Pediatric Oncology Nursing (eBook)

Dedication 6
Preface 8
Contributors 10
Contents 12
PART I 24
Chapter 1 Leukemia 24
1.1 Acute Lymphoblastic Leukemia 25
1.2 Acute Myeloid Leukemia 39
1.3 Chronic Myeloid Leukemia 43
1.4 Juvenile Myelomonocytic Leukemia 44
1.5 Langerhans Cell Histiocytosis 45
References 46
Chapter 2 Solid Tumors 48
2.1 Hodgkin’s Disease 49
2.2 Non-Hodgkin’s Lymphoma 53
2.3 Ewing’s Sarcoma Family of Tumors 60
2.4 Osteosarcoma 64
2.5 Liver Tumors 68
2.6 Neuroblastoma 73
2.7 Renal Tumors 80
2.8 Retinoblastoma 85
2.9 Rhabdomyosarcoma 89
2.10 Non-rhabdomyosarcomatous Soft Tissue Sarcomas 94
2.11 Germ Cell Tumors 96
2.12 Rare Tumors 100
References 102
Bibliography 105
Chapter 3 Common Central Nervous System Tumors 108
3.1 Causes/Epidemiology 109
3.2 Distribution/Classification 109
3.3 Staging 110
3.4 Molecular Genetics of Brain Tumors 110
3.5 Diagnosis 110
3.6 Specialist Referral 112
3.7 Hydrocephalus 112
3.8 Treatment 112
3.9 Prognosis 114
3.10 Specific Tumors 115
3.11 Follow-up 123
3.12 The Late Effects and Rehabilitation of Survivors 123
3.13 Palliative Care 123
3.14 Future Perspectives/New Innovations 123
References 124
Bibliography 124
PART II 126
Chapter 4 Anemias 126
4.1 Anemia 127
4.2 Iron Deficiency Anemia 129
4.3 Sickle Cell Disease 132
4.4 Thalassemia 141
4.5 Hemolytic Anemia 144
4.6 Bone Marrow Failure Syndromes 149
References 153
Chapter 5 Neutropenia 157
5.1 Epidemiology 157
5.2 Etiology 158
5.3 Symptoms and Clinical Signs 159
5.4 Diagnostic Testing 159
5.5 Treatment 159
5.6 Prognosis 161
5.7 Follow-up 161
Reference 161
Bibliography 161
Chapter 6 Thrombocytopenia 163
6.1 Epidemiology 163
6.2 Etiology 164
6.3 Symptoms and Clinical Signs 164
6.4 Diagnostic Testing 166
6.5 Treatment 167
6.6 Prognosis 168
6.7 Follow-up 169
6.8 Future Perspectives 169
References 169
Bibliography 169
Chapter 7 BleedingDisorders 171
7.1 Hemophilia --- Nicole M. Sevier 171
7.2 Von Willebrand Disease 178
References 183
PART III 184
Chapter 8 Chemotherapy 184
8.1 Introduction 185
8.2 Chemotherapy Principles 185
8.3 Clinical Trials 188
8.4 Types of Chemotherapy Agents 188
8.5 Administration of Chemotherapy Agents 192
8.6 Routes of Administration and Practice Considerations 197
8.7 Safe Practice Considerations 201
8.8 Administration of Chemotherapy in the Home 204
8.9 Extravasation 207
8.10 Acute Hypersensitivity Reactions to Chemotherapy 212
References 214
Bibliography 215
Chapter 9 Radiation Therapy 217
9.1 Principles of treatment 217
9.2 Description of treatment 218
9.3 Methods of delivery 218
9.4 Potential side effects 220
9.5 Special considerations 221
9.6 Future Perspectives 222
References 222
Chapter 10 Hematopoietic Stem Cell Transplantation 223
10.1 Principles of Treatment 223
10.2 Description of Treatment 226
10.3 Potential Side Effects 229
10.4 Special Considerations 237
10.5 Future Perspectives 238
References 238
Bibliography 238
Chapter 11 Surgical Approaches to Childhood Cancer 242
11.1 Principles of Treatment 242
11.2 Description of Treatment 242
11.3 Method of Delivery 243
11.4 Potential Side Effects 245
11.5 Special Considerations 246
11.6 Future Perspectives 247
References 248
Bibliography 248
Chapter 12 Gene Therapy 249
12.1 Introduction 249
12.2 Principles of Treatment 250
12.3 Method of Delivery 251
12.4 Potential Side Effects 252
12.5 Special Considerations 252
12.6 Future Perspectives 253
References 253
Chapter 13 Complementary and Alternative Therapy 256
13.1 Principles of Treatment 256
13.2 Description of Treatment 257
13.3 Method of Delivery 257
13.4 Potential Side Effects 258
13.5 Special Considerations 260
13.6 Future Perspectives 261
References 261
PART IV 262
Chapter 14 Metabolic System 262
14.1 Cancer Cachexia 262
14.2 Obesity 264
14.3 Tumour Lysis Syndrome 265
14.4 Hypercalcaemia 270
14.5 Impaired Glucose Tolerance Following Bone Marrow Transplant 272
References 272
Chapter 15 Gastrointestinal Tract 274
15.1 Mucositis 275
15.2 Dental Caries 278
15.3 Nausea and Vomiting 279
15.4 Constipation 283
15.5 Diarrhoea 286
15.6 Typhlitis 289
15.7 Perirectal Cellulitis 290
15.8 Acute Gastrointestinal Graft Versus Host Disease 291
15.9 Chemical Hepatitis 293
References 294
Chapter 16 Bone Marrow 296
16.1 Anemia 297
16.2 Neutropenia 298
16.3 Thrombocytopenia 304
16.4 Transfusion Issues 304
16.5 Disseminated Intravascular Coagulation 306
16.6 Septic Shock 308
16.7 Immune Suppression 309
References 311
Chapter 17 Respiratory System 314
17.1 Pneumocystis Pneumonia 314
17.2 Pneumonitis 317
17.3 Fibrosis 318
17.4 Compromised Airway 319
References 321
Chapter 18 Renal System 324
18.1 Nephrectomy 325
18.2 Cytotoxic Drug Excretion 329
18.3 Nephrotoxicity 336
18.4 Hemorrhagic Cystitis 342
References 347
Chapter 19 Cardiovascular System 349
19.1 Cardiotoxicity/Cardiomyopathy 349
19.2 Veno-occlusive Disease 354
References 358
Bibliography 358
Chapter 20 Central Nervous System 359
20.1 Spinal Cord Compression 359
20.2 Fatigue 360
20.3 Cognitive Deficits 363
20.4 Diabetes Insipidus 365
References 365
Chapter 21 Musculoskeletal System 368
21.1 Limb Salvage Procedures 368
21.2 Amputation 371
21.3 Altered Bone Density and Increased Risk of Fracture 374
References 375
Cahapter 22 Skin Cutaneous Toxicities 378
22.1 Alopecia 378
22.2 Altered Skin Integrity Associated with Radiation Therapy 380
22.3 Radiation Sensitivity and Recall 381
22.4 Photosensitivity 382
22.5 Cutaneous Reactions Associated with High-dose Cytosine Arabinoside 382
22.6 Nail Dystrophies 383
22.7 Graft Versus Host Disease 383
References 386
Chapter 23 Endocrine System 388
23.1 Hypothalamic-Pituitary Dysfunction 388
23.2 Growth Hormone Deficiency 389
23.3 Hypothalamic-Pituitary-Gonadal Axis 390
23.4 Thyroid Disorders 392
23.5 Hypothalamic-Pituitary-Adrenal Axis 392
23.6 Other Pituitary Hormones 393
References 396
Chapter 24 Ototoxicity 398
24.1 Incidence 398
24.2 Prevention and Treatment 401
References 404
Chapter 25 Eyes – Ocular complications 406
25.1 Ocular Toxicity Associated with High-dose Cytarabine Arabinoside 406
25.2 Cataracts 407
References 408
PART V 410
Chapter 26 Nutrition and Hydration in Children with Cancer 410
26.1 Introduction 410
26.2 Principles of Treatment 411
26.3 Method of Delivery 412
26.4 Special Considerations 413
References 419
Bibliography 419
Chapter 27 Pain in Children with Cancer 420
27.1 Introduction 420
27.2 Causes of Pain in Childhood Cancer 421
27.3 Assessment 421
27.4 Cultural Issues 425
27.5 Principles of Treatment 427
27.6 Treatment 427
27.7 Summary 434
References 435
Bibliography 435
Chapter 28 Blood Transfusion Therapy 436
28.1 Introduction 437
28.2 Blood Screening Guidelines 437
28.3 Transfusion Complications 439
28.4 Erythrocyte Transfusion 442
28.5 Platelet Transfusion Options 443
28.6 Granulocyte Transfusion 444
28.7 Albumin 445
28.8 Fresh Frozen Plasma (FFP) 445
28.9 Cryoprecipitate 446
28.10 Intravenous Immunoglobulin (IVIG) 446
28.11 Recombinant Human (rHu) Erythropoietin Alpha 446
28.12 Palliative Care Issues for Transfusion Therapy 446
References 447
Bibliography 447
Chapter 29 Growth Factors 448
29.1 Principles of Treatment 448
29.2 Method of Delivery 450
29.3 Future Perspectives 451
References 452
Chapter 30 Care of the Dying Child and the Family 454
30.1 Children’s Understanding of Death 454
30.2 Explaining Death to Children 456
30.3 Pediatric Palliative Care 456
30.4 Grief 457
30.5 Cultural and Spiritual Care 461
30.6 Bereavement 462
30.7 Resources 463
References 464
Bibliography 465
Subject Index 466

Chapter 9
Radiation Therapy (S. 195-196)

Joan M. O’Brien · Deborah Tomlinson

Radiotherapy has had a role in malignancies for the last century. X-rays were discovered by Von Roentgen in 1895 and were used diagnostically.The element radium was isolated by Marie and Pierre Curie in 1898. The first therapeutic report of a patient cures by radiation therapy was in 1899. However it has a diminishing role in childhood malignancies due to more effective chemotherapy regimens and the recognition of late effects of radiation treatment. Children will often be assessed on an individual level regarding the need of radiotherapy. However it is still required for around 20% of children and young people with cancer. Focus in radiation therapy (XRT) has been on methods of delivery that will minimize injury to normal tissues, to try to avoid long-term negative sequalae.

9.1 Principles of treatment

Radiotherapy causes damage to cells in a localised area. Ionising radiation both causes and treats cancer. Damage is caused by breaking strands of DNA, either double or single strands. This inhibits cell division. It may harm normal cells in the area they pass through or in the area around tumor. Radiation treatment has three main roles in the treatment of childhood and young person:

- Radical: Treatment with curative intent
- Adjuvant: "Added on" treatment
- Palliative: Treatment aimed at symptom control

Radiation is frequently used as part of a bone marrow ablative regimen. At times radiation may be used to ameliorate side effects from tumors that are threaten life or organ function, to quickly reduce the size of a mass that is impinging on the airway, or to relieve pressure on the spinal cord to decrease or prevent paralysis. Palliative radiotherapy is given to relieve pain in progressive or metastatic disease. It provides shrinkage of tumor to relieve pain and/or obstructions interfering with quality of life. The dose is monitored to ensure minimal toxicities.

9.2 Description of treatment

All radiation emits radiant energy, either in waves and particle form.

- Electrons are electromagnetic and produced from a linear accelerator. They can provide treatment to super.cial tumors and have increased absorption to bone.(X-rays are electromagnetic radiation that is produced extranuclearly, electrons are accelerated to high energy and then stopped abruptly at a tungsten target (Farah and Weichselbaum 1994)).
- Gamma rays are electromagnetic radiation produced intranuclearly from a radioactive source. They provide local and wide-.eld radiation, and are skin sparing. Gamma rays require lead or concrete to absorb them.
- Protons are high energy atoms, emitted from a machine, for the treatment of tumours needing speci.c dose localization. They are delivered by stereotaxis (a form of radiation that delivers the beam in an extremely precise manner).

9.2.1 Cell radiosensitivity

Factors that contribute to cell radiosensitivity include:
- Phase of cell cycle that cell is in: Studies have shown that cells are most radiosensitive in the M and G2 phases and most resistant in late S phase (Farah and Weichselbaum 1994). Between dose fractions, cells may move through the cell cycle to more sensitive phases. This process is called “reassortment”. This allows for a greater cell kill.