Journal of Pediatric Oncology Nursing recent issues

Editorial: APHON's 32nd Annual Conference: Something for Everyone

Kline, N. E. — 2008-09-02

Aspergillosis Prophylaxis and Treatment for Pediatric HSCT Patients: Environmental and Pharmacologic Options

Doyle, S. C. — 2008-09-02

Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of viral, bacterial, fungal, and parasitic infections both pretransplant and post-transplant. One of the most dangerous infections that can be acquired during this time is aspergillosis. Several drugs are available for prophylaxis, though no particular regimen has been proven to be superior; although the CDC has clear recommendations regarding prophylaxis for many other infections (such as cytomegalovirus, herpes simplex, toxoplasmosis, and Candida) for HSCT patients, there are none for aspergillosis. Researchers have varying opinions as to which drugs are best for prophylaxis. In this article, pharmacologic and environmental options for prophylaxis are discussed as well as antifungals currently in use, and recommendations on how nurses can help keep their patients safe from this infection are given.

Depression, Anxiety, Hopelessness, and Social Support Levels of the Parents of Children With Cancer

Bayat, M., Erdem, E., Gul Kuzucu, E. — 2008-09-02

When a child is diagnosed with cancer, family members are affected both socially and psychologically. This study was conducted to determine the depression, anxiety (state and trait), hopelessness, and perceived social support levels of 94 parents of children with cancer followed up at a university hospital. Data were collected using a questionnaire form and included descriptive characteristics, Beck Depression Inventory, Multidimensional Scale of Perceived Social Support, State—Trait Anxiety Inventory, and The Hopelessness Scale. A positive relationship was found between depression and hopelessness scores and between state and trait anxiety scores for both mothers and fathers. Also, a negative relationship was found between social support and depression scores and between hopelessness and social support scores. Apart from fathers, a positive relationship between depression and trait anxiety scores and a negative relationship between state anxiety and hopelessness scores were found in mothers. Based on these results, it seems that it would be highly beneficial to provide psychological and social support and social support groups to help parents cope with these problems.

Nutritional Issues in Adolescents After Bone Marrow Transplant: A Literature Review

Rodgers, C., Walsh, T. — 2008-09-02

Bone marrow transplantation and related complications can cause gastrointestinal (GI) side effects that can lead to poor nutrition, which has been associated with several morbidity and mortality issues. Adolescents require adequate nutrition not only to maintain health but to advance with normal growth and development. This article synthesizes the bone marrow transplant (BMT) literature regarding adolescents' nutritional needs, etiologies of altered oral intake, GI symptoms, nutritional assessments, nutritional interventions, and quality of life associated with poor nutrition. In addition, gaps in knowledge in the literature are identified. To provide effective and thorough care to patients during their BMT recovery, the knowledge base of nutritional and eating issues after transplant needs to become more comprehensive. Nurses play an important role in gathering and reporting clinical information. By anticipating potential risk factors, assessing and identifying symptoms, and initiating appropriate interventions promptly, patients can experience a more positive BMT experience.

Health-Related Quality of Life Relates to School Attendance in Children on Treatment for Cancer

af Sandeberg, M., Johansson, E., Bjork, O., Wettergren, L. — 2008-09-02

The aims of this study are to follow health-related quality of life (HRQOL), school attendance, and social interaction with friends in children with cancer and to explore potential relationships between HRQOL and school attendance. The study also describes self-reported reasons for not attending school and not meeting friends. During a 2-year period, all schoolchildren in Sweden starting treatment for cancer were invited to participate in the study. Participants (N = 101) were assessed 3 times during the first 5 months of treatment using 2 questionnaires: DISABKIDS Chronic Generic Module (DCGM-37) and a study-specific questionnaire. The results indicate a diminished HRQOL that remained stable over the study period, with girls rating worse HRQOL compared with boys. School attendance significantly increased over time, and approximately half of the children attended school 5 months after start of treatment. Self-reported HRQOL was positively correlated to days of school attendance. The results emphasize the importance of psychosocial care and nursing for children diagnosed with cancer, especially for girls. Research to further explore gender differences in HRQOL among children diagnosed for cancer is recommended.

Social Support and Symptom Distress in Adolescents/Young Adults With Cancer

Corey, A. L., Haase, J. E., Azzouz, F., Monahan, P. O. — 2008-09-02

The purpose of this secondary analysis was to describe the relationships of friend, family, and health care provider social support to pain, fatigue, depressed mood, and insomnia in adolescents and young adults with cancer using the Adolescent Resilience Model. Specific aims of the study were to describe the relationships of 3 separate sources of perceived support—friends, family, and health care providers to the symptom-related distress of pain, fatigue, depressed mood, and insomnia.

Phenomenology in Pediatric Cancer Nursing Research

Fochtman, D. — 2008-06-20

What does it mean to have cancer as a child or adolescent? To understand this, researchers must study the illness from the child's point of view and listen to these children's descriptions of their "lived world." Phenomenology is a qualitative research methodology that can be used to discover and interpret meaning. To use phenomenology congruently, the philosophical background must be understood as well as the adaptation of the philosophical basis to research in the caring sciences. Only when clinicians truly understand the meaning of this illness to the child can they design nursing interventions to ease suffering and increase quality of life in children and adolescents with cancer.

Talking With Others Who "Just Know": Perceptions of Adolescents With Cancer Who Participate in a Teen Group

Cassano, J., Nagel, K., O'Mara, L. — 2008-06-20

Adolescents with cancer have social support needs that are challenging to meet. A qualitative descriptive study was done using in-person interviews with 11 participants between the ages of 14 and 20. The purpose of the study was to explore and describe adolescent's perceptions of a teen support group. Two main themes emerged: Satisfying Elements and Challenges in the teen group. The subthemes under Satisfying Elements include participants being able to talk to others who "just know," sharing experiences while having fun as a normal teenager, and giving or receiving inspiration. Subthemes under Challenges as identified by participants include ensuring that activities during teen events meet the needs of all participants and dealing with the death of a group member. Study findings suggest that adolescent's feel supported when they are among others in similar circumstances while engaging in normal activity. Offering this type of group for adolescents with cancer provides them with the ongoing opportunities for connection with their peers that is often needed throughout the treatment journey.

Examining the Push--Pull Method of Blood Sampling From Central Venous Access Devices

Adlard, K. — 2008-06-20

The placement of a central venous access device (CVAD) has revolutionized supportive care for pediatric cancer patients. The CVAD is used to administer chemotherapy/biotherapy, blood products, total parenteral nutrition, antibiotics, and many other supportive medications. CVADs also provide the ability to obtain blood samples without the trauma associated with venipuncture. Frequent blood sampling is often needed to monitor the side effects and response of the cancer treatment. Unfortunately, the most common method requires discarding blood (0.5-10 mL, depending on the institution's protocol) with each lab draws, for various reasons. For pediatric oncology patients, this can result in a large volume of blood being discarded and subsequently increase the need for blood transfusions. Repeated exposure to allogeneic (donor) blood products can put this patient population at additional risk for alloimmunization and febrile reactions. The purpose of this study is to test the limits of agreement between laboratory values (chemistry panel 18 and complete blood count) obtained using the push—pull and standard methods of blood sampling from CVADs in pediatric oncology patients.

Antibiotics in 30 Minutes or Less for Febrile Neutropenic Patients: A Quality Control Measure in a New Hospital

Corey, A. L., Snyder, S. — 2008-06-20

Infections are the most common complication in patients receiving treatment for cancer with neutropenia being the primary risk factor for the development of an infection. In the neutropenic patient, bacteremia remains a significant cause of mortality. Although the literature reports that prompt empiric antibiotic therapy to prevent death caused by virulent organisms is the standard of care, the literature fails to identify what prompt antibiotic administration means. Door/fever-to-patient antibiotic delivery was evaluated as a quality control measure in a new children's hospital. Initially, door/fever-to-patient time was significantly delayed. Collaboration between pharmacy, hospital bed control, medical, and nursing staff resulted in many changes in practice by all groups. As a result, the goal for prompt antibiotic delivery of thirty minutes or less is now achievable.

The Role of the Long-Term Follow-up Clinic in Discovering New Emerging Late Effects in Adult Survivors of Childhood Cancer

Meeske, K. A., Nelson, M. B. — 2008-06-20

Our understanding of late effects in long-term survivors of childhood cancer is continually evolving as significant numbers of survivors are entering middle to later adulthood. Effects of conventional treatment on premature aging are being recognized, as are long-term effects of newer therapies. Clinicians in long-term follow-up clinics are in a unique position to monitor for recognized late effects and to be alert to signs and symptoms of late effects that have not been previously reported in the pediatric cancer literature. This article presents 2 young adult survivors who displayed subtle signs of impaired cerebral blood flow due to carotid artery stenosis many years after being treated with neck irradiation. When the first patient presented nearly a decade ago in the clinic with symptoms, premature carotid artery disease was not a radiation-related late effect that had been reported previously in survivors of childhood cancer. These cases are used to illustrate the key role of long-term follow-up clinics in identifying new and emerging treatment-related late effects and underscore the importance of lifetime surveillance and the need for collaboration between pediatric and adult health care providers.

Using Plain Language Skills to Create an Educational Brochure About Sperm Banking for Adolescent and Young Adult Males With Cancer

Nagel, K., Wizowski, L., Duckworth, J., Cassano, J., Hahn, S. A., Neal, M. — 2008-06-20

Writing in plain language makes it easier for patients to read, understand, and make informed decisions about sperm banking. Greater attention to the issue and properly designed educational brochures for use by nurses in oncology and reproductive health is of evident importance but of unknown impact. A multidisciplinary clinical team followed an evidence-based, patient-centered approach to develop "plain language" patient education materials about sperm banking for adolescent and young adult (AYA) males with cancer. A patient education booklet was produced and implemented as part of the planned patient education for AYA male oncology patients at McMaster Children's Hospital, Hamilton Health Sciences, in Hamilton, Ontario, Canada. The patient education booklet for use by health professionals as a teaching tool to facilitate discussion with AYA males has been produced with the hope that it will contribute to better informed decision making regarding sperm banking and increased use of this technology for fertility preservation.

Neurocognitive Impairment in Children Treated for Cancer: How Do We Measure Cognitive Outcomes?

Gross-King, M., Booth-Jones, M., Couluris, M. — 2008-06-20

As the number of childhood cancer survivors grows, more attention on the identification and management of late effects, such as neurocognitive decline, is needed. This study, investigating treatment with central nervous system (CNS) stimulants for cognitive changes related to pediatric cancer treatment, confirmed a common concern. How should neurocognitive decline be measured and followed up after cancer therapy? Multiple pediatric standardized cognitive tests are available, but there is no consensus on an efficient way to measure the most common areas of decline, specifically impaired concentration, memory, and mental processing speed. The authors' report recognized 12 pediatric patients at risk for cognitive dysfunction, of whom 3 tested positive for early neurocognitive deficits using 3 subscales of the Wechsler Intelligence Scale for Children—III (WISC-III), which measure working verbal memory (Digit Span), mental processing speed (Symbol Search), and psychomotor speed (Coding). To predict the expected level of performance on WISC-III subscales, the patients' IQ was estimated using the Wide Range Achievement Test—3 reading subtest. Patients were treated with long-acting CNS stimulants and followed up serially using the WISC-III subscales.

A Dimensional Analysis of the Concept: Good Death of a Child With Cancer

Hendrickson, K., McCorkle, R. — 2008-04-17

The death of a child is painful to all witnesses, but the experience varies among individuals, and differing perspectives lead to a variety of definitions for a good death. This analysis is undertaken to clarify the dimensions involved in a good death of a child with cancer and to examine them from 3 perspectives: the dying child, the child's family, and the health care providers.

Establishing Literature-Based Items for an Oral Mucositis Assessment Tool in Children

Tomlinson, D., Judd, P., Hendershot, E., Maloney, A.-M., Sung, L. — 2008-04-17

Although there are numerous instruments for oral mucositis (OM) assessment in adults, there is a lack of validated instruments for use in children. The objectives of this systematic review were to describe literature-based items that should be considered for a pediatric mucositis scale and other issues that should be considered when assessing mucositis in children. Literature search of PubMed and bibliography searches identified articles relevant to the assessment of mucositis and mucositis assessment studies in children. The elements established from the literature were grouped under objective, subjective, and functional items. Other issues that require consideration include the conditions for the assessment of the oral cavity and the etiology of OM. The resultant list included 23 items that have been used in mucositis assessment scales. This list of items may be used as an initial step in developing a new pediatric OM scale that particularly focuses on the unique issues in children.

Peer-Supported Storytelling for Grieving Pediatric Oncology Nurses

Macpherson, C. F. — 2008-04-17

Telling stories about deceased patients to supportive peers is frequently mentioned as an activity used for meaning-making in anecdotal reports of clinical practice and the literature addressing nurses' experiences caring for dying children. This study examines peer-supported storytelling for grieving pediatric oncology nurses using a mixed methods single-group descriptive repeated measures design. Participants were 6 registered nurses from a tertiary care pediatric hospital inpatient oncology unit who self-identified as experiencing grief. Participants met in self-selected dyads for 2 storytelling sessions. Questionnaires were completed at baseline, midpoint, and study end. Sessions were audio-recorded. Participants reported (1) receiving and providing support during sessions; (2) that sessions had an impact on their grief; (3) that sessions had an impact on their meaning-making, and the explicit session focus on making sense of and identifying benefit in their experiences was particularly helpful. There was a significant positive correlation between participant report of number of special patient deaths during career and impact of sessions on grief.

I'll Show Them: The Social Construction of (In)Competence in Survivors of Childhood Brain Tumors

Boydell, K. M., Stasiulis, E., Greenberg, M., Greenberg, C., Spiegler, B. — 2008-04-17

Multimodal therapy for the treatment of childhood cancer has resulted in increased survival rates, yet as growing cohorts of children mature, late effects are becoming apparent. Specifically, brain tumor survivors tend to have poor social skills, peer relationship problems, academic difficulties, and delayed college entry. This article addresses findings specific to the unique experience of childhood cancer survivors as they transition from adolescence to adulthood. Qualitative methods involving focus groups and in-depth interviews with 14 childhood cancer survivors and 22 family members were used. The dialectic of incompetence/competence pervaded all narratives. Contradictory concepts of integration/ isolation, realistic/unrealistic goals, and the need for special help/no help were underscored by respondents. The struggle to deal with these contradictory factors led to the simultaneous resistance and acceptance of feelings of competence.

Primary Prevention of Skin Cancer in Children and Adolescents: A Review of the Literature

Hart, K. M., DeMarco, R. F. — 2008-03-18

Although skin cancer is an easily preventable disease, self-directed prevention behaviors in children are difficult to achieve. The purpose of this article is to evaluate the status of primary prevention interventions and identify gaps in national and international research in order to make suggestions for further intervention design. A comprehensive search of MEDLINE, CINAHL, and PSYCHinfo databases was conducted to collect published research used in this review. The most effective interventions used multicomponent curricula administered over an extended period of time. Younger children were more receptive to interventions than were older children, who had stronger attitudes against sun-protective behaviors. Interventions in Australia have been more successful than interventions in North America and Europe. Further research needs to be conducted to create primary prevention interventions that address informational gaps. Specifically testing the dose and effect of individual educational components and bundling of components with reliable and valid outcome measures would help health care researchers define and measure the most effective way to battle social norms and attitudes of children and sun exposure.

Skeletal Complications After Bone Marrow Transplant in Childhood

Ruble, K. — 2008-03-18

Childhood cancer survivors are a growing population with special medical needs. It is projected that 66% of these survivors will have at least 1 adverse health effect and 33% will have a severe, chronic, or lethal health disorder. The Institute of Medicine (2003) has recognized the skeletal system to be at risk for long-term complications from treatment for childhood cancer. Bone marrow transplant is frequently used to treat childhood malignancies and is known to cause skeletal complications. Complex mechanisms contribute to skeletal outcomes after bone marrow transplant, all of which can affect optimal physical functioning. Nurses have taken an important role in providing clinical care and conducting research for this population. A thorough understanding of the mechanisms involved in skeletal complications can help the nurse provide state-of-the-art care and design studies to promote optimal results for bone marrow transplant survivors. This article reviews the literature on skeletal complications associated with allogeneic bone marrow transplant and identifies incidence, etiology, symptoms, monitoring, and treatment of specific complications.

Chemotherapy-Related Fatigue in Childhood Cancer: Correlates, Consequences, and Coping Strategies

Whitsett, S. F., Gudmundsdottir, M., Davies, B., McCarthy, P., Friedman, D. — 2008-03-18

The aim of this research is to examine the experience and impact of chemotherapy-related fatigue in recently diagnosed pediatric oncology patients. A repeated-measures, within-subjects, mixed (quantitative plus qualitative) design was used to prospectively assess fatigue during early chemotherapy cycles and to compare fatigue to depressive symptoms. Parental interviews collected concurrently were analyzed for descriptions of the child's fatigue and mood states and for strategies to cope with fatigue. Results indicated a significant correlation between fatigue and depression, but qualitative analyses suggested that the 2 phenomena may be unique and distinguishable. Qualitative analyses of parent interviews also identified specific strategies that were frequently used in response to high levels of fatigue. The findings illustrate the significant impact of chemotherapy-related fatigue in children being treated for cancer. The study also provides guidance for the assessment of fatigue and related symptoms and identifies specific strategies for coping with fatigue.

Sperm Banking for Adolescents With Cancer

2008-03-18

Recent advances in diagnostic and therapeutic methods in pediatric oncology have led to greater survival rates in children with malignancies. However, major long-term complications can occur that limit the quality of survival, infertility being one of them. Chemotherapy, radiation treatment, surgery, and combinations of these treatments have been implicated in causing infertility, with males being especially sensitive to therapy. Cryopreservation of semen, or sperm banking, is an easy, widely available means to preserve fertility for adolescent and young adult males with cancer. In this article, the pertinent literature is reviewed, and a sperm-banking program is described. Recommendations are offered for institutions attempting to develop a successful program, and the nurse's role in education and facilitation is discussed.

Discussions Regarding Sperm Banking With Adolescent and Young Adult Males Who Have Cancer

Nagel, K., Neal, M. — 2008-03-18

With improved survival rates among cancer patients, attention to fertility preservation is of paramount importance. An open-ended survey was used to question oncology and reproductive health nurses regarding their interactions with male adolescents and young adults with cancer about sperm banking. Four main areas of interest were identified: (a) key staff need to be identified to initiate discussions about sperm banking, (b) most staff felt unprepared for these discussions, (c) staff education was needed, and (d) provision of educational materials would benefit both staff and patients. The use of sperm banking, as part of the treatment protocol for adolescent and young adult males with cancer, requires the expertise and cooperation of a multidisciplinary team of experts from both oncology and fertility. Because nurses are the primary contacts with patients, nurses' role in promoting the discussion around sperm banking is crucial.

Determining the Understandability and Acceptability of an Oral Mucositis Daily Questionnaire

2008-03-18

Oral mucositis research in children receiving anticancer therapy has been impeded by the lack of an acceptable, appropriate assessment scale. Some scales attempt to measure subjective symptoms associated with mucositis such as pain and difficulty swallowing. These types of patient-reported outcomes are gaining prominence in clinical trials because they capture the perspective of the patients in whom the intervention is designed to benefit. In mucositis research, very few patient-reported outcome measures have been developed. The aim of this study was to determine whether an adaptation of the adult-validated Oral Mucositis Daily Questionnaire is understandable and acceptable for use in the pediatric oncology/hematology population. Twelve subjects were asked to rate their opinion of understandability and acceptability of the adapted Oral Mucositis Daily Questionnaire. As a result of their comments, minor changes were made. Evaluation of the psychometric properties of this instrument can now be performed.

The Adolescent Perspective on Participation in Treatment Decision Making: A Pilot Study

Stegenga, K., Ward-Smith, P. — 2008-03-18

Few research studies have obtained data directly from the adolescent with cancer regarding decision making. The developmental stage of these patients focuses on developing independence, yet the health care decisions required for cancer treatment preclude independent decision making. The purpose of this pilot, or exploratory, study was to determine whether the research question is appropriate and whether participants between 13 and 15 years of age were capable of providing rigorous data. The results suggest that treatment decision making was not a concern for these patients and that they were capable and appropriate study participants. Semistructured interviews were performed with 3 adolescents diagnosed with cancer within the previous 3 to 6 months. These data were qualitatively analyzed using Colaizzi's technique, which identified themes perceived as critical by these participants. Independent behavior, such as decision making, is not relevant at this health care juncture. However, support, information, and education are desired. These should be routinely available using means appropriate for adolescents. Infusing information and education into the health care plan from time of diagnosis may allow the adolescent to become knowledgeable about the disease process. This may enable him or her to participate in health care treatment decisions, when appropriate.