Cancer in Children and Young People

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.

• Preface xiForeword xiiiContributors xvAcknowledgements xviiPart 1 Chemotherapy 1Commentary: Chemotherapy 3Jamie Cargill1. Principles of Chemotherapy 7Angela HoulstonThe history of the development of chemotherapy 7Cell cycle 7Growth fraction 8Pharmacokinetics and pharmacodynamics 9Protocol development and clinical trials 9Considerations when planning chemotherapy treatments 10Treatment approaches 11References 132. Chemotherapy Agents 15Angela HoulstonClassification of drugs 15References 193. Administration of Chemotherapy 21Angela HoulstonSafe practice with cytotoxic drugs: legislation 21Consent 21Safe handling 21Reconstitution and preparation of chemotherapeutic agents 22Personal Protective Equipment (PPE) 22Work practices 23Patient support 25Setting for chemotherapy administration 25Administration of chemotherapy 27Routes of administration 28Intrathecal route 31The intramuscular and subcutaneous routes 32References 334. Side Effects of Chemotherapy 35Karen SelwoodIntroduction 35Gastrointestinal tract 36Taste alteration 42Nausea and vomiting 43Pharmacological interventions 46Anorexia/weight loss 48Haematological problems 55The compromised immune system 60Viral infections 60Cutaneous side effects 61Conclusion 65References 655. Oncological Emergencies 73Karen SelwoodIntroduction 73Septic shock 73Home care 74Disseminated intravascular coagulation (DIC) 75Anaphylaxis 77Acute tumour lysis syndrome (ATLS) 77Hyperuricaemia 79Hyperkalaemia 80Hyperphosphataemia and hypocalcaemia 81Nursing implications of ATLS 81Spinal cord compression 82Conclusion 82References 826. Future Trends 85Karen SelwoodIntroduction 85Treatment strategies 86Targeted approaches 86Proteasome 87Gene therapy 87Tumour vaccines 88Hormone therapy 88Combination therapy 88New treatments for cancer – the nurse’s role 88References 89Part 2 Haematopoietic Stem Cell Transplantation 91Commentary: Haematopoietic Stem Cell Transplantation 93Helen Webster7. Background to the Haematopoietic Stem Cell Transplant (HSCT) Procedure 97Nikki Bennett-Rees and Sian HopkinsHistory 97Types of transplant 98Diseases for which haematopoietic stem cell transplant is a treatment modality 99Tissue typing 100Adult unrelated donors 102References 1058. Preparation for Bone Marrow Transplant 107Nikki Bennett-Rees, Sian Hopkins and Joanna StoneThe family 107Negotiation 109Support 109Preparation of children 110Conditioning regimens 113Preparation of a sibling donor 116Ethical use of sibling donors 117Saviour siblings 121Preparation of non-donor siblings 122References 1229. Collection and Infusion of Bone Marrow, Peripheral Blood Stem Cells and Umbilical Cord Cells 125Nikki Bennett-Rees and Sian HopkinsCollection of bone marrow 125Complications of donation 126Collection of peripheral blood stem cells (pbsc) 126Venous access 128Stem cell collection 129Collection of umbilical cord blood cells 130Issues surrounding umbilical cord banking 131Bone marrow/stem cell infusion 131References 13310. Protective Isolation: Nursing Issues 135Nikki Bennett-Rees and Sian HopkinsIntroduction 135Infection prophylaxis 136Protective isolation 137Dietary restrictions 138Mouth care 139Skin care 140Infection screening 140The effects of isolation 140References 14111. Complications of Stem Cell Transplant 143Nikki Bennett-Rees and Sian HopkinsIntroduction 143Mucositis 143Treatment and nursing implications 144Pancytopenia 147Haematological complications 147Infection 150Veno-occlusive disease 154Graft versus host disease (GVHD) 156Graft versus leukaemia (GVL) 159References 16012. Discharge Planning and Psychosocial Issues for the Family 163Nikki Bennett-Rees and Sian HopkinsDischarge planning 163Psychosocial effects of stem cell transplant on the family 166References 16813. Staff Support in Stem Cell Transplant Units 169Sian HopkinsEducational needs of nurses in blood and bone marrow transplant units 170References 17114. Further Developments in Stem Cell Transplantation 173Nikki Bennett-Rees, Sian Hopkins, Lesley Henderson and Jinhua Xu-BayfordGene therapy 173What is gene therapy? 173Gene therapy prospects for primary immunodeficiencies 174What does the gene therapy process involve for the child? 174Care of the child undergoing gene therapy for X-linked SCID 176Care of the child undergoing gene therapy for ADA-SCID or CGD 177Parental support 178Risks and side effects of gene therapy 178The future 179References 179Part 3 Surgery 181Commentary: General Surgery 183Charlie RogersIntroduction 183Diagnosis 183Continuity of care 183Pain 184Central venous access 185Conclusion 186References 18615. General Surgery 187Rachel Hollis, Sharon Denton and Gill ChapmanIntroduction 187The challenge of surgical care in paediatric oncology 188Surgery as a diagnostic tool 189Surgery as a treatment modality 192Preparing the child and the family for surgery 198Post-operative nursing care 201Discharge planning 206Late effects of surgical treatment 206Surgery in supportive care 208Management of infection 212Surgery to avoid the complications of radiotherapy 213Future trends in surgery 214References 214Commentary: Neuro-oncology 219Jennie Sacree16. Neuro-oncology 223Lindy May and Beth WardIntroduction 223Overview of brain tumours 223Increased intracranial pressure and hydrocephalus 225Tumour types 226Investigations into brain tumours 227Neurological assessment 228Play therapy 232The multidisciplinary team 232Pre-operative care 233Intra-operative care 233Post-operative management 234Long-term concerns: morbidity and mortality 236Jack’s journey through CNS tumour treatment 236Ongoing needs of a child with a brain tumour 237Adjuvant treatment: specifics of treating a child with a CNS tumour 239Late effects of CNS tumours and acute rehabilitation needs 242Rehabilitation needs 244Second malignancy 244Discharge planning 244Relapse and chemotherapy clinical trials 245Relapse: the child 245Palliative care 245The future of neuro-oncology 246References 247Commentary: Primary Bone Cancer in Young People 251Lin Russell17. Primary Bone Cancer in Young People 255Chris HenryIntroduction 255Types of tumours and their presentation 257Treatment options 260Limb conservation surgery 262Amputation 265Altered body image 268Discharge planning 268Late effects 269Future trends 272Impact of setting 273References 275Part 4 Radiotherapy 27918. The Nature of Radiotherapy 281Monica HopkinsIntroduction 281Indications for the use of radiation in the care of children with cancer 282The nature of radiation 282Artificial production of radiation for clinical use 283Radiation dose 284Effect of ionising radiation on human tissue 284Hazards to healthy tissue during radiotherapy 285Conclusion 286References 28619. Administration of Radiotherapy 289Monica HopkinsIntroduction 289External beam therapy (teletherapy) 289Brachytherapy 297Use of unsealed sources (intravenous radioactive materials) 299Administration of alternative radiotherapy techniques 302What does the future hold for radiotherapy? 304References 30620. Tumours and Radiotherapy Treatment 311Monica Hopkins and Cornelia ScottBrain tumours 311Adverse effects of radiotherapy in the treatment of brain tumours 312Acute lymphoblastic leukaemia with CNS involvement 314Tumours of the head and neck 315Retinoblastoma 315Non-Hodgkin’s lymphoma 316Hodgkin’s lymphoma 316Radiotherapy for abdominal tumours 317Malignant mesenchymal tumours such as rhabdomyosarcoma 317Wilms’ tumour 317Neuroblastoma 318Pelvic irradiation 318Extremity radiation 319Conclusion 319References 32021. Acute and Sub-acute Side Effects of Radiotherapy 321Monica Hopkins and Cornelia ScottIntroduction 321Acute reactions in healthy tissue 321Skin 322The gastrointestinal tract 328Mouth 328Promotion of nutritional intake 331Pain control 332Small intestine 333Bone marrow 334Hair follicles 335Fatigue 335Brain 336Pneumonitis 337Cystitis 337Conclusion 338References 33822. The Role of Radiotherapy in Palliative Care 343Monica HopkinsThe decision to use radiotherapy in the palliative care of children 343Radiotherapy in oncological emergencies 344Radiotherapy in end of life symptom management 346References 348Part 5 Late Effect of Cancer Therapies 35123. Overview of Long-Term Follow-Up 353Susan MehtaFuture challenges 354Long-term effects of cancer treatment 354The nursing role 354Health education 355Conclusion 355References 35524. Potential Physical Issues Following Cancer Treatment 357Ruth Elson and Susan MehtaEndocrinopathies 357Thyroid gland 358Hypothalamic pituitary axis 359Gonadal dysfunction 360Fertility 363Liver 365Neurological impairment 366Neuropsychological 368Eyes 369Craniofacial and dental 370Skin 371Musculoskeletal 371Hearing 373Gastrointestinal 374Cardiac 375Renal and bladder 376Pulmonary 377Second malignancies 378References 37925. The Role of the Nurse in Long-Term Follow-Up 383Beverly HorneAssessment, planning, implementation and evaluation of programmes of care 383Support and advice 384Liaison and education 384Provision and facilitation of alternative models of care 385Research and audit 386Health promotion provision 387Participation in specialist LTFU clinics 387Conclusion 387References 38726. Health Promotion for Long-Term Follow-Up Patients 389Beverly HorneSmoking 390Alcohol consumption 391Recreational drug use 391Nutrition, physical activity and achieving a healthy weight 391Breast awareness 393Testicular self-examination 393Sexual health 393Sun protection 394Theoretical approaches and models 394Conclusion 395References 39527. Quality of Life in Long-Term Survivors of Childhood Cancer 397Anthony PennDefining quality of life in the health-care setting? 397Physical function 398Psychological function 398Cognition 399Social function 399Education 400Employment and insurance 400Interpersonal relationships and marriage 401Conclusion 401References 402Index 405