Leukemia is the most commonly diagnosed cancer in children nowadays. It is also known as cancer of the blood and is caused by increase in numbers of abnormal white blood cells, the cell that is responsible for fighting infections in the body. Leukemia is a global problem which causes premature deaths in children, 160 000 new cases are recorded every year and 90000 of those cases end up dying. In 2017, about 4,970 children, adolescents and young adults are expected to be diagnosed with leukemia throughout the US. From 2008 to 2012, leukemia represented 26.7 percent of all the types of cancer occurring among children and adolescents. The leukemia death rate for children and adolescents younger than 15 years in the US has declined by 80.0 percent from 3.0 per 100,000 population in 1969 to 0.6 per 100,000 population in 2013.

In 2006 Fiji had established a twinning program with Christchurch Oncology Centre in NZ. This program basically links paediatric oncology units in resource-rich countries with units in countries with limited resources. This relationship is established to help improve awareness and developing and introducing treatment guidelines keeping in mind the limited resources a developing nation has. For non-treatable cancers in Fiji– 41% of the cases died within 1 month of diagnosis. Over the past 15years 52% of people who are affected with leukaemia died but when the twinning program was introduced, there is a drastic improvement in the outcome from 70% to 48.6% of cases diagnosed died of cancer.

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Leukemia happens when there is uncontrolled production of immature white blood cells in the bone marrow, so the bone marrow becomes overcrowded with the immature cells thus the production of normal blood cells is decreased. Leukemia may be acute, with sudden onset and short duration, or chronic with a slow onset and symptoms that persist for a period. With leukemia, cancer occurs in the stem cells, causing excessive growth of a specific type of leukocyte. These cells are abnormal and their excessive production in the bone marrow stops normal bone marrow production of red blood cells, platelets, and mature leukocytes. This result in anaemia, thrombocytopenia and leukopenia. Without treatment, the patient dies of infection or haemorrhage. For patient with acute leukemia, these changes occur rapidly and, without intervention, progress to death. Chronic leukemia may be present for years before changes appear.

Mr X is 15 years old I taukei male admitted in oncology unit.He is diagnosed with leukemia and has exhausted all his medical options. He belongs to the middle adolescent group, and this group is considered as transitional stage from childhood to adulthood.A thorough understanding of adolescence depends on the society’s knowledge on their normal growth and development.

Several changes occur at this time. For a male this the time where puberty comes in. They tend to grow taller and more muscular, voice gets deeper, facial hair grows, needs a lot of sleep and they always eat a lot and are almost always hungry.

Some cancer treatment may affect the child’sgrowth so they may end up a bit shorter as adult while some are more likely to be overweight. Feeling exhausted and lacking energy for day to day activities is also common. There is also change of appetite, some lose their appetite while some eat more. Lastly is the changing of their body image, for example is hair loss.
At the age of 15 a boy will be able to think in a more complex way. This is the time where they start to set goals for the future, makes decision on their own, differentiate between right and wrong and understand the effects of his behaviour
Some leukemia treatments have been implicated as potential source of damage to the developing central nervous system. Some children who are undergoing treatment end up with poor performance at school, lack of concentration and poor in problem solving.

Normally at this age adolescence shows strong feelings and emotions. They become sensitive to others and also conscious of their physical appearance or how their peers viewed them. At times they usually act without thinking this is because they still developing and they still learning that actionshave consequences and even risks sometimes.

A child with leukaemia will also be affected emotionally and some will last for a long time. They usually have a feeling of resentment for having to go through leukaemia while his/her peer do not. They are concerned with the physical changes that results from the treatment, and also concerned about being treated differently or discriminated by friends. They are usually over worried,depressed or angry and even left out because they have to go through all those changes and the treatment alone.
By the age of 15, many of them are aware of their sexuality and they spend more time with their friends. Some of them wants to spend time alone while others spend a great deal of time with their romantic relationship. They like to experiment things and activities and may struggle with peer pressure and probably want more independence. This is the time they start to develop stronger individual set of values and morals, they start to question things and responsible for their actions.

When cancer hits a teenager, instead of moving toward independence, they find themselves depending more on their parents to help take care of their basic needs and cancer slows down their active lifestyle. Moreover, teens with cancer can become isolated. When their counts are down, they can’t leave the house or be with crowds of people. They miss school, so they regress, or begin to behave like a younger child. They are depressed because they spend so much time alone or with their parents while their friends are going to the movies, learning to drive, and doing other activities on their own.

Play is essential to the growth and development of a child because it contributes to the cognitive, physical, social and emotional wellbeing of a child. It allows them to interact and explore the world around them. It also enable parents to engage fully with their children. Most 15-year-olds have specific interests or hobbies that they enjoy. Whether they like video games, sports, music, or movies, they can identify activities that bring them pleasure. While some of them are content to be alone, they often prefer to spend time with friends. Their time together may range from playing video games together to going to the movies.

Researchers have been researching on leukemia and have come up with some interesting facts. Binger et al(1969) did research on the impact of leukemia on patient and family. They concluded that when a child is dying he /she will have to deal with their fears and feelings alone. On the other hand, when an adult is dying they have their spouse, their children and friends to share their feelings with. Kazak (1997) talked about the post-traumatic stress, family functioning and social support in survivors of childhood leukemia and their family. They compared leukemia survivors and their parents to other participant and their parents. They found out that the survivors and their parents are mostly affected. They concluded that there is a need for psychological intervention during and after cancer treatment. Lastly, Hafiq, Jamal and Islam (2015)did a research in Bangladesh regarding oral care of children with ALL on chemotherapy. they concluded that parents be aware of the complications and preventing or reducing these through preventive measures and simple oral treatment. Parents should advicethe nutritional advise to prevent mucositis and drugs which cause caries teeth should be avoided
Having a life-threatening illness like leukemia as a child can have a lasting impact on both the child and the family. Getting to know that your child has been diagnosed with leukemia can really affect you personally as the parents. Knowing that your child may not survive for long and your lack of knowledge on the sickness and the treatment.Some family may worry about financial stresses, the cost of treatment and travelling expenses from home to the hospital and vice versa as the child will be admitted so often. Some may lose their job as they have to stay home with their child or stay with the child in the hospital full time.As for the child who is diagnosed with leukemia, he/she might have to leave school altogether during treatment. The patient will also be sickly and will be required to stay in the hospital for some time. Most of the children temporary looses their hair during the treatment course. These will affect the child psychologically and the fear of being victimised by peers and others that he/she has cancer.

Children and family should be well prepared over the course of leukemia treatment. They should be educated and also given information on what to expect during the treatment. The oncology unit should also set up family support group where families of leukemia children can talk about what they faces and how they go about those problems. The care of a leukemia child should involve everybody, the parents , the siblings, dietician , the nurse , councellor and the whoever the child thinks that should be involved in his treatment. During family conference all the family members should be present so that there is no misinterpretation of information. Encourage parents to ask as many question as they want and to raise their concern. Fortunately for Fiji we have some non government organisation who helps with cancer patient with their financial stresses and some other needs. No one chooses to have leukemia therefore we should all work together in supporting and treatment of leukemia.


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