Customised pediatric palliative care: Integrating oncological and palliative care priorities.

AIM: To describe the experience involving the early introduction of palliative care (PC) in oncological patients treated within the paediatric oncology unit of the Istituto Nazionale Tumori of Milan and compare this cohort with a cohort of patients resident in the same area treated before the introduction of early palliative care. METHODS: A virtual team was assembled in 2015. The PC providers operate outside the hospital. Conference calls were scheduled to discuss patients' problems. This sample was compared with the clinical records of patients residing in the same area who died between 2009 and 2014. RESULTS: Between January 2015 and April 2019, 41 patients residing in the Milan area mainly with CNS tumours or sarcomas were referred to the team. Comparing the results with the previous cohort, there was a rise in the number of patients dying at home or in a hospice and the duration of PC increased over time. From 2015, none of the patients died in an intensive care unit. CONCLUSION: Patients managed by the virtual team were able to continue their cancer treatments, take part in Phase I trials and receive PC. All patients with a poor prognosis should have PC at an early stage.

[Continuity and school reentry support of patients with serious diseases: experiences in pediatric oncology.] / Il supporto alla continuità scolastica nella cura multidisciplinare dei pazienti con patologie gravi: esperienze in oncologia pediatrica.

Dealing with a serious illness always implies, and particularly for a child, important physical and psychological stresses. If on the one hand, the adult could have adaption's resources which allow him to deal with the illness's implications, on the other hand, for a child, the interference of the disease with growing steps may cause serious problems. For this reason, the clinicians and the family have to support the educational and social continuity of the child's interactions. The school experience, in fact, helps and supports the psychological and social development of the patient. This article has the aim of describing the experiences of the authors considering the Italian legislation, discussing the scientific literature and the approaches and resources which can be used in order to maintain the children within their school career. The experiences of the authors have been collected in the Paediatric Unit of an oncology's hospital. However, these experiences may be useful also in other contexts where children are being treated for different diseases.

[Conflict and divorce management in the field of pediatric care. Experience in pediatric oncology.] / Gestione della conflittualità e della separazione genitoriale. Esperienze in oncologia pediatrica.

Divorces and separations have become more frequent over the last 20 years and for this reason they are issues of great importance with possible effects on medical treatments. Conflicts between the adults frequently affect the children involved in the separation of their parents. If, on the one hand, the parental conflict is a hard and distressing experience for the whole family, on the other hand this situation gets even more complicated if a child is affected by a serious illness. Since there is a lack of studies about the management arrangements of these situations, this article aims to illustrate the experiences gained in a pediatric ward of a big oncology hospital and the appropriate multidisciplinary management arrangements. These experiences, however, can be applied also in other contexts where children are being treated and where the conflict between parents can either produce different difficulties in the performance of the therapy or prejudice the child's serenity.

When a foreign adolescent orphan refuses to be treated: Considerations on a clinical case.

Providing medical treatment for unaccompanied foreign minors can prove particularly demanding when a patient is not fully compliant. This report describes the case of a 13-year-old boy from Sub-Saharan Africa brought to Italy to receive treatment for a neoplasm. Right from the start, he showed strong oppositional reactions, with aggressive and self-harming behavior. This made it necessary to activate various different psychological, psychiatric, and social-support resources, and to adapt the proposed treatments to the patient's willingness and ability to cooperate. Here we outline the assessments and actions (also from the economic and organizational standpoint) that need to be implemented in any scheme to bring young foreign orphans to Italy for specialist medical care.

At least we can send some flowers...

AIMS AND BACKGROUND: Cancer may demand lengthy treatment and the emotional attachment between care providers and the patient may become intense, especially when the latter is a child. If patients die, their families and the care-providing staff need help to cope with the loss. SHORT COMMUNICATION: We describe a procedure in use at the Istituto Nazionale Tumori in Milan for taking leave of families whose children die. This practice is based on simply sending flowers to families who have lost their child, and was started after an emotionally very demanding case. CONCLUSION: . Our sending flowers with a handwritten condolence letter is a simple gesture that seems to have helped both the patients' families and the members of our care-providing team in the process of mourning.