Identifying the educational needs of parents at the completion of their child's cancer therapy.

For parents of children with cancer, the experience of completing treatment can be a time of celebration and hope as well as anxiety and fear. Previous research has identified the time immediately following completion of therapy as one of the most difficult and anxiety producing periods in parents' trajectory of cancer treatment. A gap in knowledge exists to guide nursing practice regarding parents' educational needs. The purpose of this study was to (a) determine the educational needs of parents as their children completed cancer treatment and (b) assess the feasibility of measuring parental educational needs, anxiety, and family management styles as treatment ends. The results support previous findings that parents are anxious at the end of therapy. Fear of relapse was their primary concern. Although parents desire education at the end of therapy, attention to parental readiness to learn and the individual needs of the patient and family must be considered. In the feasibility portion of this study, parents were able to complete the questionnaires with no negative feedback provided.

Fertility concerns for young males undergoing cancer therapy.

OBJECTIVES: To review the treatment factors that can affect male fertility, and the practices at a large metropolitan children's hospital that has successfully developed a sperm banking program. The role of the nurse in the education of families and facilitating the sperm banking process will be described. DATA SOURCES: Review of the literature and anecdotal information. CONCLUSION: Because of increased survival rates over the past three decades in children diagnosed with cancer, the importance of preserving fertility has become paramount in the minds of health care providers, families, and patients. IMPLICATIONS FOR NURSING PRACTICE: Early identification and prompt referral for sperm banking by nurses are key factors in helping young male adolescents with cancer.

Sperm banking for adolescents with cancer.

Recent advances in diagnostic and therapeutic methods in pediatric oncology have led to greater survival rates in children with malignancies. However, major long-term complications can occur that limit the quality of survival, infertility being one of them. Chemotherapy, radiation treatment, surgery, and combinations of these treatments have been implicated in causing infertility, with males being especially sensitive to therapy. Cryopreservation of semen, or sperm banking, is an easy, widely available means to preserve fertility for adolescent and young adult males with cancer. In this article, the pertinent literature is reviewed, and a sperm-banking program is described. Recommendations are offered for institutions attempting to develop a successful program, and the nurse's role in education and facilitation is discussed.

Sperm banking for adolescent and young adult cancer patients: sperm quality, patient, and parent perspectives.

BACKGROUND: Infertility is often a complication for adolescent and young adult males who receive cancer therapy, a problem that might be averted through using cryopreserved sperm. We aim to evaluate feasibility of offering newly diagnosed patients the opportunity to bank sperm and, to determine the beliefs and decision-making processes of patients and their parents who considered sperm banking. PROCEDURE: Eligible patients and parents were approached and offered sperm cryopreservation. Semen samples from patients who sequentially attempted sperm banking were analyzed. Questionnaires were then administered to patients and parents who had been approached about sperm banking. RESULTS: Semen samples from 68 patients were analyzed. Nine patients were azoospermic; all had been pre-treated with chemotherapy. Fifty patients completed the questionnaire. Parent and patient made the decision together to bank 80% of the time. All sons who attempted to bank and their parents felt they had made the right decision, including those who attempted but failed. CONCLUSIONS: Viable sperm can be collected successfully from adolescent and young adults who are newly diagnosed with cancer. Semen quality was dramatically reduced by one course of gonadotoxic therapy. Parents and patients want information regarding sperm cryopreservation early. Parents appear to play an important role in the decision to sperm bank. We recommend sperm banking be offered to all eligible patients.

Clinical application of family management styles to families of children with cancer.

The potential clinical application of family management styles for working with families who have children with cancer is discussed. Case studies are used to illustrate the usefulness and clinical application of the model.

Fertility in males treated for Hodgkins disease with COPP/ABV hybrid.

More than 80% of those diagnosed with Hodgkins disease (HD) will survive long-term. For the past decade, a modified hybrid consisting of cyclophosphamide (2.4-3.6g/m(2)), vincristine, procarbazine, and prednisone (COPP) together with adriamycin, bleomycin, and vinblastine (ABV) has been used to treat patients with HD. Little data exists on how this modified hybrid impacts male fertility. Eleven male patients treated with COPP-ABV hybrid were studied. Nine out of 11 subjects were categorized as infertile by semen analysis; 7 of 9 were azoospermic. There was no association between fertility status and prepubertal status at diagnosis or gonadotropin status. Despite lower doses of cyclophosphamide, treatment with the current COPP/ABV hybrid leads to infertility in the majority of young men. It is likely that procarbazine, an effective yet potent gonadotoxic agent, is responsible for this outcome.

Prevalence of and risk factors for hydrocele in survivors of Wilms tumor.

BACKGROUND: The purpose of this study is to evaluate the prevalence of hydrocele as a complication of Wilms tumor (WT) therapy and nephrectomy and to determine whether radiation therapy to the flank increases the risk. We hypothesize that radiation increases the risk of hydrocele formation in patients treated for WT. METHODS: A retrospective, medical review of the chart was completed on 57 male patients with WT diagnosed between 1985 and 2000. RESULTS: There is an increased prevalence of hydrocele in males that had a nephrectomy as part of their WT therapy. CONCLUSIONS: Male survivors of WT are at risk for development of a subsequent hydrocele that appears to be related to their prior surgery.

Development and implementation of a carboplatin desensitization protocol for children with neurofibromatosis, type 1 and hypersensitivity reactions in an outpatient oncology clinic.

Neurofibromatosis, type 1 (NF 1), is a relatively common disorder. Children with NF 1 are at much greater risk for the development of optic pathway tumors, which are sometimes treated with chemotherapy. As a result, many oncology centers and clinics are now seeing and treating NF patients. One of the most frequently used drugs is carboplatin. However, as many as 30% of NF patients may develop a reaction to carboplatin, which can include anaphylaxis. This often results in the cessation of the medication and treatment protocol. At the Children's Hospital of Philadelphia a desensitization protocol has been instituted with children who have had such reactions and whose tumors have demonstrated a positive response to the treatment. The desensitization process is quite complex and requires an interdisciplinary approach. However, it is the nursing personnel that are key to the successful coordination and delivery of such a protocol in an oncology outpatient clinic on a regular basis.