Cancer in Children and Young People (eBook)

Dr Faith Gibson, Lecturer in Children's Nursing Research, institute of Child Health, Great Ormond Street Hospital and King's College London, London. Louise Soanes, Senior Sister for Children's Services, McElwain Ward, The Royal Marsden Hospital, Downs Road, Surrey. Both editors have extensive experience of paediatric cancer nursing practice, education and research and are established authors in the field of oncology nursing.?Each has contributed to a large number of successful texts and journals and has well-established links with the UK, European and international cancer nursing community.

Cancer in Children and Young People 3
Contents 7
Preface 13
Foreword 15
Contributors 17
Acknowledgements 19
Part 1 Chemotherapy 21
Commentary: Chemotherapy 23
1. Principles of Chemotherapy 27
The history of the development of chemotherapy 27
Cell cycle 27
Growth fraction 28
Pharmacokinetics and pharmacodynamics 29
Protocol development and clinical trials 29
Considerations when planning chemotherapy treatments 30
Treatment approaches 31
References 33
2. Chemotherapy Agents 35
Classification of drugs 35
References 39
3. Administration of Chemotherapy 41
Safe practice with cytotoxic drugs: legislation 41
Consent 41
Safe handling 41
Reconstitution and preparation of chemotherapeutic agents 42
Personal Protective Equipment (PPE) 42
Work practices 43
Patient support 45
Setting for chemotherapy administration 45
Administration of chemotherapy 47
Routes of administration 48
Intrathecal route 51
The intramuscular and subcutaneous routes 52
References 53
4. Side Effects of Chemotherapy 55
Introduction 55
Gastrointestinal tract 56
Taste alteration 62
Nausea and vomiting 63
Pharmacological interventions 66
Anorexia/weight loss 68
Haematological problems 75
The compromised immune system 80
Viral infections 80
Cutaneous side effects 81
Conclusion 85
References 85
5. Oncological Emergencies 93
Introduction 93
Septic shock 93
Home care 94
Disseminated intravascular coagulation (DIC) 95
Anaphylaxis 97
Acute tumour lysis syndrome (ATLS) 97
Hyperuricaemia 99
Hyperkalaemia 100
Hyperphosphataemia and hypocalcaemia 101
Nursing implications of ATLS 101
Spinal cord compression 102
Conclusion 102
References 102
6. Future Trends 105
Introduction 105
Treatment strategies 106
Targeted approaches 106
Proteasome 107
Gene therapy 107
Tumour vaccines 108
Hormone therapy 108
Combination therapy 108
New treatments for cancer – the nurse’s role 108
References 109
Part 2 Haematopoietic Stem Cell Transplantation 111
Commentary: Haematopoietic Stem Cell Transplantation 113
7. Background to the Haematopoietic Stem Cell Transplant (HSCT) Procedure 117
History 117
Types of transplant 118
Diseases for which haematopoietic stem cell transplant is a treatment modality 119
Tissue typing 120
Adult unrelated donors 122
References 125
8. Preparation for Bone Marrow Transplant 127
The family 127
Negotiation 129
Support 129
Preparation of children 130
Conditioning regimens 133
Preparation of a sibling donor 136
Ethical use of sibling donors 137
Saviour siblings 141
Preparation of non-donor siblings 142
References 142
9. Collection and Infusion of Bone Marrow, Peripheral Blood Stem Cells and Umbilical Cord Cells 145
Collection of bone marrow 145
Complications of donation 146
Collection of peripheral blood stem cells (PBSC) 146
Venous access 148
Stem cell collection 149
Collection of umbilical cord blood cells 150
Issues surrounding umbilical cord banking 151
Bone marrow/stem cell infusion 151
References 153
10. Protective Isolation: Nursing Issues 155
Introduction 155
Infection prophylaxis 156
Protective isolation 157
Dietary restrictions 158
Mouth care 159
Skin care 160
Infection screening 160
The effects of isolation 160
References 161
11. Complications of Stem Cell Transplant 163
Introduction 163
Mucositis 163
Treatment and nursing implications 164
Pancytopenia 167
Haematological complications 167
Infection 170
Veno-occlusive disease 174
Graft versus host disease (GVHD) 176
Graft versus leukaemia (GVL) 179
References 180
12. Discharge Planning and Psychosocial Issues for the Family 183
Discharge planning 183
Psychosocial effects of stem cell transplant on the family 186
References 188
13. Staff Support in Stem Cell Transplant Units 189
Educational needs of nurses in blood and bone marrow transplant units 190
References 191
14. Further Developments in Stem Cell Transplantation 193
Gene therapy 193
What is gene therapy? 193
Gene therapy prospects for primary immunodeficiencies 194
What does the gene therapy process involve for the child? 194
Care of the child undergoing gene therapy for X-linked SCID 196
Care of the child undergoing gene therapy for ADA-SCID or CGD 197
Parental support 198
Risks and side effects of gene therapy 198
The future 199
References 199
Part 3 Surgery 201
Commentary: General Surgery 203
Introduction 203
Diagnosis 203
Continuity of care 203
Pain 204
Central venous access 205
Conclusion 206
References 206
15. General Surgery 207
Introduction 207
The challenge of surgical care in paediatric oncology 208
Surgery as a diagnostic tool 209
Surgery as a treatment modality 212
Preparing the child and the family for surgery 218
Post-operative nursing care 221
Discharge planning 226
Late effects of surgical treatment 226
Surgery in supportive care 228
Management of infection 232
Surgery to avoid the complications of radiotherapy 233
Future trends in surgery 234
References 234
Commentary: Neuro-oncology 239
16. Neuro-oncology 243
Introduction 243
Overview of brain tumours 243
Increased intracranial pressure and hydrocephalus 245
Tumour types 246
Investigations into brain tumours 247
Neurological assessment 248
Play therapy 252
The multidisciplinary team 252
Pre-operative care 253
Intra-operative care 253
Post-operative management 254
Long-term concerns: morbidity and mortality 256
Jack’s journey through CNS tumour treatment 256
Ongoing needs of a child with a brain tumour 257
Adjuvant treatment: specifics of treating a child with a CNS tumour 259
Late effects of CNS tumours and acute rehabilitation needs 262
Rehabilitation needs 264
Second malignancy 264
Discharge planning 264
Relapse and chemotherapy clinical trials 265
Relapse: the child 265
Palliative care 265
The future of neuro-oncology 266
References 267
Commentary: Primary Bone Cancer in Young People 271
17. Primary Bone Cancer in Young People 275
Introduction 275
Types of tumours and their presentation 277
Treatment options 280
Limb conservation surgery 282
Amputation 285
Altered body image 288
Discharge planning 288
Late effects 289
Future trends 292
Impact of setting 293
References 295
Part 4 Radiotherapy 299
18. The Nature of Radiotherapy 301
Introduction 301
Indications for the use of radiation in the care of children with cancer 302
The nature of radiation 302
Artificial production of radiation for clinical use 303
Radiation dose 304
Effect of ionising radiation on human tissue 304
Hazards to healthy tissue during radiotherapy 305
Conclusion 306
References 306
19. Administration of Radiotherapy 309
Introduction 309
External beam therapy (teletherapy) 309
Brachytherapy 317
Use of unsealed sources (intravenous radioactive materials) 319
Administration of alternative radiotherapy techniques 322
What does the future hold for radiotherapy? 324
References 326
20. Tumours and Radiotherapy Treatment 331
Brain tumours 331
Adverse effects of radiotherapy in the treatment of brain tumours 332
Acute lymphoblastic leukaemia with CNS involvement 334
Tumours of the head and neck 335
Retinoblastoma 335
Non-Hodgkin’s lymphoma 336
Hodgkin’s lymphoma 336
Radiotherapy for abdominal tumours 337
Malignant mesenchymal tumours such as rhabdomyosarcoma 337
Wilms’ tumour 337
Neuroblastoma 338
Pelvic irradiation 338
Extremity radiation 339
Conclusion 339
References 340
21. Acute and Sub-acute Side Effects of Radiotherapy 341
Introduction 341
Acute reactions in healthy tissue 341
Skin 342
The gastrointestinal tract 348
Mouth 348
Promotion of nutritional intake 351
Pain control 352
Small intestine 353
Bone marrow 354
Hair follicles 355
Fatigue 355
Brain 356
Pneumonitis 357
Cystitis 357
Conclusion 358
References 358
22. The Role of Radiotherapy in Palliative Care 363
The decision to use radiotherapy in the palliative care of children 363
Radiotherapy in oncological emergencies 364
Radiotherapy in end of life symptom management 366
References 368
Part 5 Late Effect of Cancer Therapies 371
23. Overview of Long-Term Follow-Up 373
Future challenges 374
Long-term effects of cancer treatment 374
The nursing role 374
Health education 375
Conclusion 375
References 375
24. Potential Physical Issues Following Cancer Treatment 377
Endocrinopathies 377
Thyroid gland 378
Hypothalamic pituitary axis 379
Gonadal dysfunction 380
Fertility 383
Liver 385
Neurological impairment 386
Neuropsychological 388
Eyes 389
Craniofacial and dental 390
Skin 391
Musculoskeletal 391
Hearing 393
Gastrointestinal 394
Cardiac 395
Renal and bladder 396
Pulmonary 397
Second malignancies 398
References 399
25. The Role of the Nurse in Long-Term Follow-Up 403
Assessment, planning, implementation and evaluation of programmes of care 403
Support and advice 404
Liaison and education 404
Provision and facilitation of alternative models of care 405
Research and audit 406
Health promotion provision 407
Participation in specialist LTFU clinics 407
Conclusion 407
References 407
26. Health Promotion for Long-Term Follow-Up Patients 409
Smoking 410
Alcohol consumption 411
Recreational drug use 411
Nutrition, physical activity and achieving a healthy weight 411
Breast awareness 413
Testicular self-examination 413
Sexual health 413
Sun protection 414
Theoretical approaches and models 414
Conclusion 415
References 415
27. Quality of Life in Long-Term Survivors of Childhood Cancer 417
Defining quality of life in the health-care setting? 417
Physical function 418
Psychological function 418
Cognition 419
Social function 419
Education 420
Employment and insurance 420
Interpersonal relationships and marriage 421
Conclusion 421
References 422
Index 425