Journal of Pediatric Oncology Nursing RSS feed -- OnlineFirst Articles

Cradle to Commencement: Transitioning Adolescents With Sickle Cell Disease to Adult Providers

Doulton, D. M. — Fri, 06 Nov 2009 17:09:04 PST

Children with sickle cell disease (SCD) are surviving past childhood and well into adulthood. Concerns are raised as to who is going to care for these children as they reach adulthood. We have developed a 2-part transition program. We have transitioned 20 of our 18- to 27-year-old patients to adult providers recognizing that early preparation is essential. At the newborn’s initial visit or transfer from another clinic the transition program is explained to the family. At age 13 years, all our patients are given a "Preparation for Transition" binder. This binder is reviewed in detail with the patient and parent on a regular basis. At 18 years of age, coordinating with the milestone of graduating from high school and depending on developmental age, the transition is completed. The goal is a continuum of care in the transition process.

Consensus Statements: Ambulatory Pediatric Oncology Nursing Practice

Fri, 06 Nov 2009 17:09:03 PST

The pre-conference workshop at the 32nd Annual Conference of the Association of Pediatric Hematology/Oncology Nursing, held in September 2008, focused on issues faced by pediatric oncology nurses in the ambulatory setting. The workshop was developed after several years of intense discussions at several forums. Therefore the need for an extended discussion period with ambulatory pediatric oncology nurses across the country to address these concerns was evident.

There has been a major shift over the past ten years from inpatient to outpatient treatment in oncology (Chabot & Fox, 2005). This shift has resulted in numerous unique challenges for the pediatric oncology nurse. Challenges include lack of staffing resources for fluctuating patient volume and acuity, telephone triage volume and management, home care patient issues, scheduling systems, patient flow and wait time, and multi-institutional communication. This article reports the results of the APHON workshop which utilized the evidence from adult ambulatory oncology literature and standards and the recommendations of the expert pediatric oncology nurse participants to develop global statements about pediatric oncology ambulatory practice standards. The energy and productivity of the group was evidence of a common theme and demand for attention to the ambulatory nursing staff and practice. The ability to identify common threads and reach consensus with powerful statements of practice supports the continued use of such forums to move practice forward.

How Children With Cancer Communicate and Think About Symptoms

Vatne, T. M., Slaughter, L., Ruland, C. M. — Fri, 30 Oct 2009 15:33:27 PDT

Background. For clinicians to effectively help children with their illness and symptoms, it is important to communicate with them in a language they can understand. Methods. This study investigates how well children with cancer and healthy children understood 44 symptom terms; their thoughts about these symptoms in terms of causes, consequences, and cures; and what other terms the children use to express these symptoms. It also explores if there are differences in understanding and thoughts about symptoms between children who have the experience of cancer and those who do not. In all, 6 children with cancer and 8 healthy children participated in semistructured interviews. Results. Children demonstrated a good understanding of symptom terms, yet were not always able to explain the symptoms. They had a rich vocabulary to talk about symptoms but did not use childish terms. Children with cancer had a more varied vocabulary for symptoms, but they did not use more medical terms. This study contributes to knowledge about children’s understanding of symptoms that can be helpful to clinicians when communicating with children about their illness.

Adequacy of Nutritional Support in Pediatric Blood and Marrow Transplantation

Cohen, J., Maurice, L. — Thu, 15 Oct 2009 12:36:46 PDT

The use of nutrition support has become standard practice in blood and marrow transplantation, but what remains unclear is whether patients receive adequate nutrition supplementation during this time.This study is a retrospective audit of the nutritional supplementation of 34 pediatric patients admitted to a pediatric oncology unit for a blood and marrow transplantation. All patients received parenteral nutrition (PN) as their standard nutritional therapy with an average of 79 ± 10.6% of their estimated requirements given over the transplant period.The glucose/amino acid infusion was inadequate on 40% of PN days mainly because of fluid overload causing a reduction in infusion rates.The lipid infusion was inadequate on 60% of PN days mainly because of stoppages when drugs and/or blood were infused. The mean percentage weight change on discharge was +0.3 ± 4.7%. This had a large range of between -9.9% and +7.9% of body weight and did not seem to be related to adequacy of nutrition during transplant.This study showed that although frequent rate reductions in nutrition infusions did occur, most patients still received the majority of their nutritional requirements.

Off-Therapy Headaches in Pediatric Brain Tumor Patients: A Retrospective Review

Johnson, A. H., Jordan, C., Mazewski, C. — Mon, 17 Aug 2009 13:17:42 PDT

To determine the incidence, timing, and characteristics of headaches in a population of off-therapy pediatric brain tumor patients, a retrospective chart review was conducted on 3 subpopulations of children followed in a multidisciplinary neuro-oncology clinic in the Southeastern United States. Data collected included tumor type and location, treatment, associated symptoms, and description and timing of headaches. In all, 71 charts were reviewed from which headaches in 3 subtypes of tumors were identified (29 medulloblastomas, 36 cerebellar juvenile pilocytic astrocytomas [JPAs], and 16 craniopharyngiomas). Off-therapy headaches were noted in 6 (21%) of medulloblastomas, 10 (28%) of JPAs, and 11 (69%) of craniopharyngiomas. Almost half of those patients with prediagnosis headaches had recurrent off-therapy headaches. Given the incidence of this symptom, headache must be highlighted in posttreatment and late effects monitoring. Whether provided by the oncology team or primary care provider, headache assessment, treatment, and prevention counseling can be improved through utilization of newly developed tools and written educational materials. Experienced nurses can play key roles in this aspect of posttreatment pediatric care of brain tumor patients.

Multiple Symptoms in Pediatric Oncology Patients: A Systematic Review

Baggott, C., Dodd, M., Kennedy, C., Marina, N., Miaskowski, C. — Mon, 17 Aug 2009 13:17:42 PDT

Clinical experience suggests that children with cancer experience multiple symptoms as a result of their disease and/or its treatment. These symptoms may have a negative impact on children’s ability to function and on their quality of life. No systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. The purposes of this article are to summarize the findings from the studies of multiple symptoms in pediatric oncology patients and to describe directions for future research. Although there has been a recent increase in the studies of the multiple symptoms in pediatric cancer patients, only 9 studies were found that met the inclusion criteria for this review. Thus, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Additional research is warranted on the prevalence and impact of multiple symptoms, particularly among homogeneous samples of patients. Future directions for symptom studies in pediatric oncology include symptom cluster research and the search for biological bases for the untoward effects of cancer treatment.

Experience With Electrolyte Levels After Craniotomy for Pediatric Brain Tumors

Madden, J., Dobyns, E., Handler, M., Foreman, N. — Mon, 17 Aug 2009 13:17:41 PDT

Children with brain tumors routinely undergo craniotomies for tumor resections. Nurses and nurse practitioners are critical in closely monitoring these patients. Postoperatively, these children may develop inappropriate vasopressin secretion, cerebral salt wasting syndrome, or a combination of both. Inappropriate fluid and electrolyte administration may exacerbate symptoms. Both high and low sodium levels are associated with significant complications. Sodium levels were prospectively observed for 72 hours perioperatively. Overall, 36 patients had 201 serum sodium levels measured over the course of 1 year. Postoperatively, 79 (39%) of the sodium levels were <135 mEq/L or >145 mEq/L. Of these abnormal sodium levels, 3 (1%) were <125 mEq/L and 2 (1%) were >165 mEq/L. All the abnormal sodium levels occurred in patients with suprasellar or hypothalamic lesions. This study suggests that children with resections of suprasellar or hypothalamic tumors need specialist attention in postoperative management of fluid and electrolytes. The nurse is in the ideal role to monitor closely the pediatric brain tumor patient at high risk for abnormal sodium levels.

Feasibility and Preliminary Outcomes From a Pilot Study of Coping Skills Training for Adolsecent-Young Adult Survivors of Childhood Cancer and Their Parents

Santacroce, S. J., Asmus, K., Lottick, N., Grey, M. — Mon, 17 Aug 2009 13:17:41 PDT

Uncertainty is a central feature of long-term childhood cancer survivorship during which time it principally has to do with late effects. Therefore, the purposes of this article are (a) to assess feasibility of a randomized clinical trial of a telephone-delivered coping skills training (CST) intervention in terms of recruitment, retention, and timeline, as well as the performance of the study measures; and (b) to demonstrate trends in change on outcomes within the context of a small pilot study. The results of this pilot study suggest that HEROS PLUS CST has clinical relevance and that in-person long-term follow-up plus telephone-delivered psychosocial care is a practical way to deliver integrated care to adolescent–young adult childhood cancer survivors and their parents.

The Influence of 2 Hospitals' Designs and Policies on Social Interaction and Privacy as Coping Factors for Children With Cancer and Their Families

Rollins, J. A. — Mon, 17 Aug 2009 13:17:42 PDT

Children with cancer and their families benefit from both social interaction and privacy in attempting to cope with the stresses of a child’s hospitalization and illness. An analysis of findings from a study of stress and coping for children with cancer evaluated design features affecting social interaction and privacy at a hospital in the United Kingdom and a hospital in the United States and some of the ways in which these features and related hospital policies uphold the philosophy of family-centered care and support coping. Implications of these findings with the current call for single occupancy rooms in both countries are explored.