FATHER SATURNINO URIOS UNIVERSITY

San Francisco St. Butuan City 8600, Region XIII

Caraga, Philippines
Nursing Program

EVIDENCE-BASED READING

Title/ Topic

The importance of evidence-based supportive care practice guidelines in childhood

cancer—a plea for their development and implementation

Research Findings

In the last century, medications had changed significantly. In the late 1940s, major
changes in cure rates in developed countries became visible since the introduction of
chemotherapy in pediatric oncology. On the other hand, in 1960s, the five-year survival rate was
20%, this increased to 40% in the 1970s and is currently 80% in developed countries. Even though
the current survival rates are distinguished, the ultimate goal is to treat and cure the children
with cancer. For instance, the mission statements of the St. Jude Children’s Research Hospital
(USA) and the recently founded Dutch national Princess Maxima Center for Pediatric Oncology
both include the achievement of a greater than 90% childhood cancer overall survival rate in the
next decade as their goal. The primary reason for the improvement of survival is the introduction
of intensive treatment protocols, encompassing chemotherapy, radiotherapy, and/or surgery.
However, increased rate of mortality rate in children with cancer are deeply caused by treatment-
related toxicity. For instance, a study in children with acute lymphoblastic leukemia found that
one in four deaths in their cohort was due to treatment-related toxicity. Furthermore, with cure
rates improving, fewer children will die from the cancer itself and a higher proportion of deaths
will be treatment-related. According to the study, in order to lessen short and long-term
morbidities and mortality rate due to adverse effects of treatment or treatment-related toxicity
optimal supportive care is significantly important. Since, a supportive care defined as the
prevention and management of the adverse effects of cancer and its treatment across the cancer
continuum and is thus all care provided to children with cancer, apart from the primary anti-
cancer treatment and follow-up care. Furthermore, developing CPGs does not automatically
guarantee an improvement in the quality of care and health outcomes. Studies have shown that
30 to 50% of patients do not receive the recommended best practice.

Conclusion

With increasing survival, supportive care became more essential in improving both short
and long-term mortality and morbidities in children with cancer. The development and use of
supportive care Clinical Practice Guidelines (CPGs) are the imperative next steps in bridging the
gap between current evidence and daily practice. Despite the fact that significant work has been
done already, there are many topics which supports the supportive care in pediatric oncology
that can and should be covered. In such a way, nurses can reduce morbidity and mortality in
children suffering from cancer. Thus, international and national collaboration is important to
avoid replication and to be efficient in work. Nurses should be working together to develop and
implement trustworthy supportive care CPGs on topics which are important to clinicians,
families, and children with cancer for positive patient outcomes.

Analysis

In children who is suffering from cancer, supportive care that is consistent with evidence-
based guidelines has led positive patient outcomes and more efficient care delivery. According
to the Multinational Association of Supportive Care in Cancer, supportive care in cancer is the
prevention and management of the adverse effects of cancer and its treatment across the cancer
continuum and is thus all care provided to children with cancer, apart from the primary anti-
cancer treatment and follow-up care. Concerning supportive care in oncology, there are many
evidences that promotes guideline-consistent care, thus there was a study that showed the
adherence to an evidence-based guideline in relation to initiating antibiotic therapy in adult low-
risk febrile neutropenia and the reduction of chemotherapy-induced nausea and vomiting after
highly or moderately emetogenic chemotherapy was associated with decreased mortality.
Supportive care Clinical Practice Guidelines (CDGs) were proven to have several advantages that
help the nurses to provide high-quality nursing care to cancer patients. Supportive care CDGs
have potential to improve patient health outcomes and facilitate the nurses to absorb and
synthesize the current vast amount of literature. Furthermore, these guidelines improve
structure and consistency of care, improves patient knowledge and awareness, enhancing public
policy with regards to preventive interventions and exposure of gaps in contemporary scientific
knowledge. However, developing CPGs does not automatically guarantee an improvement in the
quality of care and health outcomes. Studies have shown that 30 to 50% of patients do not
receive the recommended best practice. So with that, dissemination and implementation
strategies of Supportive care CPGs should be develop and improve in every hospital settings in
order to promote positive outcomes to every child with cancer. Moreover, aside from
implementation, evaluation is also essential to evaluate whether the CPG is actually used in
practice and if it contributes to an improvement in care.

Reference

Loeffen, E. AH., Kremer, L. CM., Mulder, R. L., Gonzalez, A. F., Dupuis, L. L., Sung, L., Robinson, P.
D., Van de Wetering, M. D., and Tissing, W. J.E. (2017). The importance of evidence-based
supportive care practice guidelines in childhood cancer—a plea for their development and
implementation. Support Care Cancer, 25(4): 1121–1125. doi: 10.1007/s00520-016-3501-
y. Retrieved from https://guides.library.uq.edu.au/referencing/apa7/journal-articles