The Childs With Cancer

 Incidence of Cancer in Childhood:

◦ Cancer is the second leading cause of death for
children under age 5 to 14 years
◦ In 2003, about 1,500 children died of cancer, 1/3rd
from leukemia
◦ Types of tumors vary by age
 © 2006 by Pearson Education, Inc.
Jane W. Ball and Ruth C. Bindler
Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
 Immune system more immature in children
◦ This affects how well body can defend itself
◦ Nonspecific and specific cellular responses are
immature
 Children are still growing and
developing
◦ As a result, some cancers grow and progress
more rapidly
◦ Apoptosis (programmed-cell death) not well-
developed in young children
◦ Children more commonly present with
metastases at time of dx than adults
 Childhood cancers respond better to
chemotherapy
 Children tolerate chemotherapy better than
adults
 Childhood survivors of cancer need to be
monitored for late-effects and long-term side
effects of cancer treatment
 Alterations in cellular growth occur in
response to external and internal stimuli
 Neoplasms are caused by one or a
combination of three factors;
◦ External stimuli that cause genetic mutations
◦ Innate immune system and gene abnormalities
◦ Chromosomal abnormalities
 Vary by type and location
◦ Pain
◦ Cachexia
 (syndrome characterized by anorexia, weight loss,
anemia, asthenia (weakness) and early satiety)
◦ Anemia
◦ Infections
◦ Neurologic symptoms
◦ Palpable mass
 CBC  Radiographic
 Bone marrow examination
aspiration  MRI
 Bone marrow  CT scan
biopsy  USG
 Lumbar puncture
 Biopsy of Tumor
 Child managed by Pediatric Oncology Team
 Therapy may be singular or combination
◦ Surgery
◦ Chemotherapy (protocol-action plan for chemo)
◦ Radiation
◦ Biotherapy (antibodies developed to target tumor
cells for apoptosis; cancer vaccines)
◦ HSCT (hematopoietic stem cell transplant)
◦ Complementary therapies
◦ Palliative care (presence of palliative care team)
 © 2006 by Pearson Education, Inc.
Jane W. Ball and Ruth C. Bindler
Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
 Nausea/ Vomiting
 Alopecia
 Malaise
 Bone Marrow Depression
◦ Infection
◦ Bleeding
◦ Anemia
 Stomatitis
 Based on type of cancer and therapy
◦ Infection
◦ Pain
◦ Nutrition
◦ Growth and Development
◦ Emotional
◦ Spiritual
 Oncologic emergencies result from the cancer
itself or as a side effect of treatment.
 Most common emergencies are tumor lysis
syndrome
 3 Types of Oncological Emergencies:
◦ Metabolic
◦ Hematologic
◦ Space-occupying lesions
 Metabolic
◦ Tumor lysis syndrome:
 Metabolic emergency results from lysis of tumor cells.
This cell destruction releases high levels of uric acid,
K+, and phosphates into the blood. Low levels of Na
and Ca occur and metabolic acidosis results.
 Most commonly seen in lymphoma and ALL
 Hematologic:
◦ Results from bone marrow suppression or
infiltration of brain and respiratory tissue w/ high
numbers of leukemic blast cells (hyperleukocytosis)
◦ Bone marrow suppression results in anemia and
thrombocytopenia
◦ This leads to coagulation problems and
hemorrhage.
 Space-occupying lesions
◦ Tumors w/ extensive growth that may result in life-
threatening situations (increased intracranial
pressure, brain herniation, respiratory
complications, etc.)
 Nursing interventions focus on preventive
teaching for all families about risk factors
for cancer
 Health promotion and health maintenance
of the child undergoing cancer treatment
 Carrying out treatment interventions
 Managing health problems r/t both cancer
and the side effects of tx
 Partnering w/ families to manage the
challenging psychosocial needs that emerge
when cancer is diagnosed.
 Obtain a thorough history. Including:
◦ Family hx of cancer
◦ Hx of exposure to known carcinogens
◦ Does parent work w/ chemicals/ asbestos
◦ Was child tx’d w/ radiation/ chemo for cancer
previously
◦ Does the child have any known conditions such as
Down’s syndrome
◦ Any congenital anomalies
 Physiologic Assessment
◦ Includes possible s/sx of cancer or thorough
physical assessment if cancer already identified
 Psychosocial Assessment
◦ Stress and coping
◦ Knowledge
◦ Support systems
◦ Body Image
 Developmental Assessment
◦ Children under 6 should be regularly screened for
developmental surveillance
◦ If changes in development are noted, or
regression in milestones occurs during tx, refer
to specialist
 Assessment for Impact of Cancer Survival
◦ 1 in 1,000 young adults is survivor of childhood
cancer
◦ Ongoing care is essential: long-term follow-up
clinics
◦ Help families manage long-term effects of cancer
tx
 Nursing Diagnosis
◦ Risk of injury related to chemotherapy treatment
◦ Risk of infection related to depressed body
defenses
◦ Altered nutrition: less than body requirements
related to loss appetite
◦ Pain related to diagnosis, treatment, physiology
effect of cancer
◦ Altered family process related to having a child with
a life threatening disease
 NOC
◦ Risk control
 Monitor health status change
 Avoids exposure to health treat
◦ Immune status
 Body themperature
 Weigh loss
◦ Infection severity
 Lethargy
 white blood count depression
 NIC
◦ Infections protection
 Monitor for the change in energy level
 Monitor temperature
◦ Infection control
 Isolated persons exposed to communicable diseases
 Encourage rest
 Limit the number of visitors
 Wash Hand before and after care activity
 NOC
◦ Risk control
 NIC
◦ Chemotherapy management
◦ Nausea management
 NOC
◦ Nutritional status: food and fluids intake
◦ Nutritional status: nutrient intake
 NIC
◦ Nutrition management
◦ Nutrition therapy
 NOC
◦ Pain level
◦ Pain distruptive effect
◦ Pain control
 NIC
◦ Pain management
 NOC
◦ Family functioning
◦ Family coping
◦ Family normalizations
◦ Knowledge: illness care
 NIC
◦ Counseling
◦ Family support
 A

© 2006 by Pearson Education, Inc.

Jane W. Ball and Ruth C. Bindler
Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.