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Childhood Leukemia A Guide for Families Friends and
Caregivers 3rd Edition Nancy Keene Digital Instant
Download
Author(s): Nancy Keene
ISBN(s): 9780596500153, 0596500157
Edition: Third Edition
File Details: PDF, 4.99 MB
Year: 2002
Language: english
 Nancy Keene 3rd
Edition
“This most complete parent guide available covers
not only detailed and precise medical information,
but also day-to-day practical advice.”
—F. LEONARD JOHNSON, MD, CHIEF, DIVISION OF PEDIATRIC
HEMATOLOGY/ONCOLOGY OREGON HEALTH AND SCIENCE UNIVERSITY

CHILDHOOD
LEUKEMIA
A Guide for Families, Friends
& Caregivers

Understanding the diagnosis

Getting excellent treatment


Coping with side effects


Finding emotional support


Identifying resources

Patient-Centered Guides
 Praise for “Childhood Leukemia”
“Of all the many kinds of help we had (and we had lots) the book was the single best gift
we received. It was the gift of knowledge, so we could ask intelligent questions about our
daughter’s care. It was the gift of security, allowing us to foresee much of what was
coming, and giving us the tools we needed to cope. And it was the gift of hope, for we
could see that many children do, indeed, get through this trying time, and come through
the grueling treatment intact.”
—Kim Warren
Mother of a leukemia survivor

• • • • •

“Faced with a diagnosis of a life threatening disease, parents of a newly diagnosed child
with leukemia often struggle to understand the facts and explanations of the disease and
treatment they face, while at the same time dealing with overwhelming feelings of fear,
confusion and isolation. The great value of Nancy Keene’s exceptional book is that it puts
the facts and explanations into understandable terms while acknowledging and dealing
with the emotional aspects as only parents who have had similar experience, can. This
combination of science, clinical facts and humanism is a potent weapon for both new and
seasoned parents who must travel this demanding path. It is also of enormous value to
those of us who try to help parents understand and cope as our professional obligation.”
—Mark L. Greenberg, MD, OC, MBChB, FRCP(C)
Professor of Pediatrics, University of Toronto
Senior Staff Oncologist, Hospital for Sick Children
Medical Director, Pediatric Oncology Group of Ontario

• • • • •

“Our 7-year-old daughter was diagnosed November, 2000, with ALL. We were immedi-
ately given a copy of your book by the hospital. Initially, we were reluctant to open it and
face the information inside. However, once we decided to pull our heads from the sand,
we have found Childhood Leukemia to be our absolute bible. Not only do we use it for
general information, but we rely heavily on this book for reassurance in times of crisis
(real or potential). I cannot imagine not having the information so close at hand and so
well organized.”
—Jocelyn Hillman
Mother of a leukemia patient

• • • • •

“I am a physician in academics and the parent of a child with cancer. One of the paralyz-
ing things about having a child with cancer is how suddenly and unexpectedly your
world is turned upside down. It is the hardest and scariest thing I have ever experienced,
and reading the advice and wisdom of parents who have made the journey before me was
of immeasurable benefit to me.
The toll that pediatric cancer takes on families is unquantified, but includes physical and
psychiatric illness in the child and in family members, divorce, and tremendous financial
stress. Having a resource for coping with all these hardships is the first step toward put-
ting the world back together, and Nancy Keene’s books are the best solution I have found.”
—Catherine L. Woodman, MD
Departments of Psychiatry and Family Medicine
University of Iowa

• • • • •

“This book is an extraordinary resource. In its pages the reader will find clear, concise,
and understandable information about childhood leukemia. And even more powerfully,
the reader will “hear” the voices of parents who share their experiences in their own
words: what worked, what didn’t, what helped, what hurt. Families, friends, and care-
givers who use this book will have information and support at their fingertips, and a
powerful tool with which to help young people with leukemia get what they need to
claim their lives in spite of this disease and the toll it takes.”
—Kathy Ruccione, RN, MPH
Nursing Administrator
Director, LIFE Program (Long-Term Information,
Follow-up and Evaluation)
Co-Director, Health Promotion and Outcomes Program
Childrens Center for Cancer and Blood Diseases
Childrens Hospital of Los Angeles

• • • • •

“I highly recommend Childhood Leukemia to all families of children with leukemia. It is an

immediate help for the newly diagnosed parent and a comprehensive reference for the
subsequent years of treatment. This book covers everything — and I mean everything —
that a parent needs to know about the issues surrounding treatment for childhood leuke-
mia. It amazes me that for a disease as rare as childhood leukemia, someone as talented a
writer as Nancy took the time to write such a complete and useful book.”
—Patty Feist
Parent a survivor of ALL
Organic chemist
Editor, Pediatric Oncology Resource Center
http://www.acor.org/ped-onc

• • • • •

“What’s compelling about Childhood Leukemia: A Guide for Families, Friends, and Caregivers
is the amount of useful medical information and practical advice it contains.... As the
mother of a two-time survivor of ALL — yes it can recur, in my daughter’s case after a
14-year remission—I can vouch that the road to cure is bumpy, filled with life-threatening
complications and requiring aggressive in-hospital care. Keene spells it all out... A valuable
resource to help parents and children regain their equilibrium after diagnosis and during
the two to three years of treatment.”
—Patricia Dane Rogers
The Washington Post

• • • • •

“This book is an invaluable reference for children, their family and their health care
providers. It provides important information written in ways families can understands. Ms.
Keene presents difficult and sometimes troubling information in a sensitive and balanced
manner. I highly recommend it for patients, family members and health care providers.”
—Debra L. Friedman, MD
Assistant Professor of Pediatrics
Children’s Hospital Regional Medical Center
Seattle, WA

• • • • •

“Childhood Leukemia was and is an invaluable resource for me. I discovered it a few months
into my daughter’s leukemia journey and have read and reread it. When Katie was first
diagnosed I was told mountains of information, but was unable to absorb much of it due
to the initial shock of having a child with cancer. Having all that information and much
more at my fingertips has been a huge help. Sometimes it helped me just to know what
questions to ask. Even now, months after treatment has ended, I continue to refer to the
book for information about the different drugs that were used; I also use the book to help
other parents who have questions.”
—Pat Lee
Mother of a leukemia survivor

• • • • •

“This is the most comprehensive resource available for parents and caregivers of children
diagnosed with leukemia. These families must become immediate experts and Childhood
Leukemia: A Guide for Families, Friends & Caregivers presents up-to-date information in
understandable language. Parents find the vignettes helpful, comforting and encouraging.
We believe so strongly in this book that a copy is given to each family.”
—Mary McSherry, ACSW, LSW
Social Worker, Division of Oncology
The Children’s Hospital of Philadelphia

• • • • •
“Keene has written a comprehensive handbook to serve as a road map for others, from
diagnosis through treatments.”
—Library Journal, starred review
First edition was 1 of only 33 books recommended for
a core children’s medical collection in 1998.

• • • • •

“Finally, a book that truly addresses what is needed, practically and emotionally, to “work”
the system for the benefit of the family. No preaching! No proselytizing! No slant towards
a personal experience. No nagging feeling that the book has been written by doctors.
Rather, my conviction is that this book wrote itself from careful and honest listening to
parents, children, siblings, doctors, and others traveling the road that is the experience of
cancer in a child.”
—Grace Ann Monaco, JD
A Founder of the Candlelighters
Childhood Cancer Foundation

• • • • •

“Nancy Keene, whose daughter survived childhood leukemia, offers help and support in
this comprehensive guide for families, friends, and health care providers of childhood
leukemia patients.
Leukemia Society staff and volunteers regularly use this guide as a valuable reference tool.
‘This is an excellent guide for living and coping with childhood leukemia,’ says Hildy
Dillon, Director of the Information Resource Center at the Leukemia Society of America.”
—NewsLine, Fall, 1999
Leukemia Society of America
(now the Leukemia and Lymphoma Society)
 Childhood
Leukemia
A Guide for Families, Friends & Caregivers
Third Edition

Nancy Keene

Beijing • Cambridge • Farnham • Köln • Paris • Sebastopol • Taipei • Tokyo

Childhood Leukemia: A Guide for Families, Friends & Caregivers, Third Edition
by Nancy Keene

Copyright © 2002 O’Reilly & Associates, Inc. All rights reserved.

Printed in the United States of America.

Published by O’Reilly & Associates, Inc., 1005 Gravenstein Hwy N., Sebastopol, CA 95472.

Editor: Linda Lamb

Production Editor: Tom Dorsaneo

Cover Designer: Kristen Throop

Printing History: June 1997, First Edition

October 1999, Second Edition
May 2002, Third Edition

Many of the designations used by manufacturers and sellers to distinguish their products are claimed
as trademarks. Where those designations appear in this book, and O’Reilly & Associates, Inc. was
aware of a trademark claim, the designations have been printed in caps or initial caps.
This book is meant to educate and should not be used as an alternative for professional medical care.
Although we have exerted every effort to ensure that the information presented is accurate at the time
of publication, there is no guarantee that this information will remain current over time. Appropriate
medical professionals should be consulted before adopting any procedures or treatments discussed
in this book.

Library of Congress Cataloging-in-Publication Data:

Keene, Nancy.
Childhood leukemia: a guide for families, friends & caregivers / Nancy Keene.—3rd ed.
p. cm.—(Patient-centered guides)
Includes bibliographical references and index.
ISBN 0-596-50015-7
1. Leukemia in children. I. Title. II. Series.

RJ416.L4 K44 2002

618.92’99419--dc21 2002025184

This book is printed on acid-free paper with 85% recycled content, 15% post-consumer waste.
O’Reilly & Associates, Inc., is committed to using paper with the highest recycled content available
consistent with high quality.

[M]
 ❦
To my daughters
Kathryn and Alison
 Table of Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

1. Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Signs and symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Where should your child receive treatment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Physical responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Emotional responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The immediate future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2. Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Leukemia is a disease of the blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Who gets leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Diagnosing leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Best treatments for leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Types of leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Acute lymphoblastic leukemia (ALL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Acute myeloid leukemia (AML) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chronic myelogenous leukemia (CML) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Juvenile myelomonocytic leukemia (JMML) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Telling your child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

3. Coping with Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Planning for procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pain management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

4. Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Enrollment in clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Standard treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Types of clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Randomization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

ix
 Design of clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Supervision of clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Questions to ask about clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Informed consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Assent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
The protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
The entire trial document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Saying no to a clinical trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Removing a child from a clinical trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Pros and cons of clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

5. Family and Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

The extended family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Restructuring family life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

6. Forming a Partnership with the Medical Team . . . . . . . . . . . . . . . . . . . . . . . 106

The hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Finding an oncologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Choosing a hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Types of relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Getting a second opinion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Conflict resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Changing doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

7. Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
The room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Parking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
The endless waiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Befriending the staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Being an advocate for your child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Playing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

8. Venous Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

External catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Subcutaneous port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Peripherally inserted central catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

x TABLE OF CONTENTS
 Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Choosing not to use a catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Making a decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Adhesives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

9. Sources of Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Hospital social workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Support groups for parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Support groups for children with cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Support groups for siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Parent-to-parent programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Hospital resource rooms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Clergy and religious community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Individual and family counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Camps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

10. Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

How chemotherapy drugs work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
How chemotherapy drugs are given . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Dosages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Chemotherapy drugs and their possible side effects . . . . . . . . . . . . . . . . . . . . . . 173
Prophylactic antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Colony-stimulating factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Antinausea drugs used during chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Drugs used to relieve pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Local anesthetics to prevent pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Adjunctive treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Alternative treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

11. Common Side Effects of Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

Hair loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Nausea and vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Low blood counts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Fatigue and weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Bed wetting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Dental problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Mouth and throat sores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231

TABLE OF CONTENTS xi
 Changes in taste and smell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Skin and nail problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Steroid problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Learning disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Eating problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234

12. Radiation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Types of radiation treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Possible short-term side effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Possible long-term side effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

13. Record-Keeping and Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Keeping medical records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Keeping financial records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Coping with insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Sources of financial assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265

14. Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

Treatment side effects and eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
A balanced diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Vitamin supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Making eating fun and nutritious . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
What kids really eat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Parent advice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Commercial nutritional supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Feeding by tube and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

15. School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

Keeping the school informed about treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Keeping teacher and classmates involved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Keeping up with schoolwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Siblings need help, too . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Returning to school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Avoiding communicable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
What about preschoolers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Identifying cognitive late effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Record-keeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
The terminally ill child and school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
On accepting disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312

xii TABLE OF CONTENTS

16. Siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Telling the sibling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Emotional responses of the siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Sibling experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Helping siblings cope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Positive outcomes for the siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333

17. Feelings, Communication, and Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Feelings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Common behavioral changes of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Common behavioral changes of parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
Improving communication and discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

18. End of Treatment and Beyond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

Emotional issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Last day of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Catheter removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Ceremonies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362
What is normal? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Follow-up care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Keeping the doctor informed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
The military . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380

19. Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

Signs and symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Emotional responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
Deciding on a treatment plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

20. Stem Cell Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

When are transplants necessary? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Types of transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Finding a donor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Choosing a transplant center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Paying for the transplant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Donating marrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
The transplant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407

TABLE OF CONTENTS xiii

 Emotional responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Long-term side effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416

21. Death and Bereavement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421

Transitioning from active treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Supportive care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Dying in the hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Dying at home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428
Siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
The funeral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
The role of family and friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Sibling grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
Parental grief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
Looking back after many years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

Appendices
A. Photographs of Our Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449

B. Blood Counts and What They Mean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

C. Resource Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463

D. Books and Online Sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495

xiv TABLE OF CONTENTS

 Foreword

EVERY YEAR IN THE UNITED STATES approximately 12,000 children and adolescents under
the age of twenty years are diagnosed with cancer. Of these children, approximately
2,500 will be afflicted with acute lymphoblastic leukemia and 500 with other types of
childhood leukemia. Significant progress has been made in the treatment of childhood
cancer over the past four decades, best illustrated by the dramatically improved cure rate
for children diagnosed with acute lymphoblastic leukemia. A leading textbook on child-
hood cancer published in 1960* described leukemia in childhood as being “incurable.”
Today, the cure rate for children diagnosed with acute lymphoblastic leukemia is 75
percent overall, and over 85 percent in certain groups of children with particular
types of leukemia.
Not every child with leukemia, however, is guaranteed a cure, and progress in the
treatment of certain types of leukemia has been definite but slow. Long-term effects
following childhood cancer and its treatment are now common as more children are
cured of cancer. Thus the diagnosis of any form of cancer in a child remains devastat-
ing to a family suddenly thrust into a foreign and threatening world of new and
frightening words, medical tests and treatments, uncertainty about the future and,
perhaps worst of all for parents, loss of control in guiding their child’s life.
The best resource to help survive this new world is knowledge. Nancy Keene has
taken her experience following the diagnosis of leukemia in her 3-year-old daughter,
Katy, melded this with the experiences of more than 100 other families, and produced
an invaluable source of knowledge for parents of children diagnosed with cancer.
Although the book focuses on leukemia, it contains information that will prove
extremely helpful to parents and families coping with any type of childhood cancer.
Keene writes in her introduction, “I wanted to provide the insight and experiences of
veteran parents who have all felt the hope, helplessness, anger, humor, longing, panic,
ignorance, warmth, and anguish of their children’s treatment for cancer. I wanted
parents to know how other children react to treatment, and I wanted to offer tips to
make it easier.” She has clearly succeeded.

* Ariel, I.M., and A.T. Pack, eds. Cancer and Allied Diseases of Infancy and Childhood. Boston:
Little, Brown & Company, 1960.
xv
Other documents randomly have
different content
 Philosophy - Cheat Sheet
Summer 2022 - Research Center

Prepared by: Prof. Davis

Date: August 12, 2025

Practice 1: Theoretical framework and methodology

Learning Objective 1: Comparative analysis and synthesis
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Practical applications and examples
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 3: Problem-solving strategies and techniques
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 4: Problem-solving strategies and techniques
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 4: Diagram/Chart/Graph]
Learning Objective 5: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 5: Experimental procedures and results
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 6: Diagram/Chart/Graph]
Practice Problem 6: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 7: Diagram/Chart/Graph]
Key Concept: Interdisciplinary approaches
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Interdisciplinary approaches
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 2: Key terms and definitions
Important: Theoretical framework and methodology
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 11: Problem-solving strategies and techniques
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 14: Diagram/Chart/Graph]
Important: Ethical considerations and implications
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Study tips and learning strategies
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 17: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 20: Diagram/Chart/Graph]
Exercise 3: Problem-solving strategies and techniques
Key Concept: Theoretical framework and methodology
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 21: Learning outcomes and objectives
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Best practices and recommendations
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 23: Diagram/Chart/Graph]
Key Concept: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 24: Interdisciplinary approaches
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Problem-solving strategies and techniques
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Assessment criteria and rubrics
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Problem-solving strategies and techniques
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 29: Diagram/Chart/Graph]
Definition: Learning outcomes and objectives
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Module 4: Research findings and conclusions
Note: Current trends and future directions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Statistical analysis and interpretation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 33: Diagram/Chart/Graph]
Example 33: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Critical analysis and evaluation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 35: Literature review and discussion
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Research findings and conclusions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Ethical considerations and implications
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 38: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 39: Key terms and definitions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Part 5: Assessment criteria and rubrics
Example 40: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 41: Case studies and real-world applications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 42: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 43: Diagram/Chart/Graph]
Remember: Interdisciplinary approaches
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 45: Fundamental concepts and principles
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 47: Key terms and definitions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 48: Learning outcomes and objectives
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Interdisciplinary approaches
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
References 6: Research findings and conclusions
Definition: Research findings and conclusions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 53: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 54: Statistical analysis and interpretation
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 55: Diagram/Chart/Graph]
Example 55: Current trends and future directions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 56: Diagram/Chart/Graph]
Definition: Fundamental concepts and principles
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Fundamental concepts and principles
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Historical development and evolution
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 60: Diagram/Chart/Graph]
Lesson 7: Ethical considerations and implications
Practice Problem 60: Current trends and future directions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 61: Theoretical framework and methodology
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Current trends and future directions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 63: Experimental procedures and results
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Practical applications and examples
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Comparative analysis and synthesis
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Historical development and evolution
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 67: Diagram/Chart/Graph]
Key Concept: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Experimental procedures and results
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 69: Diagram/Chart/Graph]
Practice Problem 69: Ethical considerations and implications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Appendix 8: Interdisciplinary approaches
Practice Problem 70: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 71: Diagram/Chart/Graph]
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