issues in child health cancer

University Degree Education and Teaching

0613044

According to Miller (2006, p.74) “The World Health Organisation (WHO) has defined health as:

a state of complete physical, mental and social well-being, not merely the absence of disease. (WHO, 1948, p.100). Yet, Miller (2006, p.74) argues that: “The ability to achieve complete well-being in each aspect of a person’s life is perhaps rather idealistic, however this definition does indicate that health is much more than physical welfare”. Furthermore, Senior et al (1998, p.5) suggested that according to “Blaxter (1999a)... Any study of health and illness, including an essay or project on health, must make it clear, that health is essential contested. ‘Essential Contested’ means there is no single agreed definition”. Consequently, this tells me that ‘health’ is a complex issue that is almost impossible to find a reasonable definition for, due to the fact, that is subject to individuals own views.

Benzeval et al (1995, p.22) suggested that: “...there are many influences on an individual’s health, often categorised into biological factors; the physical and social environment; personal lifestyle and health services”. That is to say that, factors such as inequality, poverty, nutrition, housing, mortality and morbidity can affect significantly the health of families and children.

The British Medical Association (1999, p.28) indicated that: “... health inequalities between class groups in our society appear to be widening... The United Nations Development Programme considers that Britain is now one of the most unequal industrialised countries in the world”.

Wyse (2004, p.250) believed that: “Poverty in relation to children is caused by a number of different factors, many of which relate to the circumstances of their family”. Benzeval et al (1995, p.72) also believed that: “Families with children form a disproportionate part of the poorest section of society. This is particularly true of lone parent families and the families of people who are unemployed or earn low wages”. Additionaly,

Benzeval et al (1995, p.10) indicated that: “In Britain mortality rates at all ages are two to three times higher among disadvantaged social groups than their more affluent counterparts. Individuals with poor socioeconomic circumstances also experience higher levels of illness and disability. Lone parents are considered to be one of the most disadvantaged groups in society. Families that live in poverty are more likely to suffer from ill health because they have less access to fundamental health services. However, Booting et al (1997, p.187) stated that: “...In contrast to the long-term trend of decreasing infant and childhood mortality, measures of morbidity suggest that there has been an increase in the prevalence of ill-health in childhood”.

According to the British Medical Association (1999, p.45) “one of the foundations of physical and psychological well-being is good food. Receiving a good diet has clear and obvious health outcomes (...) structural and environmental factors, principally inadequate income and inadequate access to healthy food, make it much more difficult for low income families to improve their diets”. A family that lives in poverty may not be able to afford food that is rich in nutrients, iron, vitamins and protein; as a consequence, the child will have a poor diet and this can affect their immune system leaving them prone to infections and slower illnesses recovery. Proper nutrition in childhood can prevent illnesses and also reinforces good eating habits, and that will ensure that children grow to their full potential.

Benzeval et al (1995, p.53) believed that: “It may seem obvious that ‘bad housing damages your health’ but proving the case is not always easy. People who live in decaying, overcrowded properties are likely to be poor and face other disadvantages; the fact that they do not enjoy such good health as those in decent housing is clearly not attributed to housing conditions alone”. Children from family backgrounds linked to poverty usually live in bad housing conditions, resulting in poor standards of living conditions such as ill health.

Childhood Cancer is the health issue that is going to be discussed.

According to Parker et al (1979, p13), said that: “Cancer is not a very common disease in children”. Furthermore, Cancerbackup (2007) suggested that: “Children’s cancers are rare. In the UK, only 1 in every 600 children under 15 years of age develops cancer. This means that approximately 1700 (up to the age of 15) in the UK are diagnosed with cancer each year”.

The National Registry of Childhood Tumours in Britain plays a vital part on the study of cancer because it has the capability to gather and keep up to date information (with the assistance of several network sources) of the country’s cancer childhood population.

Stiller et al (2007, p.7) stated that: “The NRCT is the largest register of childhood cancer in the world and in 2006 includes nearly 80,000 cases”.

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Stiller et al (2007, p.7) stated that: “The NRCT is the largest register of childhood cancer in the world and in 2006 includes nearly 80,000 cases”.

Cancer is a malignant disease that can occur to any person such being an adult or child of any age, gender and ethnicity. This disease is known to be caused by the development of abnormal cells that generally forms a tumour that has the ability to destroy surrounding tissue and spread to any part of the human body. However, cancer like leukaemia does not form tumours. This can be supported by Parker et al (1979, p.11) that said: “Cancer happens when too many of the wrong kind of cells are produced. Muscle cells may grow all mixed up with bone and other kinds of cells. Very often these are not true bone or muscle cells at all. They just look like them. Often the cancer cells are not properly formed. They go wild and keep multiplying before they have the chance to mature. The cancer cells keep on increasing, and the body is unable to defend itself against them. These cells often form a lump or tumour, which can be in any part of the body from brain to the toes”.

Various studies found that the most common childhood cancer is leukaemia. Parker et al (1979, p.14) suggested that: “Leukemia is the most common cancer in children. About one-third of all childhood cancers are leukemias”. Although it has been more than twenty years since Parker et al analyses, a recent study carried out by the Cancer Research UK* showed that the most common childhood cancer still remains the same one; Stiller et al (2007, p.11) also acknowledged that: “The most common forms of cancer in children are leukaemia’s (about one-third of cases) and the neoplasm’s of the brain and spinal cord (about one-quarter)...”.

(*Please refer to the appendix)

Parker et al (1979, p.15) defined leukaemia as: “...a disease of the white blood cells. Just as there are two types of white blood cells, there are two main types of leukaemia that affect children. There are several other kinds of leukemia, but these are very rare in children. Both of the common types are acute, which means that they come on suddenly, with very little warning. Of the two, acute lymphocytic leukemia (often referred to as ALL) is the most common. This disease affects the lymphocytes and is the easiest to control”.

Once again various studies found that acute lymphoblastic leukaemia affects more boys than girls and is more frequent during the early years (0 -5 years of age). Stiller et al (2004, p.14) supports these facts by suggesting on the national statistics report that: “The incidence of childhood cancer (ALL) is about one fifth more common amongst boys than girls. The different types of cancer tend to occur predominantly at different ages. For example, there is a peak in the common type o leukaemia at ages 2 to three years”.

According to Parker et al (1979, p.25) “Cancer treatment is one of the most complicated of all medical treatments. It involves specialists in many fields, ranging from the doctor who prescribes and gives the chemotherapy, to the specialist radiologist who designs and supervises the radiotherapy, the surgeon, and the parents of the child with cancer. All these people are important to treatment, and they are backed up by many others: nurses, technicians, laboratory staff, social workers and scientists”. As a result, cancer treatment is seen as a very delicate issue that is only possible because of the existence of great cooperation between health professionals, the children’s and their families.

Parker et al (1979, p.28) also believed that: “All cancer treatments have one thing in common: they get rid of cancer cells in one way or another. Surgery cuts them out, chemotherapy and radiotherapy kill them”. On the other hand Brown et al (2006) argued that: “Aggressive therapy such as bone marrow and peripheral stem cell transplantation, became a viable and widespread alternative for children with high risk disease, as well as those with recurrent disease , but these brought about substantial new challenges related to isolation, severe physical pain and emotional difficulties...(Powers et al. 1995)“).

Cancer treatment should start as soon as there is a medical diagnosis. Chemotherapy, radiotherapy and surgery are the ordinary treatments used to fight cancer, although, these treatments can be used as one or as a combination. In fact there are other treatments specifically used for leukaemia that are indeed very invasive to the human body and consequently have many awful side effects, however according to Stiller et al (2004, p.14) National statistics report: “Since 1960’s, there have been great advances in the treatment of most childhood cancers and these have resulted in markedly higher survival rates... By 1999, mortality from cancer had more than halved to 34 per million...The dramatic reductions in mortality (...) reflect the substantial improvements in survival rates for children with cancer”. Although the medical procedures to treat cancer are physically and emotionally invasive it has considerably reduced childhood mortality rates, meaning that there are more children who have survived cancer than ever before.

According to Whiting (2006, p.7) “On their fiftieth anniversary, the United Nations in its Universal Declaration of Human Rights (1998) reiterated that the family is: the natural and fundamental group unit of society and is entitled to protection by society and the state”. [Article 16(3)].

Whiting (2006, p.8) suggested that: “Most children are born into a family (Rutherford, 1998). ... Whatever the organisation of the family, most people still consider it to be the most important element in their lives (Bernardes, 1997). Whiting (2006, p.8) also suggested: as stated by “Rutherford (1998) Family will have a tremendous insight into the uniqueness of the child and their individual needs- it is therefore essential that the care of the sick child is considered within the context of the family(...)”.

Whiting (2006, p.17) stated that: “Teare and Smith (2004) clearly identify that parents want to be involved in the care of their sick child; in addition, key documents, such as the Children Act (1989) and the more recent National Service Framework for Children, Young People and Maternity Services (DH and DfES, 2004), state that both the child and the parents should be fully involved in decision-making processes”. Therefore, it is vital that parents are involved throughout the care of their ill child because they know their children’s needs better than anyone else and this is essential for the child’s well- being.

The European Journal of Cancer care, suggested that Woodgate (2006, p.8) performed a “longitudinal qualitative study” on the impact that childhood cancer had on the life of families and children.

Woodgate’s research found that many families had similar feelings towards the experience of their child having cancer. Woodgate (2006, p.11) stated that: “Upon receiving the diagnosis of cancer, the children and families realized that their world as they knew it, would and did change forever...Statements expressed by parents and children such as ‘it is a huge thing to deal with ’or ‘nothing will be compared to cancer’ clearly reinforced cancer as a major life experience. The world as all families once knew it was no longer as safe or secure or as certain .A sense that something terrible was about to occur overshadowed children and families...”. Nothing in the world can prepare a family for the shocking impact of their child being diagnosed with cancer. Feelings of sadness, anger, disbelief, distress and many more mark the beginning of a long and unpredictable journey against one of the most feared diseases of this century, and only time can reveal its outcome.

Whiting (2006, p.10) supports this assumption by stating: “Families may react to their child’s illness in a variety of ways; some of the most common responses are... disbelief.... guilt... anger... fear... frustration...”.

Parker et al (1979, p. 3) believed that: “Anger is another very common emotion. He also added “...you may feel resentful that this child’s cancer has forced you to make many sacrifices and to give up things you liked to do. If you were a working mother, you may have to give up work because of the child. It is quite natural to feel angry sometimes about things like this”. Parker et al (1979, p.4) then suggested that: “One of the jobs of the medical social worker is to talk with parents about their problems and to help them find ways of coping”. According to the National Service Framework for Children (Standard for Hospital Services) (2003, p.18)”Children and their families need timely, relevant and effective personal and material support to help them cope with illness or disability. In addition to the generic support provided by all members of the multidisciplinary team, this includes:

Specialised support, such of that provided by a mental health professional or social worker for those with emotional and psychological difficulties...
Advice on available financial support, including for example, for families whose child is in hospital at a distance from home...
Help with child care arrangement for siblings...
Provision of information on support group and voluntary organisations”.

The Every Child Matters agenda (working together to safeguard children) (2006, p.32) reinforces what has already been stated by the National Service Framework by stating that: “Parenting can be challenging. Parents themselves require and deserve support. Asking for help should be seen as sign of responsibility rather than parenting failure”. Cancer treatment involves working with a team of health professionals that are there to ensure that the child’s and families needs are met. Parents play a vital role in their child’s treatment and recovery process so it is crucial that they receive the right support to help them cope with the situation.

Woodgate (2006, p.12) study on the impact of cancer in families and children also established that: “The siblings at times were like outsiders, watching their family from a distance. Moreover, it was like their sense of self did not matter or exist. The siblings were only concerned about their ill brothers’ or sisters’ needs and for the most part would put their ill siblings’ needs before their own”. Furthermore, Whiting (2006, p.11) stated: “Siblings reactions to sister’s or brother’s illness may include anger, resentment, jealousy and guilt”. It is clear that neither Woodgate nor Whiting findings represents what all families who experience childhood cancer feel, as each family, child and siblings are unique and may experience feelings in different ways; however it is important to reassure children that it is normal to have these multitude of different feelings. The same applies to the parents and carers, because cancer is emotionally demanding, and we are only humans, therefore we are not perfect.

In addition Woodgate (2006, p.11) research established that: “Another significant loss feared by all families was the break-up of the family. Next to struggling with beating the cancer, families found the struggle to keep the family together as one of the most difficult things about childhood cancer”. Yet, Parker et al (1979, p. 8) challenged this theory by stating that: “Sometimes, a crisis like cancer in a child has the opposite effect on husbands and wives, driving them apart... Fortunately, it doesn’t happen very often”. Cancer is a very demanding disease, but is important that families communicate and listen to each others about their emotions as much as possible in order to avoid a family crisis, as this could significantly jeopardise the child’s treatment course.

Another concern that families encountered during Woodgate’s research was: “...families feared or experienced other similar losses that encompassed a range of events including loss of the daily routines of life, friends, health or income (Woodgate, 2006, p.11)”. Moreover, Click Sargent (childhood cancer charity, 2006) indicated that: “Many families experience extra costs associated with their child’s cancer treatment. This can be a real worry especially as many parents reduce working hours to care for their child”. Furthermore, the Macmillan support charity (no date) suggested that: “The Department for Work and Pensions (DWP) is responsible for social security benefits, such as Income Support and Attendance Allowance. The DWP has several agencies that handle these benefits, including Jobcentre Plus, the Pension Service and the Disability and Carers Service”. The Government has the legal obligation to support families and children in times of hardship. The Department for Work and Pensions (Government Body), offers a range of welfare benefits for families with children that suffer from diasbilities or chronic ill health. This support is crucial to all families as it will help them cope with living expences, and as a result, it will ease families finacial strain.

Numerous studies suggest that physical, emotional, psychological and other effects on children may vary according to age and treatment.

As stated by The Macmillan support (no date): “Young children with cancer will have to cope with the worry or discomfort of treatment, and being separated from parents, family and friends and familiar surroundings while in hospital”. Whiting (2006, p.13) suggested that: “...today families are actively encouraged to spend as much time as possible with their children”. In addition Whiting (2006, p.14) described: “‘Home’ for families is frequently related to feelings of comfort, safety, familiarity, privacy and sanctuary (Darbyshire, 1994). These feelings may be lost if the environment is unfamiliar (for example during hospitalisation)”. It is paramount for a child of any age to have their parent’s present with them when they are hospitalised. This ensures they receive the best care and it also gives children the reassurance and comfort that they need at this particularly difficult time of their lives.

The Macmillan support (no date) also stated that: “Teenagers with cancer have said the hardest things to deal with are being out of school and away from their friends, and coping with the side effects, some of which may mean they will look and feel different to their peers. For adolescents in general it’s a time of physical (puberty) and psychological change, so being diagnosed with cancer can lead to anxiety and frustration because they see themselves unable to develop at the same pace and in the way their peers are developing”. Adolescence is the transitional time from childhood into youth; being diagnosed with cancer during these years can be much harder as young people became more aware of the impact that their physical appearance can cause on other people. It is important that incessant support is given to help them overcome this difficulty, so that they feel good about themselves like they would if they did not have cancer.

Conclusion:

Sadly, issues in child health like poverty and social inequalities can influence a child’s and their family health. Social circumstances are thought to be the root to many of these issues, typically affecting the most disadvantage groups of society. It is important to ensure that every child has a healthy, safe and secure childhood, as this is essential to their development and well-being. Policies such as the Children Act (2004) and Every Child Matters Agenda were made to protect and improve the health and well- being of families and children so that they can have a better chance in life.

Word Count: 3,281

Reference List:

Banton, R. (2004) ‘Overview of Health’, Wyse, D. (ed) Childhood Studies An Introduction. Cornwall: Blackwell Publishing.

Benzeval, M., Webb, S. (1995) ‘Family poverty and poor health’, Benzeval, M., Judge, K., Whitehead, M. (ed) Tackling Inequalities in Health, An agenda for action. London: King’s Fund

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http://www.statistics.gov.uk/downloads/theme_health/DS15_HlthInequals_v2.pdf

(Accessed: 08 December 2007).

Brown, R. (2006) Comprehensive Handbook of Childhood Cancer and Sickle Cell Disease: A Biopsychosocial Approach. United States: Oxford University Press.

CLIC Sargent – Caring for Children with Cancer (2006). Available at:

http://www.clicsargent.org.uk/Aboutchildhoodcancer/Forparents/Statebenefits

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HM Government (2006) Every Child Matters, Change for Children. Working Together to Safeguard Children, A guide to inter-agency working to safeguard and promote the welfare of children. Available at:

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(Accessed: 15 December 2007).

Macmillan cancer support (no date). Available at:

http://www.macmillan.org.uk/classification/support/eotional-impact.html
http://www.macmillan.org.uk/Get_Support/Financial_help/Introduction_to_the_benefits_system.aspx

(Accessed: 10, 11, 12 December 2007).

Miller, S. (2006) ‘Health Promotion: A Child-centred Approach’, Peate, I., Whiting, L. (ed) Caring for Children and Families. Colchester: John Wiley

Perker, M., Mauger, D. (1979) Children with Cancer, A Handbook for Families and Helpers. London: Cassel.

Senior, M., Viveash, B. (1998) Health and Illness. Hampshire: Macmillan Press LTD.

Stiller, C. (2007) Childhood Cancer in Britain, Incidence, Survival, Mortality. United States: Oxford University Press.

Stiller, C., Quinn, M., Rowan, S. (2004) Office for National Statistics. The health of children and young people. Chapter 13, Childhood cancer. Available at:

(Accessed: 10 December 2007).

Whiting, L. (2006) ‘Children and their families’, Peate, I., Whiting, L. (ed) Caring for Children and Families. Colchester: John Wiley.

Woodgate, R. L. (2006) ‘Life is never the same: childhood cancer narratives’, European Journal of Cancer Care, (15), 8 – 18.