Download Childhood Cancer and Treatment

CANCER IN THE
CLASSROOM:
PROVIDING A SAFE
ENVIRONMENT
Lisa Bashore, PhD, RN, CPNP, CPON
Life After Cancer Program
OBJECTIVES
 Review the various treatment modalities
given to children and adolescents with
cancer
 Discuss how cancer treatment influences
attendance and / or re entry into school
 Evaluate how safe the school environment
is for children and adolescents with cancer
CHILDHOOD CANCER
Incidence by Diagnosis
35
Leukemia-33%
30
CNS Tumors-20%
25
Lymphoma-12%
20
15
10
5
0
Neuroblastoma-7%
Rhabdo-7%
Wilms Tumor-6%
Bone Tumors-5%
Retinoblastoma-3%
Other-6%
Treatment






Surgery
Radiation
Chemotherapy
Biotherapy
Stem Cell Transplant
Alternative therapy
Chemotherapy
 Affects rapidly
dividing cells
•
•
•
•
Hair
GI tract
Mucous membranes
Bone marrow
 Anemia
 Thrombocytopenia
 Neutropenia
CHEMOTHERAPY
 Halts the growth of cancer cells
 Affects normal cells as well
• Inability to differentiate between
normal/cancer cells
CHEMOTHERAPY
 Given in different routes
 May dictate the extent of acute effects
•
•
•
•
•
Orally
Intravenously
Intrathecally
Intraosseous
Intramuscularly
RADIATION
 Delivery of high energy beams
 Damage both cancer cells and normal
cells
• Thankfully only in area radiated are
normal cells affected
 Given alone or in combination with
chemotherapy
RADIATION
 Given by different methods
 Types:
•
•
•
•
3-dimensional conformal
Intensity modulated
Proton beam
Stereotactic radiosurgery
BIOTHERAPY
 Immunotherapy
 Very targeted and used body’s immune
system
 Like Targeted minimizes damage to
healthy cells
ALTERNATIVE
THERAPY
 Many can interfere with efficacy of
treatment
 Unsafe in general
• Reduce blood counts
• Have bacteria or fungi
• Unacceptable side effects
 Massage
 Probiotics
• Contains bacteria
• Could colonize the GI tract
 St John’s Wort
• Bleeding potential
• Interaction with immunosuppressant's
COMPLEMENTARY






Yoga
Imagery
Art and Music Therapy
Meditation
Massage
Aromatherapy (??)
PALLIATIVE CARE
 Provides symptom management
throughout the continuum of care
 Comprehensive, holistic care
• Physical, emotional, spiritual, social
aspects of living with cancer
IMMEDIATE EFFECTS OF
CANCER THERAPY
TREATMENT EFFECTS
 Due to damage to normal cells/blood
cells
• Marrow
 All blood lines impacted
• Skin
• Mouth or whole GI tract
• Immune system
SIGNS, SYMPTOMS,
AFFECTS
 Fever (INFECTION)
 Fatigue
 Paleness
 Easy bruising
 Bone/joint pain
PANCYTOPENIA
 Neutropenia:
A White cell count < 1,000 with an Absolute
Neutrophil Count (ANC) low
• Associated with infections
ANC Value
Risk for Infection
Less than 500
Highest
500-1,000
Moderate
> 1,000
Lowest
 Thrombocytopenia
• Low platelets and risk for bleeding
• Normal: 150,000-450,000
• High threshold in oncology
 Anemia
 Hemoglobin: Responsible for Oxygen
transport to cells
 Normal is 12-16 g/dl depending on age
 High threshold
• Symptom dependent
GASTROINTESTINAL
EFFECTS
 Nausea & Vomiting
 Diarrhea
 Dehydration
 Constipation
OTHER
 Stomatitis
 Esophagitis
IMPACT ON THE
CHILD
 Short to extended hospitalizations
• Administration of therapy
• Infection management
• Recovery in-between
EMOTIONAL RESPONSE
TO CANCER
 Feelings of:
• Guilt
• Anger
• Sadness and loneliness
Age / Developmental responses to
cancer
 Responses
 1. Dependency
 2. Regression of development
 3. Inability to cope at all
DEALING WITH
RESPONSES
 School-Age Children
Issues
Supporting the Child
Being isolated (inpatient)
Stay in touch (web,
Skype), letters
Visits from friends
Loss of Control
Attendance at school
Do school work
 Teens
Issue
Supporting the Teen
Body Image
Allow chance to talk about
physical/emotional health
Having feelings are normal
Self Esteem
Point out positives
Allow teen to do things –
make them feel good
ATTENDING SCHOOL
 Children on cancer treatment can/do
attend school
 Important for social
development…NORMALCY
 Good communication is KEY to safe
and successful school environment
INFECTION PREVENTION
 Germs exist…exposure happens
 Good Hygiene
• Hand washing (frequently)
• Hand sanitizer
• Keep hands as clean as possible
VACCINES
 Children with cancer CANNOT receive
live vaccines
 No specific recommendations for
exposure to others
 Best they are NOT exposed to others
having just received live vaccines
INFECTION PREVENTION
 NOT share pens, cups, utensils,
etc…with the patient
 NOT be near or in contact with the
infected person
 Education of parents of classmates
INFECTION PREVENTION
 May be asked to avoid large crowds
 Classmates can visit but not all
together (1-2 at a time)
 Child may be asked to eat restricted
diet
RE-ENTERING SCHOOL
 Notify parent if
contagious diseases
present
 Offer rest times
 Hand Hygiene
 Offer gentle play options
SCHOOL INFECTION
CONTROL POLICY
 Classmates with:
•
•
•
•
Fever
Runny nose, cough
Diarrhea
Rash
NOT play with child with cancer
Cont.
 Wash hands after using bathroom
 Have wipes handy for door knobs
HEALTHY SCHOOL
ENVIRONMENT
 Have emergency contacts handy
 When to call:
•
•
•
•
•
Fevers > 101 F
Exposure to chicken pox
Bleeding (active)
Central line problems
Not drinking or voiding sufficiently
Central Lines & Nursing
Responsibility
IDENTIFYING CVL
INFECTION
 INSPECT SITE
 LOOK FOR:
•
•
•
•
REDNESS
SWELLING
DRAINAGE
INCREASED PAIN/TENDERNESS
CLASSMATE RULE
 Wash hands or use hand
gel
 Gentle play
 Avoid close interaction if
they don’t feel well
 Treat the child like they
always have
SUPPORTING THE
CHILD
 Encourage relaxed environment
•
•
•
•
•
•
•
Wear a hat
Take naps (leave class)
Drink fluids
Trips to rest room
Snacks
Indoors all times
Changes rooms alone
SCHOOL AND
EMOTIONS
 May be hard to return
• Body changes and appearance
 Visits from staff can reduce fears
 May need special care
• Education support
EMOTIONAL SUPPORT
 Children need to have a normal routine
 Feel hopeful and good about future
 Talk to classmates
• Changes in the child with cancer
• Myths about cancer
 Encourage talking and provide support
 They may need an emotional break
 Treat them like others….NORMAL
SUMMARY
 Children and adolescents with cancer are at
risk for serious acute effects…including
emotional turmoil
 Children and adolescents with cancer may
attend school when feeling well and
physician approved
 They need normalcy in a safe and healthy
environment
QUESTIONS
Resources
 www.curesearch.org
 www.lls.org
 www.beyondthecure.org
 www.pbtfus.org
References

Association of Pediatric Hematology/Oncology Nurses. (2003). Foundations of
Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review
Course.

Association of Pediatric Hematology/Oncology Nurses. (2005). APON/PBMTC’s
Foundations of Pediatric Blood and Marrow Transplantation: A Core Curriculum.

Kupst, M. J. (2009, October). Cancer Impact on the Child: Putting the Experience into
Perspective. Presented at the Association of Pediatric Hematology/Oncology Nurses,
Wisconsin.

www.childrensoncologygroup.org. Family Handbook for Children with Cancer