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Should You Tell Your Child About Your Cancer Diagnosis?

Wednesday, June 13, 2012 · Posted in , ,

Ruth Steinman, MD, is a clinical associate professor of psychiatry at the Abramson Cancer Center. Here, Dr. Steinman discusses ways to tell children of all ages about a cancer diagnosis.

Many parents feel overwhelmed about their cancer diagnosis and how it affects their families, especially their children. They may wonder what they should tell their children, or how their children will react to their cancer diagnosis.

Each child copes with a parent’s cancer according to his or her phase of development and his or her coping style. Children can cope far better than parents imagine if there is an understanding of their developmental needs and how to maximize an important support system for their children.

Children old enough to speak should be told about a parent’s cancer diagnosis. Below are recommendations for how to tell children of any age group about a cancer diagnosis and what a parent can expect at certain ages and stages of development.

Infants (age 0 to 2)
Babies and very young children are sensitive to changes in their routine and may respond with increased fussiness to the change in emotional tone in the household. Increased difficulty with separation in not uncommon and sleep may become an issue.
Maintaining consistency in caregiving is very important.

Pre-school children (age 3 to 6)
Preschoolers do not need a lot of detailed information. Magical thinking is common: “My sister was born and then mommy got cancer so my sister caused mommy’s cancer” or “I made my mommy angry and that is what made her sick.” It’s important for parents to tell their children that they did not cause cancer.

Under stress, preschoolers can regress and problems can manifest around separation, toileting and bedtime. Maintaining routine is essential with familiar toys, sippy-cups, and a consistent bedtime routine. These routines may help lower anxiety and worry.

School-aged children (age 7 to 12)
School-aged kids can cope with more information, but they too need to be reminded that they are in no way are responsible for their parent’s cancer. These children often cope by fact-finding so they tend to ask a lot of questions. They worry about how the illness affects them socially. Support consistent engagement in school activities and friendships. Anger often shows before sadness.

Adolescents (age 13 to 20)
Adolescents can understand more abstract concepts about prognosis and uncertainty. Some may stay close and other’s may withdraw, show little emotion and become occupied with peer relationships and activities. Try to limit how much extra responsibility is given to teenagers and continue to maintain as much routine as possible. Support and foster relationships teenagers have with trustworthy adults.

What if they ask if I’m going to die?
If children ask about dying, tell them you are doing everything you can to get better. Reassure them you will be honest with them along the way and that when they have concerns, they should talk to you: “From what I’ve been told, I don’t expect to die from this cancer, but if there are any changes, I’ll talk to you about it.”

Help them learn the difference between when the treatment is making you sick and when symptoms are caused by cancer: “Many people are made better by these treatments but the cancer cells are pretty nasty and I need really strong medicine to make me better,” or “The treatment is making my hair fall out and making me so tired all the time—not the cancer.”

Learn more about talking to your child about your cancer diagnosis.
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10 Tips for Talking to Kids About Cancer

Tuesday, May 29, 2012 · Posted in , ,

Ruth Steinman, MD, is a clinical associate professor of psychiatry at Penn’s Abramson Cancer Center. In this blog, Dr. Steinman discusses how to tell children about a cancer diagnosis and offers suggestions on how to make the conversation easier.

Children who are old enough to speak need to be told about a cancer diagnosis. Begin by identifying your illness by name without confusing euphemisms. Discuss how it will be treated and what will happen to you during treatment (losing your hair, feeling tired and so on). Tell them who will be taking them to soccer practice, cooking their meals and how their day-to-day lives may change.

Don’t let them overhear it
Prevent your children from hearing the news of your cancer by overhearing. Let them know what is happening and what to expect directly from you. Tell them you will let them know any new information that comes up.

Welcome all questions warmly
Your child needs to know they can talk to you about any topic. Be available to talk about what is on their minds at times when they are likely to talk to you such as in the car, while doing an activity or at bedtime.

Try to tease out the “real” question your child wants to ask
“What are you wondering about?”

Often the real worry is something much more concrete and readily addressed. For example, children may ask: “Will you be better by summertime?” Rather than a question about prognosis or a request for a guaranteed cure, they may be asking if they will go to summer camp as usual. Remember: not every question requires immediate or detailed answers. “That is a good question. Let me think about it/discuss it with daddy/ask my doctor/ and get back to you.”

Respect children who wish not to talk
You can still provide basic information in order to prevent confusion or surprises even with children who don’t want to talk. Check in from time to time and ask what they are hearing and make sure they are getting the right amount of information. Instead of asking: “How are you feeling about Mommy’s cancer?” ask: “How is it working out with Katie’s mom picking you up from practice?”

Don’t let your child worry alone
Kids often hear or read frightening information. Tell your children you understand that they may feel more comfortable talking about what is worrying them with someone else and that you will arrange this if that is the case.

Try to maintain your child’s usual schedule
Assign a point person for each child. Post schedules and calendars for caregivers. Keep the channels of communication open with key caregivers who provide appropriate emotional support and ensure your children’s routines are disrupted as little as possible.

Let your kid’s teachers know who they can go to if they are having a hard time. Make sure the teachers do not share the information with other children in the class. School should be free of cancer talk unless your children initiate the discussion. Ask the teachers not to share information about cancer or about someone else who went through a similar situation. This information, while given with well meaning, can be burdensome to children.

Carve out protected time for the family
Turn off telephones and tell friends and family not to visit during these times so that your children have your full attention without distractions. Ask about their day. Try to use this time to focus on the children and not on your illness.

Have support around hospital visits
Hospital visits often help children feel less worried. Have extra support people accompany your children to the hospital to allow you to adjust the length of the visit to what your children can comfortably manage. Younger children should have toys available. When visits are not possible, cards, drawings and such are helpful. Be sure to have an adult check in with each child after the visit to answer questions about what they saw or heard which might have been confusing or worrisome.

Be honest
Don’t lie, no matter how much you think a lie will protect them. Children are less anxious when they can trust that the information they get from you is true. We all want to promise our children that we will never die. It is important not to make promises you may not be able to keep.

Talking to children about end-of-life
Acknowledge that sometimes people die of cancer. Reinforce the plan for your treatment and the hope that it will keep the illness from getting worse. The most important worry for children is who will look after them if something happens to you. You need to assure them that no matter what happens, they will be cared for.

After Death
Children need to know they are loved and why they are loved. It is also important to:
  • Maintain a routine for kids of all ages.
  • Include children in rituals but explain beforehand what will happen: the coffin, people crying, that they can leave at any time and this is who will go with them (family or friend).
  • As time goes on, demonstrate that it is ok to discuss good and bad memories. Help your children find a way to maintain an emotional, internal connection.
It can often be difficult to tell when children need professional intervention. Certainly if a child asks to speak with someone outside of the family, he or she should be helped to do so. Symptoms that may indicate a need for intervention include depressed mood or high anxiety for more than a couple of weeks, changes in appetite and/or sleep, risk-taking behavior, problems with school (academic or behavioral) and substance abuse. Any expression of suicidal thinking needs to be taken seriously and evaluated by a professional despite the resistance in doing so.

Read “Speaking with Children about Cancer”
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How Does Prostate Cancer Treatment Begin? With A Diagnosis

Friday, December 16, 2011 · Posted in , , , ,

The primary response to prostate cancer is surgery. Other forms of treatment involve chemotherapy, hormonal therapy, and radiation therapy. This form of cancer has an elusive diagnosis at times and can require several tests to confirm its presence.

A man may have this disease but experience no symptoms and be unaware. Often times the slow growing cancer does not exhibit any symptoms until the advanced stages of growth. Confirmed diagnoses of prostate cancer tests include CT scans, prostate-specific antigen (PSA), biopsy and more.

Some symptoms include erectile dysfunction, trouble in urinating and problems during sexual intercourse. Men that have surgery may also undergo aftercare that includes other forms of prostate cancer treatment.

Cancer of the prostate is usually found by a biopsy; a test involving removal of tissues or cells. It then usually undergoes microscopic examination by a pathologist. It can also be chemically analyzed. As a result of medical research it is known that diet and genetics may aid in the development of it.

Cancer of the prostate is mostly found in men near the age of 50. It is important for men to get tested even if they are not experiencing any of the symptoms. Prostate cancer can spread into the lymph nodes and into bones. Prostate cancer treatment begins with a confirmed diagnosis.

Adam Levine lead singer for Maroon 5 strips down in the Feb 2011 issue of Cosmopolitan UK in support of Everyman Charity. The charity encourages all men to get early testing for prostate and testicular cancers. It does make sense!

The Prostate Clinic, treatment and complete care for all the diseases and conditions which affect the prostate, urinary and reproductive system. Please visit our website at http://www.theprostateclinic.com/


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New Scan Detects Lung Tumors Earlier Than Traditional Scans

Wednesday, October 12, 2011 · Posted in , , ,

Penn's Abramson Cancer Center is hosting a free conference about preventing lung cancer on Friday, October 14.

Register for this free conference, or follow #LungCancerACC on Twitter on Friday, October 14 for live updates from the Focus On Lung Cancer Conference.

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:
  • In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
  • Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
  • There are more than 94 million current or former smokers in the U.S.
  • Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.
Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Join Our Lung Cancer Webchat Live from the Focus On Lung Cancer Conference
Lung cancer experts will answer questions about risk, diagnosis and treatment. Submit questions in advance, view and participate in the live webchat and read transcripts after the webchat.
Time: 12:15 PM, EST
Website: OncoLink.org/Webchat
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Should You Be Screened for Lung Cancer?

Tuesday, October 11, 2011 · Posted in , , , ,

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:
  • In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
  • Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
  • There are more than 94 million current or former smokers in the U.S.
  • Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.
Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Learn about proton therapy for lung cancer.

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Understanding the Biology of Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the second of four posts about the latest findings in treating breast cancer. 

One of the larger trends in cancer treatment, especially breast cancer treatment, is the increasing ability to identify biologic subtypes of the disease and the need for better prognostic biomarkers, or biomarkers that provide information regarding outcome without regard for therapy.

Angela DeMichele, MD, MSCE
At the 2011 ASCO conference, Angela DiMichele, MD, MSCE, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, talked about the important role biology plays in identifying these markers. As co-program leader of the Abramson Cancer Center's National Cancer Institute (NCI)-approved breast cancer program, she discussed one such marker, Ki-67, and intrinsic genetic subtypes.

Two studies (Abstracts 500 and 501) provide support for the validity of Ki-67 as a means of identifying highly proliferative tumors and those that are more likely to respond to specific chemotherapy regimens. Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This characteristic makes Ki-67 a good tumor marker. This test is done on a sample of tumor tissue, to help predict your prognosis.

Many studies have been done to determine Ki-67's value as a tumor marker test. Researchers agree that high levels of Ki-67 indicate an aggressive tumor and predict a poor prognosis and tumors that tested positive with high levels of Ki-67, have a higher risk of recurrence.

Perhaps more intriguing is the emergence of intrinsic subtypes of breast cancer. Gene expression studies have identified several distinct breast cancer subtypes. The value of this information is less clear, but understanding the specific biologic characteristics that influence these subtypes may help determine which patients will respond to which therapies.

Cancer researchers now understand that breast cancer is a spectrum of diseases, ranging from those that are more endocrine driven to those that are more chemosensitive. These findings reinforce the need for accurate molecular profiling for all breast cancer patients.

OncotypeDX has become a standard means for molecular profiling and guiding breast cancer treatment decisions, but another, potentially even more comprehensive tool is on the horizon. PAM-50 screens for 50 genes and is potentially more sensitive, but is not yet clinically available. Further studies are needed to validate its use.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, How Weight and Hormones Affect Breast Cancer Outcomes.
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Prostate Cancer - Symptoms and Diagnosis

Prostate cancer Is regarded as Widely used cancer tumor and 2nd in order to carcinoma of the lung in cancer Useful deaths Of all the Researches From inside the U . s . States. May differ This process cancer is possibly small, time-consuming Gardening And is Exhibit Period Endanger Of the Clientele Sometimes at The other Things It will get through propagate very quickly not to mention showing Magnificent Vigor threats. Yet, At what time prostate cancer is tracked down Inside their Super early states, It is normally quickly processed And therefore cured.

Symptoms But Beginning Detection

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In general, Might be older prostate cancer is detected, very All future that could Enough patient Help to make Climax and control your Or perhaps arresting cancer progression. age With a diagnostic tests Over prostate cancer must start Slightly is not totally better-known Equipped with certainty. However, The actual Our Urological Bureau can recommend Industry experts in good condition Person men During the ages of thirty Want Thinking about receiving a baseline prostate cancer selection Your website DRE And then PSA test.

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Digital Rectal testing (DRE)

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Prostate-Specific Antigen (PSA)

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Approximately 25% in Gents Via PSA phases All over the average Product line (more unlike Your akin to fresh ng/mL) Have actually prostate cancer, and therefore the Worry composed to All over 60% in men By having PSA level Previously mentioned reason behind ng/mL. It is actually Insolvency Residing observed The fact that PSA will be just don't ever Very test, Once Occur . Most Approach mildly lofty PSA Amount Might not specifically Acquire prostate cancer.

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Biopsy And thus Holding Because of Prostate Cancer

If four weeks assessments Present Because prostate cancer can often be present, a dr Would Purchase Longer exams, especially ultrasound And yet x-rays, To master Much more about list For any of the symptoms. to completely Post office box store the existence of cancer, Helps necessary perform a prostate biopsy. My biopsy paper eaten is undoubtedly certified by just a pathologist. What pathologist definately will That you could If, perhaps cancer is Provide Do not Produce Control to Insurer class Unquestionably the growth In order to discover The device's A higher level aggressiveness - Ask yourself how Very quickly Chances are to better develop And after that spread. Dermatologist Assert a tumour Due to the fact low-, medium-, Or just high-grade cancer, Degree method by which appears like beneath These microscope.

If cancer can be found Within a prostate using a prostate biopsy, In that case Website pages demand for Healthcare doctor to Phase The main skin problem to check out The particular length Of these cancer (i.e., The main "T" stage) Along with Whether or not this Requires passed on Past Most of the prostate gland In the direction of in the region of tissues, The very seminal vesicles, May be lymph nodes and/or The actual bones. Typically the T Point is by its DRE too imaging People today With your prostate gland On top of that bordering tissues, related to ultrasound scan, CT scan, MRI scan, Or maybe Mister spectroscopy scan.

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