Psychosocial well-being
Clinical psychologist drs. Laura Beek kicked off the science evening with an overview of psychosocial research in the Grootenhuis group, with a focus on reducing pain, anxiety and stress. Step one is to get a good overview of which children experience psychological effects of their illness and treatment, Beek said. ‘What is going on? How often does it occur? Can we develop a way to help the child? How well does such an intervention work? And how can you implement it in healthcare? Those are the most important questions in (neuro)psychological research.’
One example of an intervention that the Grootenhuis group is studying at the Máxima is the preparation for an MRI scan in children under the age of 8. During an MRI scan, it is important that a child lies still for a longer period of time. Children are often sedated for the scan. Laura Beek: ‘In a pilot study with a solid tumor, we wondered: would it help to practice in the practice MRI? This could help the child get used to the device, to the sound of the MRI, and what is expected, which could lower the stress for the MRI. Is anesthesia still necessary? Our study found that nearly two-thirds of children between the ages of 4 and 7 can get an MRI scan without sedation after one or two practice sessions. That saves a whole day of hospital admission, not eating before the procedure and of course less sedation. We did the pilot in the solid tumor department, and we are now also receiving many requests from neuro-oncology. We are now ready to think further about next steps and implementation in healthcare.’
Infections
Prof. dr. Wim Tissing leads a research group focused on supportive care in which one of the focus areas is the prevention and treatment of infections in children with cancer. ‘The three lines of defense in your immune system keep viruses, bacteria and fungi from entering your body,’ he said. ‘In children treated for cancer, all three lines are impacted. For example, children have damaged bowel membranes, and chemotherapy lowers the levels of immune cells in the blood.’
Tissing talked about studies into various infections in children with cancer, and how doctors can best deal with this. ‘For example, we have found a drug that prevents a potentially life-threatening fungal infection in children with acute lymphoblastic leukemia (ALL). And in three-quarters of the children with cancer who are admitted with a fever, the infection is not caused by a bacteria, but by a virus or something else. In these cases, hospitalization and antibiotics are not necessary. We are working to predict the kind of infection so that we can treat a child appropriately.’
During the COVID pandemic, Tissing and his colleagues were able to investigate the effect of vaccinations on children with cancer. ‘Not much was known about that yet,’ he said. ‘The study showed that the COVID jab worked better than expected in children treated with chemotherapy - who therefore have fewer immune cells in their blood. In the future, that knowledge can also be used for the flu jab, for example.’
Late effects
Quality of life is important during, but certainly also after treatment for childhood cancer. Dr. Heleen van der Pal works as an internist – a doctor specializing in the internal organs – at the LATER outpatient clinic in the Máxima. She is also involved in the late effects research of the Kremer group. Van der Pal: ‘Fortunately, most survivors are doing well, even though three-quarters of them experience one or more late effects. A small number of survivors have serious late effects, such as heart problems or infertility. Our research focuses largely on identifying those late effects. Who is affected by what symptoms? How does that compare to people who have not had childhood cancer? And what can we learn from this? At an international level, we are also working on guidelines for good care for survivors of childhood cancer.’
‘Anthracyclines, for example, are an important drug in the treatment of childhood cancer, but can cause heart damage. Is an ultrasound of the heart the right way to detect this? And is the treatment of heart damage the same for an elderly person with heart failure and a survivor of childhood cancer?’
‘Our LATER care is for all survivors of childhood cancer, from five years after diagnosis. With our knowledge, we improve care for survivors as well as for children who become ill now, in order to reduce or prevent late effects. That combination of care and research is wonderful.’
Watch the presentations here (in Dutch)
- Laura Beek - Reducing anxiety, pain and stress
- Wim Tissing – Preventing and treating infections during treatment
- Heleen van der Pal – Mapping the late effects of the treatment
The Princess Máxima Center organizes three science evenings every year. The next edition will take place in April. Keep an eye on our social media channels for more details.