Health-Related Quality of Life of Adolescent and Young Adult Survivors of Central Nervous System Tumors: Identifying Domains From a Survivor Perspective.

This article uses qualitative methods to describe the domains of health-related quality of life (HRQoL) that adolescent and young adult (AYA) survivors of central nervous system (CNS) tumors identify as important. Survivors clearly attributed aspects of their current HRQoL to their disease or its treatment. We identified 7 key domains of AYA CNS tumor survivorship: physical health, social well-being, mental health, cognitive functioning, health behaviors, sexual and reproductive health, and support systems. Although most aspects of HRQoL that survivors discussed represented new challenges, there were several areas where survivors pointed out positive outcomes. There is a need for a HRQoL tool designed for this population of survivors, given their unique treatment and survivorship experience. Aspects of HRQoL related to cognition, sexual and reproductive health, health behaviors, and support systems are not typically included in generic HRQoL tools but should be assessed for this population. Developing HRQoL measurement instruments that capture the most significant aspects of HRQoL will improve the ability to track HRQoL in AYA CNS tumor survivors and in the long-term management of common sequelae from CNS tumors and their treatments.

Memory disorders in children with central nervous system germ cell tumors.

Memory disorders in children and adolescents with brain tumors are rare, but devastating to social, academic, and vocational development. Many pediatric patients with intracranial germ cell tumors (GCTs) complain of memory difficulties. This study investigated memory across a series of GCT patients. A total of 33 GCT patients were retrospectively examined for diagnosis, imaging results, intelligence quotient, treatment variables, evidence of increased intracranial pressure at diagnosis, and memory. The incidence of amnesia in GCT patients was 55%. Memory disturbance could not be predicted by intelligence quotient, treatment, location of lesion, or hydrocephalus at diagnosis. The high incidence of memory deficits in GCT patients suggests a risk to memory in patients with GCT. Formal memory assessment should be considered in all patients with central nervous system GCTs. Specific counseling and planning to assist in adjustment and to ensure safety should be considered standard care for those with memory deficits. The nurse should be instrumental in facilitating understanding of this specific injury in the brain tumor population.

Pain in children with central nervous system cancer: a review of the literature.

PURPOSE/OBJECTIVES: To explore the current state of the science regarding pain in children with cancer, with special attention to literature related to central nervous system (CNS) tumors. This review used the Human Response to Illness (HRTI) model as an organizing framework. DATA SOURCES: PubMed, CINAHL, and Scopus data-bases. DATA SYNTHESIS: The literature review is presented with the four components of the HRTI model, including the physiologic, pathophysiologic, experiential, and behavioral perspectives of the pain response related to childhood cancer and childhood CNS cancer. The person and environmental factors that may influence a child's pain response are described. CONCLUSIONS: Children with cancer, including CNS cancer, continue to experience pain despite the improvements in knowledge related to pain. Pain assessment and management strategies must continue to evolve and improve for nursing professionals to provide a high level of care to this patient population. The HRTI model provides an appropriate framework to gain insight into the pediatric oncology nursing role in the assessment, management, and evaluation of pain from childhood cancers. IMPLICATIONS FOR NURSING: Nurses play a vital role in pain assessment and management for children with cancer. The HRTI model can be used to identify areas of clinical practice, education, and research that require further improvements in relation to pain in children with CNS cancer.

High-dose methotrexate and primary central nervous system lymphoma.

Primary central nervous system lymphoma (PCNSL) is a rare disease that is managed differently from other primary brain tumors and other types of systemic lymphomas. The use of high-dose methotrexate (HD-MTX) has improved survival rates. This article describes the experience of a patient treated with HD-MTX and outlines the essential aspects of care for the bedside practitioner. An understanding of the diagnostic workup and principles of treatment can minimize complications and maximize patient function as nurses care for the unique physical and emotional needs of this population.

The role of radiation therapy in the treatment of central nervous system tumors.

OBJECTIVES: To provide an overview of the management of central nervous system tumors with radiation therapy. DATA SOURCES: Book chapters, research articles, and review articles. CONCLUSION: Radiation therapy plays a primary role in the treatment and management of primary and metastatic central nervous system tumors. Radiation therapy may be administered in several modalities with either curative or palliative intent. IMPLICATIONS FOR NURSING PRACTICE: A general understanding of the treatment of central nervous system tumors with radiation, and the management of potential side effects can help to provide optimal care and improved quality of life for the patient.

Caring for patients with central nervous system metastases.

Metastatic disease of the central nervous system (CNS) is devastating. For some patients it is the first indication that they have cancer. For others with controlled systemic disease, it is the realisation that the cancer is back. This group of patients generally has a poor prognosis and, if possible, they need to understand that the treatment on offer is being prescribed for symptom control and not cure or to prolong their survival. Nurses need to provide clear and accurate information to patients and families so they can make an autonomous decision about the proposed treatment or, indeed, plan future care.

Acquired immunodeficiency syndrome-related lymphoma.

OBJECTIVES: To discuss the presentation, treatment, and aggressiveness of acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin's lymphoma and AIDS-related primary central nervous system lymphoma, and to address the differences of these lymphomas in the human immunodeficiency virus (HIV)-negative individual. DATA SOURCES: Published review articles, clinical studies, and abstracts pertaining to HIV and AIDS-related lymphomas. CONCLUSIONS: Many believe that as the therapies and supportive care for HIV-positive individuals improve, the incidence of malignancy in this patient population will continue to increase. Great controversy exists surrounding the most effective therapies for AIDS-related lymphomas. These patients should be entered into clinical trials to test appropriate hypotheses and answer the remaining questions. IMPLICATIONS FOR NURSING PRACTICE: As the HIV epidemic continues and HIV-associated malignancies increase, the nurse must understand the co-morbidity associated with both diseases. Oncology nurses play many roles in caring for this patient population and their support and intervention contribute to the response of the patient.

Central nervous system metastases.

OBJECTIVES: To review current management of individuals with metastases to the central nervous system and brachial nerve plexus, and to provide a scientific basis for nursing management of the effects of the disease and treatment. DATA SOURCES: Published articles, book chapters, clinical trial data, and experience from nursing literature. CONCLUSIONS: Central nervous system metastases are events that may create oncologic emergencies with neurologic impairment and pain. Treatment of patients with central nervous system metastases is generally palliative regardless of the type of the primary cancer. Early diagnosis and treatment improve the chances for optimal recovery of neurologic function and pain management. IMPLICATIONS FOR NURSING PRACTICE: Central nervous system metastases may develop in patients with systemic disease. Disease and treatment effects present challenges to patients, family, and care providers. Nurses have a responsibility in educating the patient/family and in providing supportive care.

Anatomy of the central nervous system.

OBJECTIVES: To provide an overview of central nervous system anatomy. DATA SOURCES: Published books and articles. CONCLUSIONS: Classification of tumors, location of primary and metastatic tumors, and initial and progressive symptoms are best understood within a solid knowledge base of neuroanatomy. IMPLICATIONS FOR NURSING PRACTICE: It is essential for nurses caring for neuro-oncology patients to be familiar with normal central nervous system anatomy. This knowledge will enable them to anticipate symptoms, response to treatment, and prognosis for recovery. Understanding of the effects of central nervous system tumors on the function of the central nervous system will help nurses provide holistic care to both patients and significant others.

Radiation therapy in tumors of the central nervous system.

OBJECTIVES: To review the role of radiation therapy in the management of primary tumors of the central nervous system (CNS). DATA SOURCES: Book chapters, review articles, and research studies. CONCLUSIONS: Radiation therapy plays an important role in the management of primary and metastatic tumors of the CNS. Radiation and surgery are combined with curative intent for low-grade tumors. Cranial radiation may be used to prevent brain metastases, and palliative radiation may be used to alleviate symptoms. IMPLICATIONS FOR NURSING PRACTICE: Helping patients with tumors of the CNS and their family members understand the anticipated side effects of the disease and the therapeutic goals of radiation therapy may help to alleviate anxiety and maintain an optimal quality of life during therapy.

HIV infections of the central nervous system. What are the nursing implications?

HIV disease attacks people without regard to age, race, gender or socioeconomic status, and the number of people affected continues to increase. The increased incidence of disease and increased length of survival will lead to a rise in HIV-related CNS syndromes. CNS involvement adds to the complexity of the disease and necessitates involvement of many disciplines. The nurse is responsibility for facilitating and coordinating the multidisciplinary team effort. The nurse must also be an advocate to provide access to beneficial services and to develop services that are not in place. The task of nursing is to assist the person living with AIDS to maintain his or her quality of life however they wish to define it.

Psychological care of neuro-oncology patients and their families.

This article examines the psychological needs of neuro-oncology patients and their families and presents two case histories which illustrate the way in which patients and their families can be brought to terms with their situations through skilled nursing intervention.