Radiation exposure in nurses during care of 131I-MIBG therapy for pediatric patients with high-risk neuroblastoma.

OBJECTIVE: 131I-meta-iodo-benzyl-guanidine (131I-MIBG) therapy has been used in children with high-risk neuroblastoma, who, in Japan, are cared for by trained nurses. To determine the safety of occupational radiation exposure in nurses, we retrospectively examined radiation exposure during therapy. METHODS: Sixty-two nurses who received radiation exposure during 131I-MIBG therapy were assessed for the daily percentage of total radiation exposure received using the formula, daily radiation exposure/total radiation dose × 100; self-care score of children was evaluated. RESULTS: Fifty-four 131I-MIBG treatments (592 ± 111 MBq/kg) were performed in neuroblastoma patients (M/F; 27 /27, mean age at 131I-MIBG treatment; 7 ± 2 years), who were isolated for 5 ± 1 days. Average total (0.36 ± 0.18 mSv; range 0.09-0.97 mSv) and daily (0.07 ± 0.05 mSv/day; range 0.02-0.32 mSv/day) radiation exposure to nurses per patient care. The daily percentage of total radiation exposure significantly decreased in 3 days after 131I-MIBG treatment (days 0, 1, and 2 was 38.2 ± 14.7%, 26.9 ± 12.6%, and 15.3 ± 7.1%, respectively), and the average self-care score was 12.2 ± 3.5 (10-27) for all patients. Higher self-care score was significantly related to younger patients' age and higher daily radiation exposure in nurses. CONCLUSION: Individual exposure to radiation was well controlled. Nurses who care for pediatric patients needing daily assistance must be aware of the radiation exposure risks, which can be reduced by establishing a care system and monitoring radiation exposure.

The Role of Nursing Professionals in the Management of Patients With High-Risk Neuroblastoma Receiving Dinutuximab Therapy.

Neuroblastoma, an embryonic cancer of the sympathetic nervous system, is the most common extracranial solid tumor in childhood. Dinutuximab (formerly called ch14.18), a monoclonal antibody targeting the disialoganglioside GD2, has been shown to significantly improve survival rates in patients with high-risk neuroblastoma. However, the safe and effective use of dinutuximab therapy in these high-risk patients requires medical expertise in patient selection, treatment administration, and the monitoring and management of adverse events. Findings of the randomized phase III study (ANBL0032) led to the approval of dinutuximab for the treatment of children with high-risk neuroblastoma. Multi-institutional nursing approaches to implementing standard protocols ensure the effective management of high-risk neuroblastoma patients receiving dinutuximab immunotherapy. Understanding and implementing recommendations for the management of the clinically important and most common adverse events are essential to ensuring patient continuation of therapy and improving patient outcomes.

The Application of an Evidence-Based Clinical Nursing Path for Improving the Preoperative and Postoperative Quality of Care of Pediatric Retroperitoneal Neuroblastoma Patients: A Randomized Controlled Trial at a Tertiary Medical Institution.

BACKGROUND: A clinical nursing path (CNP) that encourages patients and their families to become actively involved in healthcare decision-making processes may improve outcomes of pediatric retroperitoneal neuroblastoma (NB) patients. OBJECTIVE: The aim of this study was to evaluate the utility and value of an evidence-based CNP provided to pediatric retroperitoneal NB patients undergoing resection surgery. METHODS: One hundred twenty NB cases were assigned to a control group or a CNP group. The control group was provided with standard nursing care. The CNP group was provided with nursing care in accordance with an evidence-based CNP. The utility and value of the CNP were compared with standard nursing care. Outcome measures included rates of postoperative complications, lengths of hospital stay, and cost of hospitalization, as well as preoperative and postoperative quality of care and patient satisfaction with care. RESULTS: The rates of postoperative complications, length of preoperative hospitalization, total length of hospital stay, and costs of hospitalization were significantly lower for patients receiving the CNP compared with the control group. Preoperative and postoperative quality of care and patient satisfaction with care were significantly higher in patients receiving the CNP compared with the control group. CONCLUSION: Adoption of a CNP for preoperative and postoperative care of pediatric retroperitoneal NB patients undergoing resection surgery improves clinical outcomes and patient satisfaction with care. IMPLICATIONS FOR PRACTICE: A CNP can increase families' participation in a patient's recovery process, enhance nurses' understanding of the services they are providing, and improve the quality of healthcare received by patients.

Main caregivers' experiences of managing pain for children with neuroblastoma in Taiwan.

Neuroblastoma is a common malignant tumor among children. Seventy percent of children with neuroblastoma have metastatic disease when the diagnosis is established. The aim of this study was to understand the main caregivers' lived experiences in managing pain for children with neuroblastoma. A descriptive qualitative design was used. Twelve main caregivers of children with neuroblastoma were interviewed. Two themes evolved: experiences of pain and coping with pain. Three subthemes were found under the theme "experience of pain": pain assessment based on language expressions and behavioral observations, tendency of misdiagnosing tumor metastasis-related pain, and unique manifestations of pain at various phases. Four subthemes evolved under the theme "coping with pain": utilization of pharmacological and nonpharmacological modalities for pain management, learning to confront pain, seeking mental and emotional support, and adjustment of family lifestyle. The results provide a description regarding the expression of pain in children with neuroblastoma and the pain management modalities used by the main caregivers. The findings serve as a reference for health care providers in Taiwan as they manage pain for children with neuroblastoma and seek to understand the needs of the main caregivers.

[Loïs or the end of life of a child suffering from cancer]. / Loïs ou la fin de vie d'un enfant atteint de cancer.

Loïs, suffering from a malignant tumour, was supported until his death by a general paediatric department, with the collaboration of a mobile continuing care and support team and surrounded by his parents. The particularity of this multi-disciplinary support lies in the fact that the family experienced the birth of their daughter at the same time.

[The nutritional care of a child suffering from neuroblastoma]. / La prise en charge nutritionnelle d'un enfant atteint de neuroblastome.

Children are growing people. When they are suffering from cancer, they are often malnourished. Their nutritional care must be adapted and form an integral part of the overall treatment. The diet of Léa, a young girl suffering from neuroblastoma, was enriched and adjusted in order to take into account the side effects of her treatment.

Neuroblastoma: What the nurse practitioner should know.

PURPOSE: To provide a comprehensive review of the background, diagnosis, and primary care management of neuroblastoma (NBL) and to describe the pathophysiology, signs and symptoms, and diagnostic tests for the patient with NBL. DATA SOURCES: Extensive review of the worldwide scientific literature on the condition, including primary care articles and studies performed. CONCLUSIONS: NBL is one of the most common tumors of childhood and clinical presentation depends on the site of the primary tumor as well as the presence and location of any metastasis. Treatment includes a combination of surgery, chemotherapy, and radiation, as well as the newer immunotherapy. IMPLICATIONS FOR PRACTICE: NBL is often identified in the primary care setting, and it is important to be able to recognize the presentation and correctly manage the disease. The clinical presentation of NBL, the vital facts needed to ensure that this diagnosis will not be overlooked, and follow-up in a primary care setting will be reviewed.

Prevention and treatment of mucositis: a guide for nurses.

Oral mucositis is a frequent and potentially severe complication that can occur following chemotherapy or irradiation. Not only is mucositis painful but it can also result in impaired nutrition, infection, and treatment delays. Pediatric oncology nurses have a challenge to try to provide the most appropriate mouth care regimen specific to each individual patient. This review of the literature can serve as a guide for helping to prevent and to treat mucositis. It provides information about the chemotherapeutic agents responsible for causing mucositis, many of the preventive approaches used to reduce the incidence of mucositis, and the current treatments available for active mucositis. It also discusses dietary recommendations and the role of the nurse caring for the patient with mucositis.

Meeting the nursing challenges in treating children with 131I-MIBG.

This article focuses on the role of advanced practice nurses as leaders on a health care team committed to providing a collaborative approach to a unique patient population. It describes the process of implementing a clinical trial for treatment of patients with neuroblastoma with the radioisotope 131I-MIBG. As new clinical trials emerge, staff nurses face challenges in providing care to complex patients and their families. Nurses are often required to acquire new knowledge, interact with other disciplines and departments, and develop new skills in order to provide care for these patients. Advanced practice nurses can provide a critical link between the principal investigator and staff members to meet these challenges. The process used to implement this trial can serve as a model for many other interdisciplinary projects.

Solid tumors in children.

Solid tumors make up about 30% of all pediatric cancers. The most common types of solid tumors in children include brain tumors, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, and osteosarcoma. This article reviews the etiology and treatment of these diseases, and discusses the differences between adult and pediatric solid tumors.