Dissertation Ideas

The best and easiest topics to research and write about are ones in which you are interested. If you like oncology and find it interesting, choose a subject related to that. A few pediatric oncology related topics where you are sure to find lots of evidence are: reducing central line related infections, best practice neutropenic precautions, managing chronic pain, and coping with the psychological stress of a cancer diagnosis.

I think End of Life issues is a big one in Pediatric Oncology. Too often, I think, it's not discussed at the appropriate time and then decisions have to be made very quickly. I've had more than a few patients whose parents "signed the DNR just in time." In all of these patients, their prognosis was known for weeks, months, etc. but since there was always some phase 1 trial or some off label drug they were offered, end of life wasn't always discussed until the child was imminently dying. I've also seen it done the other way. Obviously, end of life isn't brought up at diagnosis for a child with ALL who has an 85-90% chance of being successfully treated, but what about for a child with DIPG- a tumor that no one survives? I've seen many of these tumors in my years in pediatric oncology and, while the prognosis is given from the get-go, I've seen cases where a child presented with acute respiratory failure, was intubated or put on BiPap and then end-of-life discussions held when it was at the point of "it's time to withdraw support."

And then, what of the parents who are realistic and say "it's time to stop"... what outside pressures do they face? 4 patients that I worked with closely died this spring from their cancers... one family, when told that their child had over a dozen new tumors and the end was nearing, decided to stop treatment. When they told people this, they were met with endless "helpful" people who saw some miracle treatment listed on the internet or were sure that Vitamin C could cure cancer. I remember another patient, who I took care of in the hospital. He was actively dying from a large brain tumor and was on a LOT of meds for comfort, one of which being ativan. He was having some respiratory issues from the tumor's effect on his brainstem... well, one day Grandma goes home and looks up ativan on wikipedia, decides that this is the cause of all of his symptoms and tries to demand that we stop this medication. How does that impact the parents, who were finally able to accept reality after several talks with the treatment team and agree to comfort measures? This topic is HUGE.