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Comprehensive Handbook of Childhood Cancer and Sickle Cell DiseaseA Biopsychosocial Approach$
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Ronald T. Brown

Print publication date: 2006

Print ISBN-13: 9780195169850

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195169850.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 16 June 2021

Adherence to Treatment Demands

Adherence to Treatment Demands

(p.138) 8 Adherence to Treatment Demands
Comprehensive Handbook of Childhood Cancer and Sickle Cell Disease

Michael A. Rapoff

Ann M. McGrath

Oxford University Press

Given the life-threatening nature of cancer, one might expect that children with cancer and their parents would be especially vigilant about following prescribed medical treatments. As illustrated in this chapter, this is not always the case (Partridge, Avorn, Wang, & Winer, 2002). Nonadherence can potentially lead to outright treatment failure, relapse, compromised outcomes, bone marrow transplant failures, or resistance to drugs such as antibiotics (Rapoff, 1999). The purpose of this chapter is to (a) review treatment demands on children with acute leukemia (the most common childhood cancer) and their families to understand better the complex behavioral requirements associated with medical treatments; (b) review studies that have investigated the extent of nonadherence to treatments for pediatric cancer, primarily leukemia; (c) examine factors predictive of adherence; (d) describe strategies for assessing adherence; (e) provide suggestions for improving adherence; and (f) suggest future directions to advance the field of adherence research in pediatric oncology. Strategies for improving adherence were gleaned from the pediatric medical adherence literature on other chronic diseases because we could not find a single adherence intervention study involving children with cancer. Acute leukemia is the most common malignancy in children (Ries et al., 1999). The specific etiology of childhood leukemia is unknown, but the causes appear to be multifactorial. Some of the factors involved in the pathogenesis of acute leukemia include exposure to ionizing radiation or certain drugs (e.g., benzene), certain chromosome abnormalities (e.g., Down syndrome), and congenital or acquired immune deficiencies (e.g., human immunodeficiency virus infection) (Golub & Arceci, 2002; Margolin, Steuber, & Poplack, 2002). The incidence of acute leukemia is 3–4 per 100,000 white children, and approximately 3,000 children will develop acute leukemia in the United States within a given year (Ries et al., 1999). The hallmark of leukemia is bone marrow failure. The bone marrow makes red blood cells, which carry oxygen; white cells, which fight infections; and platelets, which help blood clot. Children with acute leukemia commonly present with pallor and fatigue (secondary to anemia), fever and infections (caused by reduced normal white cells), and excess bruising and bleeding (secondary to low platelets).

Keywords:   acute lymphoblastic leukemia (ALL), bone marrow transplantation (BMT), diaries for treatment monitoring, drug assays, education about treatment, goal setting, microelectronic monitors, parent simulation

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