Emma Children's Hospital, Amsterdam, The Netherlands.
Semin Oncol. 2011 Jun;38(3):374-9. doi: 10.1053/j.seminoncol.2011.03.006.
In developed countries the survival rate of children with cancer exceeds 75%. Optimal supportive care is necessary to deliver the burdensome treatment protocols. As the intensity of primary treatment has escalated, so have the side effects like myelosuppression and infection. Children who receive aggressive chemotherapy have an approximately 40% chance of experiencing a febrile episode during neutropenia. Patients should be treated with intravenous broad-spectrum antibiotics even if they have been assessed as low risk. There is no proof of the usefulness of special measures concerning food products during neutropenia. In contrast to adults, most children who receive chemotherapy will have a central venous catheter inserted (≥ 80-90%). The two most important complications are infections and thrombosis. The Multinational Association of Supportive Care in Cancer (MASCC) guideline in adult oncology is available to prevent and treat nausea and vomiting. In highly emetogenic chemotherapy, the combination of a serotonin receptor antagonist plus a corticosteroid should be used. Pain in children with cancer is mainly therapy- or procedure-related. As in adults, the stepladder of the World Health Organization (WHO) is used as a guideline for adequate treatment of pain. It is of utmost importance that children receive optimal pain management during the initial procedures. Sedation is performed in many different ways. Palliative care starts with information about the incurability of the disease for parents, the patient, and the professionals involved. Children in palliative care for progressive cancer should be at home as much as possible, even in the terminal phase. The organization of health care and the facilities differ at a national level, so the requirements and choices for optimal care vary by country. Palliative care has to be incorporated into the structural base in the training of pediatricians and pediatric nurses. The first goal of palliative care is to reduce distressing symptoms. During the whole period of palliative care stepwise withdrawal and withholding of treatment options are important issues. The multidisciplinary approach should also span the broad field of psychosocial issues covering both the child's and the caregiver's specific psychosocial needs. Continuity of care is also depicted by contacts afterwards during family bereavement.
在发达国家，儿童癌症的存活率超过 75%。为了提供繁重的治疗方案，最佳的支持性护理是必要的。随着初级治疗强度的增加，骨髓抑制和感染等副作用也随之增加。接受强化化疗的儿童在中性粒细胞减少期间发生发热事件的几率约为 40%。即使患者被评估为低风险，也应使用静脉内广谱抗生素进行治疗。在中性粒细胞减少期间，关于特殊食品产品的措施的有用性尚无证据。与成人不同，大多数接受化疗的儿童将插入中心静脉导管（≥80-90%）。两个最重要的并发症是感染和血栓形成。支持癌症的多国协会（MASCC）成人肿瘤学指南可用于预防和治疗恶心和呕吐。在高度致吐性化疗中，应使用 5-羟色胺受体拮抗剂加皮质类固醇的组合。癌症儿童的疼痛主要与治疗或程序有关。与成人一样，世界卫生组织（WHO）的阶梯法被用作适当治疗疼痛的指南。在初始程序中，儿童接受最佳疼痛管理非常重要。镇静有许多不同的方式。姑息治疗从父母、患者和相关专业人员对疾病不可治愈的信息开始。患有进行性癌症的姑息治疗儿童应尽可能在家中，即使在终末期也是如此。医疗保健的组织和设施在国家层面上有所不同，因此对最佳护理的要求和选择因国家而异。姑息治疗必须纳入儿科医生和儿科护士培训的结构基础中。姑息治疗的首要目标是减轻痛苦症状。在姑息治疗的整个阶段，逐步撤回和停止治疗选择是重要的问题。多学科方法还应涵盖涵盖儿童和照顾者特定心理社会需求的广泛心理社会问题领域。连续性护理也通过丧亲之痛后与家人的联系来描绘。
