Childhood Cancer and Treatment PowerPoint Presentation

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CANCER IN THE CLASSROOM: PROVIDING A SAFE ENVIRONMENT Lisa Bashore, PhD, RN, CPNP, CPON Life After Cancer Program

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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

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CHILDHOOD CANCER Incidence by Diagnosis

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Treatment Surgery Radiation Chemotherapy Biotherapy Stem Cell Transplant Alternative therapy

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Chemotherapy Affects rapidly dividing cells Hair GI tract Mucous membranes Bone marrow Anemia Thrombocytopenia Neutropenia

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CHEMOTHERAPY Halts the growth of cancer cells Affects normal cells as well Inability to differentiate between normal/cancer cells

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CHEMOTHERAPY Given in different routes May dictate the extent of acute effects Orally Intravenously Intrathecally Intraosseous Intramuscularly

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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

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RADIATION Given by different methods Types: 3-dimensional conformal Intensity modulated Proton beam Stereotactic radiosurgery

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BIOTHERAPY Immunotherapy Very targeted and used body’s immune system Like Targeted minimizes damage to healthy cells

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ALTERNATIVE THERAPY Many can interfere with efficacy of treatment Unsafe in general Reduce blood counts Have bacteria or fungi Unacceptable side effects

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Massage Probiotics Contains bacteria Could colonize the GI tract St John’s Wort Bleeding potential Interaction with immunosuppressant's

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COMPLEMENTARY Yoga Imagery Art and Music Therapy Meditation Massage Aromatherapy (??)

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PALLIATIVE CARE Provides symptom management throughout the continuum of care Comprehensive, holistic care Physical, emotional, spiritual, social aspects of living with cancer

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IMMEDIATE EFFECTS OF CANCER THERAPY

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TREATMENT EFFECTS Due to damage to normal cells/blood cells Marrow All blood lines impacted Skin Mouth or whole GI tract Immune system

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SIGNS, SYMPTOMS, AFFECTS Fever (INFECTION) Fatigue Paleness Easy bruising Bone/joint pain

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PANCYTOPENIA Neutropenia: A White cell count < 1,000 with an Absolute Neutrophil Count (ANC) low Associated with infections

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Thrombocytopenia Low platelets and risk for bleeding Normal: 150,000-450,000 High threshold in oncology

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Anemia Hemoglobin: Responsible for Oxygen transport to cells Normal is 12-16 g/dl depending on age High threshold Symptom dependent

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GASTROINTESTINAL EFFECTS Nausea & Vomiting Diarrhea Dehydration Constipation

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OTHER Stomatitis Esophagitis

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IMPACT ON THE CHILD Short to extended hospitalizations Administration of therapy Infection management Recovery in-between

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EMOTIONAL RESPONSE TO CANCER Feelings of: Guilt Anger Sadness and loneliness Age / Developmental responses to cancer

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Responses 1. Dependency 2. Regression of development 3. Inability to cope at all

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DEALING WITH RESPONSES School-Age Children

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Teens

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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

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INFECTION PREVENTION Germs exist…exposure happens Good Hygiene Hand washing (frequently) Hand sanitizer Keep hands as clean as possible

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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

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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

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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

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RE-ENTERING SCHOOL Notify parent if contagious diseases present Offer rest times Hand Hygiene Offer gentle play options

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SCHOOL INFECTION CONTROL POLICY Classmates with: Fever Runny nose, cough Diarrhea Rash NOT play with child with cancer

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Cont. Wash hands after using bathroom Have wipes handy for door knobs

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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

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Central Lines & Nursing Responsibility

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IDENTIFYING CVL INFECTION INSPECT SITE LOOK FOR: REDNESS SWELLING DRAINAGE INCREASED PAIN/TENDERNESS

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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

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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

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SCHOOL AND EMOTIONS May be hard to return Body changes and appearance Visits from staff can reduce fears May need special care Education support

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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

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Encourage talking and provide support They may need an emotional break Treat them like others….NORMAL

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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

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QUESTIONS

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Resources www.curesearch.org www.lls.org www.beyondthecure.org www.pbtfus.org

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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