term fluctuations in their dietary intake. This has a great consequence during treatment as well as years after they have entered into remission. Treatment often has an effect on the patient which causes a dietary change. This dietary change does not often go back to normal upon completion of treatment. There is not a specific gender or age group that is affected. Instead, most patients see this to some degree. The diet of a patient cannot be judged solely on their food intake. The caloric intake and nutritional value can be examined to determine why the patient may be losing or gaining weight. This weight change could be the result of many things but most often it is due to the treatment plan, increased/ decreased dietary intake, poor dietary choices, or unhealthy behaviors that are often developed during treatment (Ladas, 2019). In order to receive a better understanding of why this happens and who this has a greater chance of happening to, a study was performed by providing patients with a series of food frequency questionnaires throughout their treatment. This questionnaire looked at the what was consumed, how much was consumed, and what the nutritional values were of the food. The Dietary Recommended Intake (DRI) and normative values (NHANES) have all done previous research and determined what is healthy for people of specific ages and genders to consume. The
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4 results of each patient’s questionnaire could be compared to the DRI and NHANES to determine if they were consuming healthy levels, low levels, or high levels of food. After completion of each questionnaire the results of dietary intake can be categorized as under, met, or exceeds. Energy intake is also observed and characterized as below, medium, or high (Ladas, 2019). Once it is decided which category the patient falls under, caloric intake may be changed to better benefit the patient and prevent further weight loss or weight gain. This specific study was performed on approximately seven-hundred and ninety-four pediatric patients that had all been diagnosed with acute lymphoblastic leukemia (Ladas, 2019). It was found that after treatment these patients commonly suffered from a decreased chance of over consuming calories, however, there was an increased chance of over consuming fats. It has been found that due to the tendency for there to be an over consumption of fats, pediatric leukemia survivors have a fifty percent increased chance of suffering from morbid obesity in later childhood, adolescence, and even in to adulthood if they do not already suffer from it during treatment. A huge part of the problems these children face once in remission has nothing to do with their health. Instead there are repercussions that relate to emotional, social, and academic development. Since pediatric patients often times still have a large amount of maturing to do the pause that their lives sometimes suffer when they are in the hospital receiving treatment can have a negative impact on their development. Children have stated that they feel behind in their academic life and left behind by friends. Returning to school is a major challenge that these children face and it is not a problem that can simply be solved by the child or parents alone. This has been found to be a problem being faced around the world. In a study performed by scientists in Korea, it is reported as an especially difficult challenge for their children. Korea has a relatively high leukemia rate in their children. Approximately four percent of every ten million
5 children in Korea are diagnosed with leukemia (An, 2019). However, Korean children and children from the United States have an eighty percent chance of survival due to new development of treatment that is constantly evolving (An, 2019). As much as sixty-five to seventy-five percent of pediatric leukemia survivors feel the effects of physical and emotional development (An, 2019). Korean culture places great significance on the education given to their children. When a pediatric leukemia survivor returns to school there is a great pressure to catch up on missed work and to quickly return to the expected academic level. There are also physical symptoms that may come with this return to a “normal” life as the child has a weakened immune system and energy levels may still remain lower than normal. When the child returns to school they are having to reacclimate themselves to being in school, dealing with the course load, and trying to reconnect with their friends. A study was performed with the assistance of fourteen people that were leukemia survivors and had an age range of fourteen years old to twenty- one years old. This study was performed simply by having a researcher sit down and have a series of interviews with each subject. It was important that the researcher always conduct themselves in a way that applied credibility, transferability, dependability, and conformability. The interview was always held in a public place that was relaxing and comfortable which allowed for the person being interviewed to completely relax and provide the best possible answers. Due to the environment surrounding Korean culture, these children felt that self -esteem, psychological function, and reactions based off of peer groups were all greatly altered upon their return to school. The major developmental task of finding their self- identity within their peer groups is an extremely important part of a child becoming an established adult within society. This is a great developmental delay that these
6 children were observed to suffer from and they state that they can know when they are behind their peers. Once these things were discussed and questioned through the series of interviews the answers can be characterized into five separate categories and eleven concepts (An, 2019). According to An (2019), the categories consisted of “feelings of alienation from friends, difficulty in studying, stuck being different from others, apologetic feelings for family, and feelings of having an uncertain future” (pg. 3). An (2019) also states that the categories may be further divided into eleven concepts which are “difficulty in getting along with friends, being upset about not being able to spend time with friends, hard to study due to blank spaces, feeling apologetic to friends, getting hurt by other’s view, feeling of resentment about being different from others, burdened by the excessive care (special treatment) of others, feeling apologetic to parents, feeling apologetic to siblings, desperation with physical limitation, and fear of recurrence” (pg. 3). These results gave an opportunity to identify ways the people around the survivors could make the transition easier. Programs have been created that will benefit the individuals, as well as the families, as they make the transition back into school. When resources are provided to help in this way there could be a decrease in these thoughts and emotions from the children and young adults. While some side effects may be immediately felt or seen right after treatment some do not occur until years later. The natural process of the body changing as a person gets older may be sped up or seen more severely in a person whose body has been changed from treatment. The different forms of treatment may cause different symptoms to occur later. As stated by Wasilewska, E., Kuziemski, K., Niedoszytko, M., Kaczorowska-Hac, B., Niedzwiecki, M.,
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7 Malgorzewicz, S., and Jassem, E. (2019), “Childhood cancer survivors are known to be at risk of serious vital organ system toxicities and long-term side effects associated with anti-neoplastic therapy which influences quality of life” (Pg. 25). These authors have simply pointed out that treatment plans may cause physical problems later in life. A very serious problem that survivors face is impairment of lung diffusion which is the ability of the lungs to exchange oxygen and carbon dioxide. This could impact their ability to perform certain physical activities which would affect quality of life and physical development or maintenance. Impairment of lung diffusion has been linked to the various forms of treatment. Chemotherapy is often the treatment of choice when dealing with leukemia, however, it cannot be directly linked to causing the impairment of lung diffusion due to so many variables. A study was performed to try to determine a more definitive answer as to why this occurs, understand any treatment-related risk factors that may be present, and understand how to better the air flow in individuals who suffer from impairment of lung diffusion (Wasilewska et al, 2019). A set of criteria were formed based off of achievement of remission of childhood hematologic malignance and non-lymphoblastic leukemia, follow-up of at least five years after completion of therapy, older than seven years of age, and the ability to perform pulmonary function tests (Wasilewska et al, 2019). Based on the criteria, one-hundred and fifty-six people were chosen to participate in the study. It was successful in the fact that it was able to determine that patients who experienced a prolonged and aggressive treatment plan were at a greater risk of developing respiratory problems. There is a possible answer to this problem in the fact that treatment has the potential to damage the alveoli-capillary barrier which would result in an increased chance for problems later on. Studies will continue in hopes to attempt to gain an even
8 better understanding which would allow for better treatment plans and possible preventative measures after treatment has been completed. Chemotherapy is very important due to the fact that it is saving the lives of these children and adults that suffer from various types of cancer. However, just as with the impairment of kung diffusion, there are physical and psychological side effects that go with this aggressive form of treatment. This is a problem that is occurring worldwide and not just in the United States. A study based out of Scandinavia was performed by the organization Adult Life after Childhood Cancer and these later term side effects were studied more in depth. This organization focused on a set list of common diseases and the rehospitalization for these diseases. A factor that was taken into consideration was the rate of morbidity for cancer survivors who had these diseases versus people who had never had cancer and had these diseases (Fidler-Benaoudia, M., Oeffinger, K., 2019). Leukemia survivors have a greater risk for hospitalization and morbidity. Ischemic heart disease and heart failure was the most common disease that survivors were hospitalized for. Obesity is also a problem that could cause reason for hospitalization later in life if not addressed before it becomes too severe. The significance of this study was to be able to receive a better understanding of what patients may have to deal with later in life. This knowledge will allow physicians, nurses, and health care professionals to be more cautious with preventative measures to ensure the patient may be in the best heath possible. Genetic counseling around the time of diagnosis, throughout treatment, and in survivorship clinics has been found to be beneficial in this area. However, since it is a fairly new concept it is having to be reinforced early on. The specific type of cancer, form of therapy, environment where the patient resides, and lifestyle should all be observed to better understand and prevent further complications after the leukemia treatment.
9 In conclusion, in can be seen that childhood leukemia is very difficult for children to have to deal with at such a young age. There are trials for the family and the patient during the treatment period, but there is potential for just as many trials after treatment. No two children are the same so not every situation will look the same. Preventative measures have come a long way over the years but there is always room for improvement. Until leukemia no longer exists there is always a child and family that will need help. Understanding how to help children after they have entered remission will benefit all that are involved.
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10 References An, H. (2019). Difficulty in Returning to School Among Adolescent Leukemia Survivors: A Qualitative Study. Retrieved from http://dx.doi.org.ahecproxy.ncahec.net/10.1016/j.ejon.2018.12.008 Fidler-Benaoudia, M., Oeffinger, K. (2019). Childhood Leukemia, Late Effects, and a Person- Centric Model of Follow-up. Retrieved from http://dx.doi.org.ahecproxy.ncahec.net/10.1093/jnci/djz018 Hockenberry, M., Hooke, M., Rodgers, C., Taylor, O., Koerner, K., Mitby, P., Moore, I., Scheurer, M., Pan, W. (2018). Symptom Trajectories in Children Receiving Treatment for Leukemia: A Latent Class Growth Analysis with Multitrajectory Modeling. Retrieved from http://dx.doi.org.ahecproxy.ncahec.net/10.1016/j.jpainsymman.2017.03.002 Ladas, E. (2019). Fluctuations in Dietary Intake During Treatment for Childhood Leukemia. Retrieved from http://dx.doi.org.ahecproxy.ncahec.net/10.1016/j.clnu.2018.12.021 Wasilewska, E., Kuziemski, K., Niedoszytko, M., Kaczorowska-Hac, B., Niedzwiecki, M., Malgorzewicz, S., Jassem, E. (2019). Impairment of Lung Diffusion Capacity- A New Consequence in the Long-Term Childhood Leukemia Survivors. Retrieved from http://dx.doi.org.ahecproxy.ncahec.net/10.1007/s00277-019-03745-4