ABSTRACT
Children with cancer and those undergoing hematopoietic stem cell transplantation frequently require anesthesia for imaging as well as diagnostic and therapeutic procedures from diagnosis through follow-up. Due to their underlying disease and side effects of chemotherapy and radiation, they are at risk for complications during this time, yet no published guideline exists for preanesthesia preparation. A comprehensive literature review served as the basis for discussions among our multidisciplinary panel of oncologists, anesthesiologists, nurse practitioners, clinical pharmacists, pediatric psychologists, surgeons and child life specialists at the Children's Hospital of Philadelphia. Due to limited literature available, this panel created an expert consensus guideline addressing anesthesia preparation for this population.
Subject(s)
Hematopoietic Stem Cell Transplantation , Neoplasms , Anesthesia, General/adverse effects , Child , Consensus , Diagnostic Imaging , Humans , Neoplasms/therapyABSTRACT
Purpose: The purpose of this study is to describe the outcomes following the implementation of an early discharge protocol for pediatric patients with osteosarcoma receiving high-dose methotrexate (MTX) to determine if the protocol safely decreased length of stay without increased toxicity. Methods: This was a retrospective descriptive cohort design. Participants included children, 5 to 25 years of age, diagnosed with osteosarcoma, who received methotrexate between December 2017 and July 2019. A total of 141 doses across fifteen individual patients were included in the cohort. Data were abstracted from the electronic health record and analyzed using descriptive statistics. Results: The majority of administrations (n = 94, 67%) met early discharge criteria without an increase in toxicity or hospital readmission. Conclusion: Pediatric patients receiving high-dose MTX for osteosarcoma can be safely discharged from the hospital when serum MTX level < 0.4 µmol/L with the implementation of education, hydration goals, frequent lab monitoring, and close follow-up. More than half of patients on this study were able to be discharged from the hospital sooner than prior protocol. More importantly, this retrospective chart review highlighted the ability to maintain safe administration without increasing toxicity.
ABSTRACT
Despite more intensive therapy, high-risk neuroblastoma continues to be a challenging disease to treat. Postconsolidation immunotherapy has been studied for many years and has proven to be effective in clinical trials. Immunotherapy has become the standard of care for patients with high-risk disease, and many institutions across the country are providing this therapy. The care of these patients is complex and often associated with many side effects. The purpose of this article is to review the most common side effects seen in clinical practice and examine their management. Furthermore, this article will discuss the need for a consistent and educated multidisciplinary front-line team to care for these patients, with advanced practitioners playing a lead role to provide the care and attention needed for this patient population.