Treatment and supportive care approaches used for children and young people depend on the underlying diagnosis and, to some extent, the child's age. Survival outcomes and impact of toxicities also differ with the age of the child.40, 41 For example, radiotherapy is avoided in children aged under three due to increased associated long term affects.40
The principal differences in cancer treatment for children compared with adults are:
- increased intensity
- toxicities may have more significant and lasting effects.
Treatment and supportive care strategies must consider the child's developmental stage. For example, during treatment with radiotherapy, the child may be required to remain still for up to 25 minutes. Treatment planning may involve discussions around use of anaesthetics and play therapy.40
The impact of diagnosis and treatment of childhood cancer is felt by the individual and extends into the family. Treatment planning for children and young people with cancer occurs in the context of this extended group.41
Treatment decision making for children with cancer
Because of their age, children are not considered legally competent to make decisions about cancer treatment. Parents or guardians must make these decisions for them. This adds to the complexity of treatment for children with cancer, as does the large number of people involved in decision making, legal issues related to decision making about minors by others, and ethical concerns about informed consent and assent.41
Parental decision making for children with cancer is extremely challenging, taking place during a period of acute emotional distress, with large amounts of complex new information to take in, and uncertainty about their child's future.
A conceptual model of parental treatment decision making has been developed. While it is acknowledged that this field requires further research, the following contextual factors have been identified as significant in parental decision making.42
- Prognosis/severity of illness: parents are more likely to rely on health care providers to make treatment decisions if the child has a poorer prognosis and increased illness severity.
- Uncertainty: parents are more likely to seek a high level of participation in decision making when outcomes are unclear.
- Culture: deference to treatment decisions of health care professionals may be related to language barriers and/or cultural norms.
- Educational level: higher degree of autonomy in decision making by parents with higher education levels.
- Emotional distress: cognitive abilities may be impaired during highly emotional times, impacting comprehension of information and ability to participate in treatment decision making.
- Knowledge and experience: throughout the treatment trajectory, parents may reclaim decision making control as their knowledge, experience, and confidence increases.
- Trust in health care professional: parents who trust the health care providers have been shown to take on more passive roles in decision making.
- Support: parents who feel supported by the health care provider or family have reported more confidence in making day-to-day decisions for their child and less decisional conflict.
Access Improving outcomes in children and young people with cancer40, and:
- Summarise the increased complexities associated with planning antineoplastic therapy in children compared with adult populations.
- Discuss the implications of the above complexities in multidisciplinary treatment planning for a two year old and a 12 year old.
Access the NHMRC Clinical Trials website: Clinical trials and children, and:
- Describe what is meant by the term 'assent' in relation to children and consent for treatment.
- Discuss how the concept of assent is incorporated into your practice area.