Nursing Management in Pediatric Patients Undergoing Chimeric Antigen Receptor T (CAR-T) Cell Therapy: A Systematic Literature Review.

OBJECTIVES: This systematic review aims to describe an overview of the overall care, patient and parent education, staff training, and management of complications from a nursing perspective of pediatric patients undergoing chimeric antigen receptor T (CAR-T) cell infusion in order to provide an updated summary of the approach to the management of these patients. CAR-T cellular therapy represents an innovation within pediatric hematology and oncology used to treat relapse and refractory leukemias, solid tumors, and lymphomas when standard therapy has not worked. However, this type of therapy could lead to the onset of some clinical complications that must be managed appropriately and promptly. Although their use is constantly increasing, the knowledge and resources in the literature are still limited. DATA SOURCES: The review was conducted from January 2022 to July 2022 in PubMed, CINAHL, Scopus, and Cochrane and produced 502 articles. Based on the selection criteria and after removing duplicate articles, 26 articles were included in the study. CONCLUSION: From these analyzed articles, it was possible to have an overview regarding the management, patient and parent education, staff training, and management of complications from a nursing perspective of pediatric patients undergoing CAR-T cell infusion. IMPLICATIONS FOR NURSING PRACTICE: The management of hematology-oncology patients undergoing CAR-T cell therapy from a nursing perspective is not simple. We hope this review can be used as a tool to guide nursing staff. In this regard, we have developed a summary table with the actions to be taken in the case of assisting a pediatric patient being treated with CAR-T.

Full Sails against Cancer.

BACKGROUND: Cancer is very disruptive in adolescence and hospitalizations interfere with this development stage in becoming independent, developing social relationships, and making plans for the future. A major challenge in the care of adolescents with cancer is being able to enhance their quality of life. The aim of this project is to increase our understanding of how adventure therapy influenced quality of life for adolescents with cancer. METHODS: Bambino Gesù Children's Hospital, in collaboration with the Tender to Nave Italia Foundation (TTNI), has been conducting a unique project, located on a beautiful brigantine of the Italian Navy. Adventure therapy is a form of experiential therapy that consists of various types of adventure, in particular outdoor and sailing activities. Ninety teenagers have been the protagonists of this project to date and filled out two questionnaires about quality of life and self-esteem, before and after the sailing experience. RESULTS: The adventure provides the opportunity for the participants to build interpersonal relationships and develop life skills that they can benefit from in the future experiences. All participants report a significant improvement in their quality of life and self-esteem at the end of this experience. CONCLUSION: This collaborative adventure project is a great way to learn and practice new behaviors, improve interpersonal skills, heal painful emotions, overcome personal obstacles and challenges, and help the teenagers to resume their developmental path after an onco-hematological diagnosis.

Feasibility of a VR Intervention to Decrease Anxiety in Children with Tumors Undergoing CVC Dressing.

Virtual reality (VR) represents a promising digital intervention for managing distress and anxiety in children with tumors undergoing painful medical procedures. In an experimental cross-over study, we administered a VR intervention consisting of relaxing games during central venous catheter (CVC) dressing. The VR sessions were compared with no-VR during CVC medication. We used the distress thermometer and RCMAS-2 scale to assess distress and anxiety levels. We also explored the satisfaction level in patients and families. We enrolled 22 children. The distress levels after medication were lower in the VR group than in those without VR (VR: median 2; IQR 0-2; no-VR: median 4; IQR: 3-5). No variation in anxiety levels was detected by VR intervention. Satisfaction for using VR was very high in children and their families although a total of 12% of children were disappointed by the effect of VR. Most healthcare workers felt that VR would be useful in routine clinical practice. A VR intervention is highly acceptable, may be efficacious in decreasing distress in children with cancer undergoing painful procedures, but it is less likely that it has a measurable impact on anxiety. Evidence from larger studies is needed to assess VR translation into the clinical workflow.

The clinical effectiveness of an integrated multidisciplinary evidence-based program to prevent intraoperative pressure injuries in high-risk children undergoing long-duration surgical procedures: A quality improvement study.

The prevention of hospital-acquired pressure injuries (HAPIs) in children undergoing long-duration surgical procedures is of critical importance due to the potential for catastrophic sequelae of these generally preventable injuries for the child and their family. Long-duration surgical procedures in children have the potential to result in high rates of HAPI due to physiological factors and the difficulty or impossibility of repositioning these patients intraoperatively. We developed and implemented a multi-modal, multi-disciplinary translational HAPI prevention quality improvement program at a large European Paediatric University Teaching Hospital. The intervention comprised the establishment of wound prevention teams, modified HAPI risk assessment tools, specific education, and the use of prophylactic dressings and fluidized positioners during long-duration surgical procedures. As part of the evaluation of the effectiveness of the program in reducing intraoperative HAPI, we conducted a prospective cohort study of 200 children undergoing long-duration surgical procedures and compared their outcomes with a matched historical cohort of 200 children who had undergone similar surgery the previous year. The findings demonstrated a reduction in HAPI in the intervention cohort of 80% (p < 0.01) compared to the comparator group when controlling for age, pathology, comorbidity, and surgical duration. We believe that the findings demonstrate that it is possible to significantly decrease HAPI incidence in these highly vulnerable children by using an evidence-based, multi-modal, multidisciplinary HAPI prevention strategy.

Pediatric onco-hematological home care during COVID-19 pandemic.

The aim of the work is to describe the protocol adopted by the Home Care Service in pediatric onco-hematological patients of a large cancer institute in Italy during COVID-19 pandemic and to present preliminary data. Based on our experience, we have developed strategies to ensure continuity of care, non-abandonment, and protection of patients and operators in a period of emergency like this. In this context, the "COVID at home" protocol plays a central role. It aims to be able to safely manage COVID-19 positive onco-hematological patients, allowing nursing and medical care in the home setting, identifying patients at risk for COVID-19 infection, and rationalizing improper accesses to the hospital.

Nurse Practitioner Management of a Blinatumomab Infusion Program: Impact on Patient Safety and Quality of Care.

The prognosis of children with acute lymphoblastic leukemia can be improved with the use of monoclonal antibodies such as blinatumomab. Many studies discuss the management and treatment of symptoms; however, none of them describe practical complications related to the continuous infusion of blinatumomab, especially during home-based therapy. The purpose of this study is to describe the experience gained over 4 years in the management of pediatric patients undergoing therapy with blinatumomab in an Italian tertiary hospital. The establishment of a nursing program dedicated to improving infusion pump management, patient support, quality of care, and patient safety will be discussed.

Electronic Assessment and Tracking of Pain at Home: A Prospective Study in Children With Hematologic or Solid Tumors.

This study aimed to evaluate the intensity and characteristics of pain, which was assessed at home by children with cancer or their parents using an app for mobile devices, for a 1-month poststudy enrollment. The participants of this observational prospective study were outpatients at the hematology/oncology department of an academic hospital in Italy, aged between 0 and 21 years, and receiving hospital-at-home care. Patients or their parents were asked to assess pain levels for one month at home using the Faces, Legs, Arms, Cry, and Consolability (FLACC) scale for patients aged <4 years and the Ospedale Pediatrico Bambino Gesù (OPBG) tool for patients aged 4 to 21 years. At study conclusion, parents were asked to complete a survey about their satisfaction with the app and to rate their child's health in general, pain intensity, and frequency in the past 4 weeks. Of the 124 participants using the app, 94 (75.8%) reported pain (≥1) at least once during the 1 month. Of these, 53 (56.4%) at most reported mild pain, 33 (35.1%) moderate pain, and eight (8.5%) severe pain. The abdomen was identified as the most frequent (56.3%) pain site by patients aged 4 to 21 years. The child's maximum pain intensity during the study period was negatively correlated with the parent's report of the child's health during the past month (r = -.29, p < .01). Most of the participants were satisfied with the app and the information received about app usage. In conclusion, the app facilitated pain assessment and tracking in patients receiving hospital-at-home care.

The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review.

Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.

Counseling for pediatric patients undergoing hematopoietic stem cell transplantation and their parents: A pilot descriptive study.

PURPOSE: This study aimed to: (1) to assess the Quality of Life (QoL) of pediatric patients who had undergone Hematopoietic Stem Cell Transplantation (HSCT) and their parents; (2) to explore how patients and parents perceived a nurse counseling intervention; and (3) to explore how health professionals consider the nurse counselor's role. METHODS: This was a pilot descriptive study using quantitative and qualitative data. RESULTS: Parents' QoL was compromised in the domains of Social Functioning, Physical and Emotional roles. Patients' QoL was poor in all the domains except in Behavior and Family Cohesion. Patients and their parents considered the counseling as an effective help. Seven categories emerged from the analysis of qualitative data: support and taking charge, empathy, active communication and listening, evasion, sharing, awareness, and organizational availability. Regarding health professionals, five categories emerged from the analysis of the interviews and a focus group: support and taking charge, recovery in self-expression, support in relationship with patients and family, connecting role, and difficult integration within the team. CONCLUSIONS: The nurse counselor could empower patients and parents to improve their attitudes towards care pathway. The nurse counselor can be an important resource in the context of HSCT, even if greater integration within the team is required.