PEDIATRIC ONCOLOGY

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PEDIATRIC ONCOLOGY

• Leslie Meador, RN, BSN, CPON
• Childrens Mercy Hospital

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What is cancer?

• Normal cells grow and divide, then eventually
  die.
• Cancer occurs when the body is unable to regulate
  cell growth, leading to an overgrowth of abnormal
  cells.

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Cell development
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Benign v. Malignant

• Benign overgrowth of cells that are NOT
  cancerous
• Malignant overgrowth of cells that ARE cancerous

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What is cancer?

• Cell development
• Healthy growth Unhealthy growth
• Normal cells Tumor cells
• Benign Malignant

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Pediatric Oncology Facts

• In the U.S., cancer remains responsible for more
  deaths from one year through adolescence than any
  other disease more deaths than asthma, diabetes,
  cystic fibrosis and AIDS combined.
• Each year in the U.S., approximately 12,500
  children and adolescents are diagnosed with
  cancer. Thats the equivalent of two average size
  classrooms diagnosed each school day.

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Pediatric Oncology Facts

• In the early 1950s, less than 10 percent of
  childhood cancer patients could be cured.
• Today, nearly 80 of children diagnosed with
  cancer become long-term survivors and the
  majority of them are considered cured.

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Pediatric Oncology Facts

• Most common childhood cancers
• -leukemia (blood)
• -brain and nervous system
• -the lymphatic system (lymphoma)
• -kidneys (Wilms tumor)
• -bones (osteosarcoma Ewings
  sarcoma)
• -muscles (rhabdomyosarcoma)

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Pediatric v. Adult
Characteristic Pediatric Adult
Frequency Rare lt1 of all cancers Common gt99 of all cancers
Primary sites Involves TISSUE Involves ORGANS
Pathogenesis Genetic alterations Environment lifestyle
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Pediatric v. Adult
Characteristic Pediatric Adult
Screening/ Early detection Small percentage screening tests are generally not applicable Many can be detected by adhering to screening guidelines
Manifestations at diagnosis Metastatic disease 80 Local or regional disease
Treatment Follows protocols as standard Doesnt always follow a protocol
Prognosis 70-90 cure (depending on tumor stage) lt60 cure (depending on tumor stage)
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Means of diagnosis

• Well child check-ups (physical assessment
  review of symptoms)
• Blood tests
• Radiology exams (x-rays, CT, MRI)
• Pathology (biopsy of mass)
• Diagnostic procedures
• -Bone marrow aspirate
• -Bone marrow biopsy
• -Lumbar puncture

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Methods for treatment

• Depends of type and stage of malignancy
• Includes the following
• -Chemotherapy
• -Radiation
• -Surgical resection
• -Stem cell transplantation

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Chemotherapy

• Chemotherapy can be delivered by the bloodstream
  to reach cancer cells all over the body, or it
  can be administered directly to specific cancer
  sites.
• Chemotherapy can be given through various
  methods
• -intravenously (IV)
• -intrathecally (IT)
• -intramuscularly (IM)
• -subcutaneously (SQ)
• -orally (PO).

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Chemotherapy

• Works by interfering with the ability of cancer
  cells to divide and reproduce themselves.
• Attacks all rapidly dividing cells.

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Rapidly dividing cells

• Hair
• Skin
• Nails
• Blood cells
• -Red blood cells
• -White blood cells
• -Platelets

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Three blood lines

• Red blood cells
• -carry oxygen to surrounding tissues
• White blood cells
• -fight off infection
• Platelets
• -help to prevent excessive bleeding assists in
  clot formation

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Complications of chemotherapy

• Anemia (low RBC)
• Thrombocytopenia (low platelet)
• Neutropenia (low WBC)
• INFECTION
• Hair loss
• Mouth sores (mucositis)
• Nausea, vomiting diarrhea
• Organ toxicities

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Radiation

• Managed by a radiation oncologist
• The radiation oncology team will precisely
  measure and mark the radiation field." This
  field is established to deliver the maximum
  radiation to the tumor with the least impact
  possible on the surrounding tissues.
• Frequency duration depends on diagnosis stage.

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Complications of radiation

• Nausea and vomiting
• Low blood counts
• Infection
• Mouth sores
• Skin changes (may look and feel like a sunburn)
• After radiation to the head and spine, other side
  effects may occur months to years later,
  including
• Problems with growth
• Hormone production
• Learning problems

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Surgery

• Can be done initially if tumor is isolated (most
  common in benign tumors or in brain kidney
  tumors).
• Usually done following a few rounds of chemo.
  This allows the tumor to shrink, which should
  allow the surgery to be less invasive.

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Complications of Surgery

• Infection
• Rupture of tumor increases risk of later
  metastasis
• Delay in other treatments due to time required to
  heal from surgery.

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Stem Cell Transplant

• Purpose
• 1. Remove any remaining diseased cells
• 2. Clear bone marrow space through
  ablative therapy (consisting of chemotherapy
  or chemotherapyradiation).
• 3. Replace bone marrow space with healthy
  stem cells.

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Complications of Stem Cell Transplant

• Organ toxicity
• Organ failure
• INFECTION
• Engraftment Failure
• Graft v. Host Disease
• Death

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• WHAT DOES CANCER LOOK LIKE?

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Normal WBC on smear
G
A
E
D
B
H
F
C

• Banded Neutrophil B. Lymphocyte
• Monocyte D. Segmented Neutrophil
• Eosinophil F. Basophil
• G. Platelet H Red blood cell

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Acute Lymphocytic Leukemia on smear
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Osteosarcoma
Humerus
Distal Femur
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Osteosarcoma
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Brain tumor
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Brain tumor
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Ginnys story
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WHY this profession?

• LOVE KIDS!!!!!!
• Hem/Onc - Increased acuity than med/surg units ?
  mentally challenging each day pathophysiology is
  complex in this population
• Opportunity to INVEST in PEOPLE
• Develop long-term relations with patients
• See effects of my efforts over time
• End of life care
• Working 3 days/week Full time!!!

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What is my day like?

• 12 hour shifts 7am 7pm
• Nurse patient ratio 13 max
• Manage care for each assigned patient, which may
  include, but not limited to medication
  administration, IVF, chemo (monitoring/managing
  side effects), blood products, procedures
  (including sedation) for BMA LP, bone marrow
  transplant infusions, monoclonal antibodies, ng
  placement/feeds, IV access, obtaining
  monitoring labs, coordinating with other
  disciplines (PT/OT, speech therapy, radiology,
  OR) being PROACTIVE in patient care, focusing
  on management while preventing further
  issues/complications.

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And the numbers are

• Starting salary 21.49/hr (CMH in top 5 salary
  for RNs in KC area)
• Shift differentials 10 evening (3-1130pm), 15
  nights (7p-7a), 10 weekend
• Specialty differentials 10 critical care, 5
  OR, SDS, PACU, 1.00/hr for approved specialty
  certifications
• Up to 3000/year educational assistance

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Why Childrens Mercy Hospitals and Clinics?

• Only pediatric hospital between St. Louis
  Denver
• Competitive salary benefits
• MAGNET Designation reflects nursing
  satisfaction
• gt50 medical/surgical sections to practice in
• CMH is expanding throughout KC area to include
  Urgent Care South in the Northland, along with
  clinics in Eastern and Western KC
• Other professions APN, PT/OT, Speech Therapy,
  Musical Therapy, Child Life Specialist, RT,
  physicians, PA, EMT and more!

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References

• Hooke, M., Kline, N., ONeill, J., Norville, R.,
  Wilson, K. (2004). (Essentials of Pediatric
  Oncology A Core Curriculum ( 2nd ed.) (pp
  2-12,57). Glenview, IL Association of Pediatric
  Oncology Nurses
• http//www.cancer.org
• http//www.childsdoc.org/fall2000/braintumors.asp
• http//www.curesearch.org/

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References cont.

• ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg
• http//www.med.harvard.edu/JPNM/TF96_97/Nov4/Write
  Up.html
• http//www-medlib.med.utah.edu/WebPath/HEMEHTML/HE
  MEIDX.html
• http//www-medlib.med.utah.edu/WebPath/BONEHTML/BO
  NE001.html

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