Ns. Rinik Eko Kapti, M. Kep.

The Childs With Cancer

 Differences between Pediatric and Adult
presentation of Cancer
• Incidence of Cancer in Childhood:
– Approximately 9,000 children diagnosed in United
States in 2003
– Cancer is the second leading cause of death for
children under age 5 to 14 years
– In 2003, about 1,500 children died of cancer, 1/3rd
from leukemia
– Types of tumors vary by age
FIGURE 29–1 Percentage of primary tumors by site of origin for different age groups. Notice that in the early years of life, in addition to leukemia, cancers that derive from embryonic cells such as sympathetic
nervous system (neuroblastoma) and eye (retinoblastoma) are common. As the child grows, lymphoma becomes more common in school years, and germ cell cancers of ovary and testes emerge as more
common causes in teens.

© 2006 by Pearson Education, Inc.

Jane W. Ball and Ruth C. Bindler
Upper Saddle River, New Jersey 07458
Child Health Nursing: Partnering with Children & Families All rights reserved.
 Anatomy and Physiology of Pediatric
Differences

• Immune system more immature in children

– This affects how well body can defend itself
– Nonspecific and specific cellular responses are immature
• Children are still growing and developing
– As a result, some cancers grow and progress more rapidly
– Apoptosis (programmed-cell death) not well-developed in
young children
– Children more commonly present with metastases at time
of dx than adults
Differences between adults and children with
cancer
• Childhood cancers respond better to
chemotherapy
• Children tolerate chemotherapy better than
adults
• Childhood survivors of cancer need to be
monitored for late-effects of cancer treatment
 Etiology and Pathophysiology
• Alterations in cellular growth occur in
response to external and internal stimuli
• Neoplasms are caused by one or a
combination of three factors;
– External stimuli that cause genetic mutations
– immune system and gene abnormalities
– Chromosomal abnormalities
 Clinical Manifestations
• Vary by type and location
– Pain
– Cachexia
• (syndrome characterized by anorexia, weight loss, anemia,
asthenia (weakness) )
– Anemia
– Infections
– Bruising
– Neurologic symptoms
– Palpable mass
 Diagnostic Tests
• Radiographic examination
CBC
• Bone marrow aspiration
MRI
• Bone marrow biopsy
CTscan
• Lumbar puncture
USG
• Biopsy of Tumor
 Clinical Therapy
• Child managed by Pediatric Oncology Team
• Therapy may be singular or combination
– Surgery
– Chemotherapy (protocol-action plan for chemo)
– Radiation
– Biotherapy (antibodies developed to target tumor cells for
apoptosis; cancer vaccines)
– HSCT (hematopoietic stem cell transplant)
– Complementary therapies
– Palliative care (presence of palliative care team)
 Treatment Modalities
• Determined by:

– Type of cancer

– Location

– Extent of disease
 Surgery
• The oldest form of cancer treatment
• Surgery plays important role in initial
diagnosis: biopsy of primary tumor.
• Excision of tumor when possible
• Facilitating treatment: insertion of catheters
for long-term treatment
 Radiation Therapy
• The use of ionizing radiation to break apart bonds within
a cell causing cell damage and death.
• External beam therapy accounts for the majority of
radiation treatments in children.
• Problems: radiation beams cannot distinguish between
malignant cells and healthy cells.
 Chemotherapy
• Primary treatment modality used to cure
many pediatric cancers.
• Chemotherapy is the use of drugs to destroy
cancer cells.
• The destruction is accomplished by inhibiting
cells within the body to divide, which
eventually leads to cell death.
 Chemotherapy
• Can be given in addition to another form of
therapy such as radiation or surgery.
• Drugs may be administered before surgery to
reduce size of tumor.
• Adjuvant chemotherapy is used after surgery
or radiation therapy to prevent relapse.
 Chemotherapy
• Combination chemotherapy is the use of more
than one class of drug.
• Administering different classes of chemo
drugs ensures a greater chance of achieving
complete cancer cell destruction and
achieving remission.
 Administration
• Chemotherapy can be given by mouth, subcutaneous or
intramuscular injections, intravenously, or intrathecally.
– Oral route used if drug is well absorbed and non
irritating to the GI tract
– Sub-q or IM: Slow systemic release
– IV push, piggyback or intravenous infusion
 Goals of Chemotherapy
• Reducing the primary tumor size
• Destroying cancer cells
• Preventing metastases and microscopic spread
of the disease
 Chemotherapy Drugs
• Alkylating drug: attack DNA
• Antimetabolites: interfere with DNA production
• Antitumor antibiotics: interferes with DNA production
• Plant alkaloids: prevent cells from dividing
• Steroid hormones: slow growth of some cancers
 Bone Marrow Transplant
• HSCT: Hematopoictic Stem Cell Transplant:
CHLA has one of the largest program.
• The option of HSCT depends on the patients
disease, disease status, and general physical
condition.
• Involves:
– Umbilical cord blood
– Parent’s stem cells
 Gene Therapy
• Use of gene therapy in the treatment of
childhood cancer is promising yet complex and
still in early phases of clinical application.
 Chemotherapy Side Effects
• Nausea/ Vomiting
• Alopecia
• Malaise
• Bone Marrow Depression
– Infection
– Bleeding
– Anemia
• Stomatitis
 Three Types of Oncological Emergencies

• Oncologic emergencies result from the cancer

itself or as a side effect of treatment.
• Most common emergencies are tumor lysis
syndrome
• 3 Types of Oncological Emergencies:
– Metabolic
– Hematologic
– Space-occupying lesions
 Types of Oncological Emergencies
• Metabolic
– Tumor lysis syndrome:
• Metabolic emergency results from lysis of tumor cells.
This cell destruction releases high levels of uric acid, K+,
and phosphates into the blood. Low levels of Na and
Ca occur and metabolic acidosis results.
 Types of Oncologic Emergencies
• Hematologic:
– Results from bone marrow suppression or
infiltration of brain and respiratory tissue w/ high
numbers of leukemic blast cells
(hyperleukocytosis)
– Bone marrow suppression results in anemia and
thrombocytopenia
– This leads to coagulation problems and
hemorrhage.
 Types of Oncologic Emergencies
• Space-occupying lesions
– Tumors w/ extensive growth that may result in
life-threatening situations (increased intracranial
pressure, brain herniation, respiratory
complications, etc.)
 Nursing Care Plan
• Based on type of cancer and therapy
– Infection control
– Pain
– Nutrition
– Growth and Development
– Emotional
– Spiritual
Nursing Management for a child with Cancer

• Nursing interventions focus on preventive, teaching

for all families about risk factors for cancer
• Health promotion and health maintenance of the
child undergoing cancer treatment
• Carrying out treatment interventions
• Managing health problems r/t both cancer and the
side effects of tx
• Partnering w/ families to manage the challenging
psychosocial needs that emerge when cancer is
diagnosed.
 Nursing Assessment and Diagnosis
• Obtain a thorough history. Including:
– Family hx of cancer
– Hx of exposure to known carcinogens
– Does parent work w/ chemicals/ asbestos
– Was child tx’d w/ radiation/ chemo for cancer
previously
– Does the child have any known conditions such as
Down’s syndrome
– Any congenital anomalies
 Nursing Assessment
• Physiologic Assessment
– Includes possible s/sx of cancer or thorough
physical assessment if cancer already identified
• Psychosocial Assessment
– Stress and coping
– Knowledge
– Support systems
– Body Image
 Nursing Assessment
• Developmental Assessment
– Children under 6 should be regularly screened for
developmental surveillance
– If changes in development are noted, or regression in
milestones occurs during tx, refer to specialist
• Assessment for Impact of Cancer Survival
– 1 in 1,000 young adults is survivor of childhood cancer
– Ongoing care is essential: long-term follow-up clinics
– Help families manage long-term effects of cancer tx
Nursing Care of the hospitalized child with Cancer

• Nursing Diagnosis
– Risk of injury related to chemotherapy treatment
– Risk of infection related to depressed body
defenses
– Altered nutrition: less than body requirements
related to loss appetite
– Pain related to diagnosis, treatment, physiology
effect of cancer
– Altered family process related to having a child
with a life threatening disease
Risk of infection related to depressed body
defenses
• NOC
– Risk control
• Monitor health status change
• Avoids exposure to health treath
– Immune status
• Body themperature
• Weigh loss
– Infection severity
• Lethargy
• white blood count depression
• NIC
– Infections protection
• Monitor for the change in energy level
• Monitor temperature
– Infection control
• Isolated persons exposed to communicable desease
• Encourage rest
• Limit the number of visitors
• Wash Hand before and after care activity
Risk of injury related to chemotherapy
treatment

• NOC
– Risk control
• NIC
– Chemotherapy management
– Nausea management
 Altered nutrition: less than body requirements
related to loss appetite
• NOC
– Nutritional status: food and fluids intake
– Nutritional status: nutrient intake
• NIC
– Nutrition management
– Nutrition therapy
Pain related to diagnosis, treatment, physiology
effect of cancer
• NOC
– Pain level
– Pain distruptive effect
– Pain control
• NIC
– Pain management
Altered family process related to having a child
with a life threatening disease
• NOC
– Family functioning
– Family coping
– Family normalizations
– Knowledge: illness care
• NIC
– Counseling
– Family support
 Pemicu
• Buatlah kelompok yang berisi 2 mahasiswa
• Diskusikan hal hal dibawah ini
– Sebutkan dan jelaskan perbedaan kanker pada anak dan orang dewasa
– Jelaskan efek samping jangka panjang dan jangka pendek dari
pemberian kemoterapi
– Jelaskan kegawatdaruratan onkology
– Jelaskan salah satu penyakit kenker pada anak dibawah ini (leukemia,
limphoma dan otak )
– Pada diagnosa yang telah dituliskan diatas, pilihlah nursing outcome
dan intervensi keperawatan berdasarkan NIC dan NOC yang ada
• Dikumpulkan pada saat ujian UAS PN
Terimakasih