title: Between parent and child: negotiating cancer treatment in adolescents.
abstract: Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Cancer in adolescents presents an extra dynamic of psychosocial complexity. The case of a 19-year-old woman with acute myelocytic leukemia is discussed. Her disease was refractory to allogeneic transplantation, and she died with severe graft-versus-host disease. Ms. P and her mother established very different relationships with the team which supported them through the transitions in her care, and Ms. P was able to die at home, with hospice care. The personal connection with the team enabled a degree of positive adjustment through the nightmare of loss. The epidemiology of cancer in adolescents and paradigms of care are reviewed. Psychosocial aspects of adolescence, opportunities for personal growth and support, and the challenge of end-of-life care are discussed.
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. rpenson@partners.org
authors.forename: Richard T
authors.initials: RT
authors.lastname: Penson
authors.forename: Paula K
authors.initials: PK
authors.lastname: Rauch
authors.forename: Steve L
authors.initials: SL
authors.lastname: McAfee
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Cashavelly
authors.forename: Kathy
authors.initials: K
authors.lastname: Clair-Hayes
authors.forename: Constance
authors.initials: C
authors.lastname: Dahlin
authors.forename: Kara M
authors.initials: KM
authors.lastname: Green
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Chabner
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lynch
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001900:Boston; D003657:Decision Making; D005192:Family Health; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000523:psychology; D017051:Hospice Care; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications / Q000523:psychology; D017008:Negotiating / Q000523:psychology; D010287:Parent-Child Relations