Pediatric Oncology Nursing : Advanced Clinical Handbook

239 Pages·2005·4.163 MB·English

by  Kline, Nancy E., Tomlinson, Deborah

PEDIATRIC ONCOLOGY
Deborah Tomlinson
Nancy E.Kline
(Eds.)
Pediatric
Oncology
Nursing
Advanced Clinical
Handbook
With 43 Figures and 203 Tables
123
Library ofCongress
Control Number 2004101947
ISBN 3-540-40851-7
Springer Berlin Heidelberg NewYork
ISSN 1613-53
Deborah Tomlinson MN,RSCN,RGN, This work is subject to copyright. All rights are reserved,
Dip.Cancer Nursing whether the whole or part ofthe material is concerned,specif-
ically the rights oftranslation,reprinting,reuse ofillustrations,
Macmillan Lecturer/Project Leader
recitation,broadcasting,reproduction on microfilm or in any
School ofNursing Studies
other way,and storage in data banks.Duplication ofthis pub-
University ofEdinburgh lication or parts thereofis permitted only under the provisions
31 Buccleuch Place ofthe German Copyright Law ofSeptember 9,1965,in its cur-
Edinburgh,EH8 9JT rent version,and permission for use must always be obtained
from Springer-Verlag. Violations are liable for prosecution
Scotland,UK
under the German Copyright Law.
Nancy E.Kline PhD,RN,CPNP,FAAN, Springer is a part ofSpringer Science+Business Media
Director springeronline.com
Center for Innovation and Clinical Scholarship
© Springer-Verlag Berlin Heidelberg 2005
Children’s Hospital Boston Printed in Germany
Wolbach 201
The use ofgeneral descriptive names,registered names,trade-
300 Longwood Avenue marks, etc. in this publication does not imply, even in the
Boston,MA 02115 absence of a specific statement,that such names are exempt
USA from the relevant protective laws and regulations and therefore
free for general use.
Product liability:The publishers cannot guarantee the accu-
racy of any information about dosage and application con-
tained in this book.In every individual case the user must
check such information by consulting the relevant literature.
Medical Editor:Dr.Julia Heidelmann,Heidelberg,Germany
Desk Editor:Meike Stoeck,Heidelberg,Germany
Cover design:Erich Kirchner,Heidelberg,Germany
Layout:Bernd Wieland,Heidelberg,Germany
Production:Pro Edit GmbH,Heidelberg,Germany
Reproduction and typesetting:AM-productions GmbH,
Wiesloch,Germany
21/3150 – 5 4 3 2 1 0
Printed on acid-free paper
V
Dedication
To the nurses,and others,
who use the information in this book,
and to the children they serve,
we dedicate this work.
To my husband Chris and our children,
Vivian,Sam and Suzanne –
to the moon and back.
Deborah Tomlinson
To my parents,and Michael.
I am forever grateful for your love and support.
Nancy E.Kline
VII
Preface
“Pediatric Oncology Nursing: Advanced Clinical etiology,symptoms and clinical signs,diagnostic and
Handbook”is a joint effort between nurses in Cana- laboratory procedures,treatment,prognosis,and fol-
da,the UK,and the USA.This is a first-time collabo- low up care are included for each ofthe disorders.
ration between pediatric hematology and oncology Part Three covers cancer treatment, including
nurses from two continents and represents a blend- chemotherapy, radiation therapy, peripheral stem
ing ofknowledge from these experts.The book is de- cell transplantation,surgery,gene therapy,and com-
signed to be a comprehensive clinical handbook for plementary and alternative medicine.The principles
nurses in advanced practice working with pediatric and description of treatment,method of treatment
hematology / oncology patients.Specific issues relat- delivery,potential side effects,and special considera-
ed to young children and adolescents with cancer and tions for each type oftreatment are discussed.
hematologic disorders are discussed. Part Four focuses on the side effects of cancer
Twenty-two contributors and two editors partici- treatment in relation to metabolic processes and the
pated in the writing of this text.Nurses in advanced gastrointestinal, hematologic, respiratory, urinary,
practice and academic roles – nurse practitioners, cardiovascular, neurologic, musculoskeletal, integu-
clinical nurse specialists,clinical instructors,lectur- mentary,and endocrine systems.The incidence,eti-
ers,and educators – were involved.One of the most ology, treatment, prevention, and prognosis are in-
appealing features ofthis text is the varied experience cluded for each side effect reviewed.
represented by nurses from different countries and Part Five includes essential information regarding
different educational backgrounds. supportive and palliative care ofpediatric cancer pa-
The book is divided into five sections:pediatric can- tients.Nutrition,hydration,pain,transfusion thera-
cers,hematologic disorders,treatment of childhood py, growth factors, and care of the dying child are
cancer,side effects oftreatment and disease,and sup- covered.The principles oftreatment for these condi-
portive and palliative care.Many tables and illustra- tions,method ofdelivery,and special considerations
tions are included for quick reference in the clinical for certain conditions are included.
setting. Future perspectives and opportunities for As the editors of“Pediatric Oncology Nursing:Ad-
new treatment options and research are discussed. vanced Clinical Handbook”we want to recognize and
Part One focuses on pediatric cancers:the leuke- thank everyone who participated in the development
mias and solid tumors.The most common pediatric ofthis text.We are profoundly aware ofthe personal
tumors,as well as some rare tumors,are discussed time and commitment that was devoted to make this
with regard to epidemiology,etiology,molecular ge- an outstanding resource,and we are grateful.It is our
netics,symptoms and clinical signs,diagnostic and hope that nurses in advanced clinical practice will
laboratory testing, staging and classification, treat- find this publication useful and that it will enrich
ment,prognosis,and follow-up care. knowledge and improve care for young people with
Part Two focuses on pediatric hematology. The cancer and hematologic disorders.
anemias,bleeding disorders,neutropenia,and throm-
bocytopenia are discussed in detail. Epidemiology, Deborah Tomlinson,Nancy E.Kline
IX
Contributors
Sharon Beardsmore SRN,RSCN,Dip Palliative Care Nicki Fitzmaurice RGN,RSCN,Dip N,BSc
Paediatric Macmillan Nurse, Paediatric Macmillan Nurse,Birmingham’s
Birmingham’s Children’s Hospital NHS Trust, Children’s Hospital NHS Trust,Birmingham,UK
Birmingham,UK
Ali Hall RSCN,RGN,BA,M.Phil,
Jane Belmore RSCN,RGN,Dip Palliative Care Ad Dip Child Development
Macmillan Clinical Nurse Specialist,Schiehallion Paediatric Oncology Outreach Nurse Specialist,
Day Care Unit,Royal Hospital for Sick Children, Schiehallion Day Care Unit,Yorkhill NHS Trust,
Yorkhill NHS Trust,Glasgow,G3 8SJ,Scotland,UK Glasgow,G3 8SJ,Scotland,UK
Rosalind BryantMN,RN,PNP Eleanor Hendershot RN,BScN,MN
Instructor ofPediatrics, Clinical Nurse Specialist/Acute Care Nurse
Pediatric Nurse Practitioner, Practitioner,Hospital For Sick Children,
Texas Children’s Cancer Center Division ofHematology Oncology –
and Hematology Service,6621 Fannin MC1-3320, Solid Tumor Program,555 University Avenue,
Houston,TX 77030,USA Toronto,Ontario,M5G 1X8,Canada
Christine Chordas MSN,RN,CPNP Kathleen E.Houlahan MS,RN
Pediatric Nurse Practitioner,Jimmy Fund Clinic, Nurse Manager,Hematology/Oncology/
Dana Farber Cancer Institute,44 Binney Street, Stem Cell Transplant,Children’s Hospital Boston,
D306,Boston,MA 02115,USA 300 Longwood Avenue,Boston,MA 02115,USA
Sandra Doyle MN,RN Elizabeth Kassner MSN,RN,CPNP
Clinical Nurse Specialist,Hospital For Sick Children, Instructor ofPediatrics,Pediatric Nurse
Division ofHematology Oncology, Practitioner,Texas Children’s Cancer Center
555 University Avenue,Toronto,Ontario M5G 1X8, and Hematology Service,3000 Bissonnet Street,
Canada #2304,Houston,TX 77005,USA
Angela M.Ethier MSN,RN,CNS,CPN Mark W.Kieran MD,PhD
Clinical Instructor and Fellow, Director,Pediatric Medical Neuro-Oncology,
UTSHC School ofNursing,4223 University Blvd., Assistant Professor ofPediatrics,
Houston,TX 77005,USA Harvard Medical School,
Dana-Farber Cancer Institute,Boston,MA,USA
X Contributors
Nancy E.Kline PhD,RN,CPNP,FAAN Margaret Parr RGN,RSCN,ENB240
Children’s Hospital Boston,Wolbach 201, Paediatric Oncology Nurse Specialist,
300 Longwood Avenue,Boston,MA 02115,USA Children’s Services,E Floor,East Block,
Queen’s Medical Centre,Derby Road,
Nan D.McIntosh RSCN,RGN,BSc (Hons), Nottingham,NG7 2UH,UK
NP Diploma
Haematology Advanced Nurse Practitioner, Fiona Reid RSCN,RGN
Schiehallion Day Care Unit,Yorkhill NHS Trust, StaffNurse
Glasgow,G3 8SJ,Scotland,UK Raigmore Hospital,Old Perth Road,Inverness,
1V2 3UJ,Scotland,UK
Anne-Marie Maloney RN,BSc,MSc
CNS/NP,The Hospital for Sick Children, Debbie Rembert MSN,RN,CNS
555 University Avenue,Toronto,Ontario M5G 1X8, Clinical Instructor and Fellow,
Canada UTSHC School ofNursing,4201 Ruskin,
Houston,TX 77005,USA
Ethel McNeill RSCN,RGN,BSc
Endocrine Nurse Specialist,Department Chris M.Senter RGN,RSCN,ONC
ofChild Health,Yorkhill NHS Trust, Macmillan Clinical Nurse Specialist,
Glasgow,G3 8SJ,Scotland,UK Royal Orthopaedic Hospital,Orthopaedic Oncology
Service,Bristol Road South,Northfield,
Colleen Nixon RN,BSN,CPON Birmingham,B31 2AP,UK
Patient Educator,Inpatient Oncology,Children’s
Hospital Boston,300 Longwood Avenue,Boston, Nicole M.Sevier MSN,RN,CPNP
MA 02115,USA Instructor ofPediatrics,Pediatric Nurse
Practitioner,Texas Children’s Cancer Center
Robbie Norville MSN,RN,CNS and Hematology Service,6621 Fannin MC1-3320,
Bone Marrow Transplant/Cell and Gene Therapy, Houston,TX 77030,USA
Clinical Nurse Specialist,Texas Children’s Cancer
Center and Hematology Service, Cara Simon MSN,RN,CPNP
6621 Fannin MC1-3320,Houston,TX 77030,USA Instructor ofPediatrics,Pediatric Nurse
Practitioner,Texas Children’s Cancer Center
Joan M.O’Brien RN,BSN,CPON and Hematology Service,6621 Fannin MC1-3320,
Hematology/Oncology Clinical Educator, Houston,TX 77030,USA
Children’s Hospital Boston,300 Longwood Avenue,
Boston,MA 02115,USA Deborah Tomlinson MN,RSCN,RGN,
Dip.Cancer Nursing
Jill Brace O’Neill MS,RN-CS,PNP Macmillan Lecturer/Project Leader,
David B.Perini Quality ofLife Clinic, School ofNursing Studies,
Dana-Farber Cancer Institute, University ofEdinburgh,
D-321,44 Binney Street, 31 Buccleuch Place,Edinburgh,EH8 9JT,
Boston,MA 02115,USA Scotland,UK
XI
Contents
PART I 1.3 Chronic Myeloid Leukemia. . . . . . . . . . . . . 20
1.3.1 Epidemiology and Etiology. . . . . . . . . 20
1 Leukemia 1.3.2 Molecular Genetics . . . . . . . . . . . . . 20
Deborah Tomlinson 1.3.3 Symptoms and Clinical Signs . . . . . . . 20
1.3.4 Diagnostics . . . . . . . . . . . . . . . . . 21
1.3.5 Treatment . . . . . . . . . . . . . . . . . . 21
1.1 Acute Lymphoblastic Leukemia . . . . . . . . . . 2
1.3.6 Prognosis. . . . . . . . . . . . . . . . . . . 21
1.1.1 Epidemiology . . . . . . . . . . . . . . . . 2
1.3.7 Future Perspectives. . . . . . . . . . . . . 21
1.1.2 Etiology . . . . . . . . . . . . . . . . . . . 4
1.4 Juvenile Myelomonocytic Leukemia . . . . . . . 21
1.1.2.1 Genetic Factors. . . . . . . . . . . . 4
1.5 Langerhans Cell Histiocytosis . . . . . . . . . . . 22
1.1.2.2 Environmental Factors . . . . . . . . 4
References . . . . . . . . . . . . . . . . . . . . . . . . . . 23
1.1.3 Molecular Genetics . . . . . . . . . . . . . 6
1.1.4 Symptoms and Clinical Signs . . . . . . . 7
1.1.5 Diagnostics . . . . . . . . . . . . . . . . . 8
1.1.6 Staging and Classification . . . . . . . . . 8 2 Solid Tumors
1.1.6.1 Risk Classification. . . . . . . . . . . 8 Eleanor Hendershot
1.1.6.2 Cell Morphology . . . . . . . . . . . 10
1.1.6.3 Cytochemistry . . . . . . . . . . . . 10
2.1 Hodgkin’s Disease . . . . . . . . . . . . . . . . . . 26
1.1.6.4 Immunophenotyping . . . . . . . . 10
2.1.1 Epidemiology . . . . . . . . . . . . . . . . 26
1.1.6.5 Cytogenetics . . . . . . . . . . . . . 11
2.1.2 Etiology . . . . . . . . . . . . . . . . . . . 27
1.1.7 Treatment . . . . . . . . . . . . . . . . . . 12
2.1.3 Molecular Genetics . . . . . . . . . . . . . 27
1.1.7.1 Induction . . . . . . . . . . . . . . . 12
2.1.4 Symptoms and Clinical Signs . . . . . . . 27
1.1.7.2 Intensification/Consolidation . . . . 13
2.1.5 Diagnostics . . . . . . . . . . . . . . . . . 27
1.1.7.3 CNS-directed Therapy . . . . . . . . 13
2.1.6 Staging and Classification . . . . . . . . . 28
1.1.7.4 Maintenance/Continuing Treatment 14
2.1.7 Treatment . . . . . . . . . . . . . . . . . . 28
1.1.7.5 Allogeneic Stem Cell Transplant . . 14
2.1.8 Prognosis . . . . . . . . . . . . . . . . . . 29
1.1.8 Prognosis. . . . . . . . . . . . . . . . . . . 15
2.1.9 Follow-up . . . . . . . . . . . . . . . . . . 30
1.1.9 Follow-up . . . . . . . . . . . . . . . . . . 15
2.1.10 Future Perspectives. . . . . . . . . . . . . 30
1.1.10 Future Perspectives. . . . . . . . . . . . . 15
2.2 Non-Hodgkin’s Lymphoma. . . . . . . . . . . . . 30
1.2 Acute Myeloid Leukemia . . . . . . . . . . . . . . 16
2.2.1 Epidemiology . . . . . . . . . . . . . . . . 30
1.2.1 Epidemiology . . . . . . . . . . . . . . . . 16
2.2.2 Etiology . . . . . . . . . . . . . . . . . . . 30
1.2.2 Etiology . . . . . . . . . . . . . . . . . . . 16
2.2.3 Molecular Genetics . . . . . . . . . . . . . 31
1.2.2.1 Genetic Factors. . . . . . . . . . . . 16
2.2.4 Symptoms and Clinical Signs . . . . . . . 31
1.2.2.2 Environmental Factors. . . . . . . . 16
2.2.5 Diagnostics . . . . . . . . . . . . . . . . . 31
1.2.3 Molecular Genetics . . . . . . . . . . . . . 16
2.2.6 Staging and Classification . . . . . . . . . 34
1.2.4 Symptoms and Clinical Signs . . . . . . . 17
2.2.7 Treatment . . . . . . . . . . . . . . . . . . 35
1.2.5 Diagnostics . . . . . . . . . . . . . . . . . 17
2.2.8 Prognosis . . . . . . . . . . . . . . . . . . 36
1.2.6 Staging and Classification . . . . . . . . . 17
2.2.9 Follow-up . . . . . . . . . . . . . . . . . . 36
1.2.7 Treatment . . . . . . . . . . . . . . . . . . 19
2.2.10 Future Perspectives. . . . . . . . . . . . . 37
1.2.8 Prognosis. . . . . . . . . . . . . . . . . . . 19
1.2.9 Follow-up . . . . . . . . . . . . . . . . . . 19
1.2.10 Future Perspectives. . . . . . . . . . . . . 20
XII Contents
2.3 Ewing’s Sarcoma Family of Tumors . . . . . . . . 37 2.8 Retinoblastoma . . . . . . . . . . . . . . . . . . . 62
2.3.1 Epidemiology . . . . . . . . . . . . . . . . 37 2.8.1 Epidemiology . . . . . . . . . . . . . . . . 62
2.3.2 Etiology . . . . . . . . . . . . . . . . . . . 37 2.8.2 Etiology . . . . . . . . . . . . . . . . . . . 62
2.3.3 Molecular Genetics . . . . . . . . . . . . . 37 2.8.3 Molecular Genetics . . . . . . . . . . . . . 62
2.3.4 Symptoms and Clinical Signs . . . . . . . 38 2.8.4 Signs and Symptoms . . . . . . . . . . . . 62
2.3.5 Diagnostics . . . . . . . . . . . . . . . . . 38 2.8.5 Diagnostics . . . . . . . . . . . . . . . . . 63
2.3.6 Staging and Classification . . . . . . . . . 38 2.8.6 Staging and Classification . . . . . . . . . 63
2.3.7 Treatment . . . . . . . . . . . . . . . . . . 39 2.8.7 Treatment . . . . . . . . . . . . . . . . . . 65
2.3.8 Prognosis . . . . . . . . . . . . . . . . . . 40 2.8.8 Prognosis . . . . . . . . . . . . . . . . . . 66
2.3.9 Follow-up . . . . . . . . . . . . . . . . . . 40 2.8.9 Follow-up . . . . . . . . . . . . . . . . . . 66
2.3.10 Future Perspectives. . . . . . . . . . . . . 41 2.8.10 Future Directions . . . . . . . . . . . . . . 66
2.4 Osteosarcoma . . . . . . . . . . . . . . . . . . . . 41 2.9 Rhabdomyosarcoma . . . . . . . . . . . . . . . . 66
2.4.1 Epidemiology . . . . . . . . . . . . . . . . 41 2.9.1 Epidemiology . . . . . . . . . . . . . . . . 66
2.4.2 Etiology . . . . . . . . . . . . . . . . . . . 41 2.9.2 Etiology . . . . . . . . . . . . . . . . . . . 66
2.4.3 Molecular Genetics . . . . . . . . . . . . . 41 2.9.3 Molecular Genetics . . . . . . . . . . . . . 67
2.4.4 Signs and Symptoms . . . . . . . . . . . . 42 2.9.4 Symptoms and Clinical Signs . . . . . . . 67
2.4.5 Diagnostics . . . . . . . . . . . . . . . . . 42 2.9.5 Diagnostics . . . . . . . . . . . . . . . . . 68
2.4.6 Staging and Classification . . . . . . . . . 43 2.9.6 Staging and Classification . . . . . . . . . 68
2.4.7 Treatment . . . . . . . . . . . . . . . . . . 43 2.9.7 Treatment . . . . . . . . . . . . . . . . . . 69
2.4.8 Prognosis . . . . . . . . . . . . . . . . . . 44 2.9.8 Prognosis . . . . . . . . . . . . . . . . . . 70
2.4.9 Follow-up . . . . . . . . . . . . . . . . . . 44 2.9.9 Follow-up . . . . . . . . . . . . . . . . . . 70
2.4.10 Future Perspectives. . . . . . . . . . . . . 44 2.9.10 Future Perspectives. . . . . . . . . . . . . 70
2.5 Liver Tumors . . . . . . . . . . . . . . . . . . . . . 45 2.10 Non-rhabdomyosarcomatous
2.5.1 Epidemiology . . . . . . . . . . . . . . . . 45 Soft Tissue Sarcomas . . . . . . . . . . . . . . . . 71
2.5.2 Etiology . . . . . . . . . . . . . . . . . . . 45 2.11 Germ Cell Tumors . . . . . . . . . . . . . . . . . . 73
2.5.3 Molecular Genetics . . . . . . . . . . . . . 45 2.11.1 Epidemiology . . . . . . . . . . . . . . . . 73
2.5.4 Symptoms and Clinical Signs . . . . . . . 45 2.11.2 Etiology . . . . . . . . . . . . . . . . . . . 73
2.5.5 Diagnostics . . . . . . . . . . . . . . . . . 46 2.11.3 Molecular Genetics . . . . . . . . . . . . . 73
2.5.6 Staging and Classification . . . . . . . . . 47 2.11.4 Symptoms and Clinical Signs . . . . . . . 73
2.5.7 Treatment . . . . . . . . . . . . . . . . . . 48 2.11.5 Diagnostics . . . . . . . . . . . . . . . . . 74
2.5.8 Prognosis . . . . . . . . . . . . . . . . . . 49 2.11.6 Staging and Classification . . . . . . . . . 75
2.5.9 Follow-up . . . . . . . . . . . . . . . . . . 49 2.11.7 Treatment . . . . . . . . . . . . . . . . . . 75
2.5.10 Future Perspectives. . . . . . . . . . . . . 49 2.11.8 Prognosis . . . . . . . . . . . . . . . . . . 76
2.6 Neuroblastoma . . . . . . . . . . . . . . . . . . . 50 2.11.9 Follow-up . . . . . . . . . . . . . . . . . . 76
2.6.1 Epidemiology . . . . . . . . . . . . . . . . 50 2.11.10 Future Perspectives. . . . . . . . . . . . . 77
2.6.2 Etiology . . . . . . . . . . . . . . . . . . . 50 2.12 Rare Tumors . . . . . . . . . . . . . . . . . . . . . 77
2.6.3 Molecular Genetics . . . . . . . . . . . . . 50 2.12.1 Adrenocortical Carcinoma (ACC) . . . . . 77
2.6.4 Symptoms and Clinical Signs . . . . . . . 51 2.12.2 Melanoma . . . . . . . . . . . . . . . . . . 77
2.6.5 Diagnostics . . . . . . . . . . . . . . . . . 52 2.12.3 Nasopharyngeal Carcinoma . . . . . . . . 78
2.6.6 Staging and Classification . . . . . . . . . 53 2.12.4 Thyroid Carcinoma . . . . . . . . . . . . . 78
2.6.7 Treatment . . . . . . . . . . . . . . . . . . 53 References . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2.6.8 Prognosis . . . . . . . . . . . . . . . . . . 55 Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . 82
2.6.9 Follow-up . . . . . . . . . . . . . . . . . . 55
2.6.10 Future Perspectives. . . . . . . . . . . . . 57
2.7 Renal Tumors . . . . . . . . . . . . . . . . . . . . 57
3 Common Central
2.7.1 Epidemiology . . . . . . . . . . . . . . . . 57
2.7.2 Etiology . . . . . . . . . . . . . . . . . . . 57 Nervous System Tumours
2.7.3 Molecular Genetics . . . . . . . . . . . . . 58 Nicki Fitzmaurice · Sharon Beardsmore
2.7.4 Symptoms and Clinical Signs . . . . . . . 58
2.7.5 Diagnostics . . . . . . . . . . . . . . . . . 58 3.1 Causes/Epidemiology. . . . . . . . . . . . . . . . 86
2.7.6 Staging and Classification . . . . . . . . . 60 3.2 Distribution/Classification . . . . . . . . . . . . . 86
2.7.7 Treatment . . . . . . . . . . . . . . . . . . 60 3.3 Staging . . . . . . . . . . . . . . . . . . . . . . . . 87
2.7.8 Prognosis . . . . . . . . . . . . . . . . . . 60 3.4 Molecular Genetics of Brain Tumours. . . . . . . 87
2.7.9 Follow-up . . . . . . . . . . . . . . . . . . 61 3.5 Diagnosis. . . . . . . . . . . . . . . . . . . . . . . 87
2.7.10 Future Perspectives. . . . . . . . . . . . . 61 3.6 Specialist Referral . . . . . . . . . . . . . . . . . . 89
3.7 Hydrocephalus. . . . . . . . . . . . . . . . . . . . 89