Foreword xiii

Contributors xv

Acknowledgements xvii

Part 1 Chemotherapy 1

Commentary: Chemotherapy 3
Jamie Cargill

1. Principles of Chemotherapy 7
Angela Houlston

The history of the development of chemotherapy 7

Cell cycle 7

Growth fraction 8

Pharmacokinetics and pharmacodynamics 9

Protocol development and clinical trials 9

Considerations when planning chemotherapy treatments 10

Treatment approaches 11

References 13

2. Chemotherapy Agents 15
Angela Houlston

Classification of drugs 15

References 19

3. Administration of Chemotherapy 21
Angela Houlston

Safe practice with cytotoxic drugs: legislation 21

Consent 21

Safe handling 21

Reconstitution and preparation of chemotherapeutic agents 22

Personal Protective Equipment (PPE) 22

Work practices 23

Patient support 25

Setting for chemotherapy administration 25

Administration of chemotherapy 27

Routes of administration 28

Intrathecal route 31

The intramuscular and subcutaneous routes 32

References 33

4. Side Effects of Chemotherapy 35
Karen Selwood

Introduction 35

Gastrointestinal tract 36

Taste alteration 42

Nausea and vomiting 43

Pharmacological interventions 46

Anorexia/weight loss 48

Haematological problems 55

The compromised immune system 60

Viral infections 60

Cutaneous side effects 61

Conclusion 65

References 65

5. Oncological Emergencies 73
Karen Selwood

Introduction 73

Septic shock 73

Home care 74

Disseminated intravascular coagulation (DIC) 75

Anaphylaxis 77

Acute tumour lysis syndrome (ATLS) 77

Hyperuricaemia 79

Hyperkalaemia 80

Hyperphosphataemia and hypocalcaemia 81

Nursing implications of ATLS 81

Spinal cord compression 82

Conclusion 82

References 82

6. Future Trends 85
Karen Selwood

Introduction 85

Treatment strategies 86

Targeted approaches 86

Proteasome 87

Gene therapy 87

Tumour vaccines 88

Hormone therapy 88

Combination therapy 88

New treatments for cancer – the nurse’s role 88

References 89

Part 2 Haematopoietic Stem Cell Transplantation 91

Commentary: Haematopoietic Stem Cell Transplantation 93
Helen Webster

7. Background to the Haematopoietic Stem Cell Transplant (HSCT) Procedure 97
Nikki Bennett-Rees and Sian Hopkins

History 97

Types of transplant 98

Diseases for which haematopoietic stem cell transplant is a treatment modality 99

Tissue typing 100

Adult unrelated donors 102

References 105

8. Preparation for Bone Marrow Transplant 107
Nikki Bennett-Rees, Sian Hopkins and Joanna Stone

The family 107

Negotiation 109

Support 109

Preparation of children 110

Conditioning regimens 113

Preparation of a sibling donor 116

Ethical use of sibling donors 117

Saviour siblings 121

Preparation of non-donor siblings 122

References 122

9. Collection and Infusion of Bone Marrow, Peripheral Blood Stem Cells and Umbilical Cord Cells 125
Nikki Bennett-Rees and Sian Hopkins

Collection of bone marrow 125

Complications of donation 126

Collection of peripheral blood stem cells (pbsc) 126

Venous access 128

Stem cell collection 129

Collection of umbilical cord blood cells 130

Issues surrounding umbilical cord banking 131

Bone marrow/stem cell infusion 131

References 133

10. Protective Isolation: Nursing Issues 135
Nikki Bennett-Rees and Sian Hopkins

Introduction 135

Infection prophylaxis 136

Protective isolation 137

Dietary restrictions 138

Mouth care 139

Skin care 140

Infection screening 140

The effects of isolation 140

References 141

11. Complications of Stem Cell Transplant 143
Nikki Bennett-Rees and Sian Hopkins

Introduction 143

Mucositis 143

Treatment and nursing implications 144

Pancytopenia 147

Haematological complications 147

Infection 150

Veno-occlusive disease 154

Graft versus host disease (GVHD) 156

Graft versus leukaemia (GVL) 159

References 160

12. Discharge Planning and Psychosocial Issues for the Family 163
Nikki Bennett-Rees and Sian Hopkins

Discharge planning 163

Psychosocial effects of stem cell transplant on the family 166

References 168

13. Staff Support in Stem Cell Transplant Units 169
Sian Hopkins

Educational needs of nurses in blood and bone marrow transplant units 170

References 171

14. Further Developments in Stem Cell Transplantation 173
Nikki Bennett-Rees, Sian Hopkins, Lesley Henderson and Jinhua Xu-Bayford

Gene therapy 173

What is gene therapy? 173

Gene therapy prospects for primary immunodeficiencies 174

What does the gene therapy process involve for the child? 174

Care of the child undergoing gene therapy for X-linked SCID 176

Care of the child undergoing gene therapy for ADA-SCID or CGD 177

Parental support 178

Risks and side effects of gene therapy 178

The future 179

References 179

Part 3 Surgery 181

Commentary: General Surgery 183
Charlie Rogers

Introduction 183

Diagnosis 183

Continuity of care 183

Pain 184

Central venous access 185

Conclusion 186

References 186

15. General Surgery 187
Rachel Hollis, Sharon Denton and Gill Chapman

Introduction 187

The challenge of surgical care in paediatric oncology 188

Surgery as a diagnostic tool 189

Surgery as a treatment modality 192

Preparing the child and the family for surgery 198

Post-operative nursing care 201

Discharge planning 206

Late effects of surgical treatment 206

Surgery in supportive care 208

Management of infection 212

Surgery to avoid the complications of radiotherapy 213

Future trends in surgery 214

References 214

Commentary: Neuro-oncology 219
Jennie Sacree

16. Neuro-oncology 223
Lindy May and Beth Ward

Introduction 223

Overview of brain tumours 223

Increased intracranial pressure and hydrocephalus 225

Tumour types 226

Investigations into brain tumours 227

Neurological assessment 228

Play therapy 232

The multidisciplinary team 232

Pre-operative care 233

Intra-operative care 233

Post-operative management 234

Long-term concerns: morbidity and mortality 236

Jack’s journey through CNS tumour treatment 236

Ongoing needs of a child with a brain tumour 237

Adjuvant treatment: specifics of treating a child with a CNS tumour 239

Late effects of CNS tumours and acute rehabilitation needs 242

Rehabilitation needs 244

Second malignancy 244

Discharge planning 244

Relapse and chemotherapy clinical trials 245

Relapse: the child 245

Palliative care 245

The future of neuro-oncology 246

References 247

Commentary: Primary Bone Cancer in Young People 251
Lin Russell

17. Primary Bone Cancer in Young People 255
Chris Henry

Introduction 255

Types of tumours and their presentation 257

Treatment options 260

Limb conservation surgery 262

Amputation 265

Altered body image 268

Discharge planning 268

Late effects 269

Future trends 272

Impact of setting 273

References 275

Part 4 Radiotherapy 279

18. The Nature of Radiotherapy 281
Monica Hopkins

Introduction 281

Indications for the use of radiation in the care of children with cancer 282

The nature of radiation 282

Artificial production of radiation for clinical use 283

Radiation dose 284

Effect of ionising radiation on human tissue 284

Hazards to healthy tissue during radiotherapy 285

Conclusion 286

References 286

19. Administration of Radiotherapy 289
Monica Hopkins

Introduction 289

External beam therapy (teletherapy) 289

Brachytherapy 297

Use of unsealed sources (intravenous radioactive materials) 299

Administration of alternative radiotherapy techniques 302

What does the future hold for radiotherapy? 304

References 306

20. Tumours and Radiotherapy Treatment 311
Monica Hopkins and Cornelia Scott

Brain tumours 311

Adverse effects of radiotherapy in the treatment of brain tumours 312

Acute lymphoblastic leukaemia with CNS involvement 314

Tumours of the head and neck 315

Retinoblastoma 315

Non-Hodgkin’s lymphoma 316

Hodgkin’s lymphoma 316

Radiotherapy for abdominal tumours 317

Malignant mesenchymal tumours such as rhabdomyosarcoma 317

Wilms’ tumour 317

Neuroblastoma 318

Pelvic irradiation 318

Extremity radiation 319

Conclusion 319

References 320

21. Acute and Sub-acute Side Effects of Radiotherapy 321
Monica Hopkins and Cornelia Scott

Introduction 321

Acute reactions in healthy tissue 321

Skin 322

The gastrointestinal tract 328

Mouth 328

Promotion of nutritional intake 331

Pain control 332

Small intestine 333

Bone marrow 334

Hair follicles 335

Fatigue 335

Brain 336

Pneumonitis 337

Cystitis 337

Conclusion 338

References 338

22. The Role of Radiotherapy in Palliative Care 343
Monica Hopkins

The decision to use radiotherapy in the palliative care of children 343

Radiotherapy in oncological emergencies 344

Radiotherapy in end of life symptom management 346

References 348

Part 5 Late Effect of Cancer Therapies 351

23. Overview of Long-Term Follow-Up 353
Susan Mehta

Future challenges 354

Long-term effects of cancer treatment 354

The nursing role 354

Health education 355

Conclusion 355

References 355

24. Potential Physical Issues Following Cancer Treatment 357
Ruth Elson and Susan Mehta

Endocrinopathies 357

Thyroid gland 358

Hypothalamic pituitary axis 359

Gonadal dysfunction 360

Fertility 363

Liver 365

Neurological impairment 366

Neuropsychological 368

Eyes 369

Craniofacial and dental 370

Skin 371

Musculoskeletal 371

Hearing 373

Gastrointestinal 374

Cardiac 375

Renal and bladder 376

Pulmonary 377

Second malignancies 378

References 379

25. The Role of the Nurse in Long-Term Follow-Up 383
Beverly Horne

Assessment, planning, implementation and evaluation of programmes of care 383

Support and advice 384

Liaison and education 384

Provision and facilitation of alternative models of care 385

Research and audit 386

Health promotion provision 387

Participation in specialist LTFU clinics 387

Conclusion 387

References 387

26. Health Promotion for Long-Term Follow-Up Patients 389
Beverly Horne

Smoking 390

Alcohol consumption 391

Recreational drug use 391

Nutrition, physical activity and achieving a healthy weight 391

Breast awareness 393

Testicular self-examination 393

Sexual health 393

Sun protection 394

Theoretical approaches and models 394

Conclusion 395

References 395

27. Quality of Life in Long-Term Survivors of Childhood Cancer 397
Anthony Penn

Defining quality of life in the health-care setting? 397

Physical function 398

Psychological function 398

Cognition 399

Social function 399

Education 400

Employment and insurance 400

Interpersonal relationships and marriage 401

Conclusion 401

References 402

Index 405