The Child with Cancer

Cancer is a group of conditions characterized by uncontrolled cell growth that goes unchecked by the immune system. Cancer can be broadly classified as hematologic or blood-borne cancers, and solid tumors.

Hematologic cancers, such as acute lymphoblastic leukemia, acute myeloid leukemia, and Hodgkin lymphoma, arise from immature blood cells or lymphatic cells.

In these cancers, the continued uncontrolled multiplication of immature cells interferes with the development and function of healthy blood and lymphatic cells.

On the other hand, solid tumors develop from specific organs. These tumors can arise in the bones, like osteosarcoma; the kidneys, like nephroblastoma; or in the colon, like colon cancer.

Regardless of the type, cancer is typically caused by genetic mutations altering cell division. Diagnosis involves a history; physical assessment; laboratory tests such as a CBC; diagnostic imaging, like MRI; and diagnostic procedures, like lumbar puncture or bone marrow biopsy.

Treatment depends on the type and staging and can include surgery, chemotherapy, biotherapy, radiation therapy, and hematopoietic stem cell transplant.

While treatment aims to destroy cancerous cells, it also destroys non-cancerous cells leading to undesired side effects in your patient.

Now, when caring for a child with cancer, you’ll manage the side effects of cancer treatment. Chemotherapeutic agents and radiation therapy to the head or abdomen can cause GI side effects, like nausea and vomiting, which may cause your patient to eat or drink less.

Given these side effects, you’ll monitor their nutritional status, weight, intake and output, and signs of dehydration. Also, remember to administer the prescribed antiemetic medications, and implement nonpharmacologic interventions for your patient, like distracting them through playing with toys or encouraging them to talk with their friends.

To support their nutritional status, encourage your patient to drink fluids like Pedialyte to replace fluids and electrolytes, and to eat small, frequent meals throughout the day.

Also be sure to teach your patient and their caregivers ways to increase their caloric intake, such as using full-fat dairy products, adding tofu to meals to increase protein, and eating snacks like trail mix, peanut butter, and dried fruit.

If oral intake isn’t possible, administer enteral or parenteral nutrition as prescribed. You may also need to consult the registered dietitian and child life specialist as needed.

Next, assess for oral ulcers. These may appear as red or eroded lesions in your patient’s mouth, and they can make it difficult to chew and swallow food.

If oral ulcers develop, administer the prescribed solutions such as sucralfate to coat the ulcers before eating. Also, perform oral hygiene at least every four hours as well as before and after eating, using mouth rinses with baking soda and salt, or solutions like chlorhexidine.

Since oral ulcers are tender and painful, try using a soft sponge toothbrush instead of a regular toothbrush for oral care.

If your patient resists a toothbrush, which is common with infants and toddlers, try wrapping gauze moistened with water or saline around your finger to gently cleanse their mouth.

You can also suggest bland, moist and soft foods, like yogurt or pudding, that are less irritating. Your patient may experience alopecia, or hair loss.

Be sure to discuss this with them as well as their caregivers to allow time to adapt; and use developmentally appropriate aids as needed, like dolls, stuffed animals, or pictures.

Explain that hair often falls out in large clumps and let them know that some patients often choose to cut their hair short or shave their head before hair loss begins.

Be sure to provide them with information on obtaining a wig if they’re interested and stress the importance of wearing a head covering in sunny or cold weather to protect their scalp.

Advise them that hair typically regrows in about three to six months but may return as a different color or texture than before.

Alright, now cancer treatment can also lead to extremely low white blood cells counts, which increases your patient’s risk of infection.

Because of this risk, monitor your patient for fever, which is a temperature of 101°F or 38.3°C or higher. If a fever develops, notify the health care provider and evaluate your patient for potential sites of infection, such as puncture sites or skin tears.

The health care team may also ask you to collect laboratory specimens to send for culture, prepare your patient for a chest x-ray, and administer antibiotics.

Then, teach your patient and their caregivers ways to prevent infection. Emphasize the importance of routine dental care, staying updated on vaccinations, and diligent hygiene practices, such as bathing and oral care.

Also, be sure to involve your pediatric patient in infection prevention by teaching them to wash their hands for as long as it takes for them to sing happy birthday twice.

Advise patients and their caregivers that their health care provider will monitor their absolute neutrophil count, or ANC, which measures the number of neutrophils, or infection-fighting white blood cells, in their body.

Teach them to avoid crowded areas if their ANC drops below 500/mm3 and to work closely with their school or daycare to be notified of infectious disease exposures.

Alright, as a quick recap… Cancer is a group of conditions characterized by uncontrolled cell growth and is classified as either a hematologic cancer or solid tumor.

Diagnosis of cancer involves a history and physical assessment, laboratory tests, diagnostic imaging, and procedures. Treatment options can include chemotherapy, biotherapy, radiation therapy, and hematopoietic stem cell transplant.

Since cancer treatment destroys not only cancerous cells but also non-cancerous cells, it can lead to unwanted side effects.

Nursing care for the pediatric patient with cancer and their caregivers involves assessing for and managing side effects, such as nausea and vomiting, oral ulcers, alopecia, and fever, as well as providing education regarding infection