A tablet game or training booklet? Two methods for evaluating symptom management and quality-of-life of children receiving chemotherapy.

PURPOSE: In chemotherapy process, the innovative and educational roles of nurses come to the forefront so that children can manage the symptoms they will encounter and thus increase their quality-of-life. Therefore, a tablet game was developed by the authors of this study to evaluate the effect of training children aged 10-16 who receive chemotherapy by a tablet game and a booklet on symptom management and quality-of-life. METHODS: This was a non-randomized pre and post-test control group study. The study sample consisted of 50 children (game: 25; booklet: 25) who met the inclusion criteria and hospitalized between February 2017-July 2018 in two hospitals' Paediatric Haematology-Oncology Units. Data collection tools consisted of a child evaluation form, Memorial Symptom Assessment Scale, KINDL-Cancer Module, a tablet game, and booklet. RESULTS: When groups were evaluated within themselves after the intervention, the decrease of disturbance level of symptoms at the game group was higher than the booklet group (p:.004). Before the intervention, there was not any difference in the quality-of-life mean between groups (p < .05). After the intervention quality-of-life total (p:.000), mental (p:.030), and treatment (p:.009) subscale means were statistically significantly less at game group than booklet group. CONCLUSIONS: Both interventions were effective for symptom management, and they were not superior to each other, but the quality-of-life was higher in the game group.

Alteration in Hepatitis B Serology in Children Receiving Chemotherapy.

Chemotherapy-induced immunosuppression can lead to hepatitis B virus (HBV) reactivation in cancer patients. Both HBV carriers and individuals with serological signs of previously resolved HBV exposure are under the risk of severe hepatitis and liver failure during and after chemotherapy. The objective of this largest retrospective study was to analyze the consequences of HBV status in children receiving chemotherapy. A total of 479 patients (273 boys and 206 girls) aged 1-211 months diagnosed with acute hematologic malignancies and solid tumors were included in the study. Serological markers for HBV before and after chemotherapy and clinical data of the patients were evaluated retrospectively. Two hundred thirty-four of the participants were found to have protective antibody titers to HBV at admission. Five children were carrying HBV before chemotherapy. They received antiviral therapy during treatment and no reactivation was detected. Antibody against hepatitis B surface antigen (antiHBs) remained positive in 194 patients after chemotherapy. However, 17.09% (40/234) lost antiHBs positivity. In this group, three patients (1.28%) who initially had positive antiHBs and antihepatitis B core antibody experienced HBV reactivation and lost their protective antiHBs at the end of the therapy. Median antiHBs titer significantly decreased after chemotherapy (213.14 [range: 24-888] vs. 180.85 [range: 0-850]) (p = 0.0094). The current relatively large trial demonstrated that protective antibody titers remarkably altered after chemotherapy, and at least 17% of the pediatric oncology cases lost antiHBs positivity. Therefore, vaccine prevention and close monitoring of serology should be considered during chemotherapy.

Chylous ascites after lymphadenectomy in a Wilms` tumor patient.

Yörük MA, Erat-Nergiz M, Timur Ç, Canbolat-Ayhan A, Ergüven M. Chylous ascites after lymphadenectomy in a Wilms` tumor patient. Turk J Pediatr 2018; 60: 436-438. Wilms` tumor is the most common renal malignancy in children and the fourth most common childhood cancer. It accounts 6-7% of all childhood malignancies. Surgical resection is an important therapy option and transabdominal or transperitoneal resection with lymph node sampling is preferred. Development of chylous ascites following intraabdominal or retroperitoneal resection in pediatric age group generally results from extensive lymph node dissection, accidental ligation or interruption of lymphatic ducts. Diseases or conditions affecting abdominal and/or retroperitoneal lymph nodes may cause chylous ascites. Postoperative chylous ascites is associated with significant morbidity and may cause mechanic, nutritional and immunological complications. In the present study, a 16-month-old infant with Stage IV Wilms` tumor who developed chylous ascites after left nephrectomy and lymphadenectomy will be presented; chylous ascites treatment with enteral nutrition and surgical treatment approach for Wilms` tumor will be reviewed.