Pediatric Nursing Demystified

Staging

More than 70% of cases are found after metastasis has occurred (stage

III or IV).

Prognosis is poor because of late discovery.

Survival inversely related to age with higher survival (75%) for infants

<1 year of age and less (50%) if >1 year of age.

Stage IV-S localized tumor with spread to liver, skin, and bone marrow

but without metastasis to bone presented in very young infant may have

good prognosis for cure.

Spontaneous regression may be noted.

Treatments

Surgical removal of tumor is treatment of choice.

Chemotherapy to shrink tumor before surgery or as main treatment with

metastasis.

• Preferred agents:
  Vincristine
  Cisplatin
  Teniposide
  Cyclophosphamide
  Carboplatin
  Doxorubicin
  Ifosfamide
  Etoposide
  With addition of bone marrow transplant or peripheral stem cell rescue,
  survival rate to 10 to 20% in infants >2 years of age.
  Radiotherapy for late-stage tumor and for emergency management of
  spinal compression by large tumor; palliative treatment of bone, lungs,
  liver, or brain.

Nursing Interventions

Support child during treatments:

• Provide antiemetic and appetite stimulant.


• Offer foods after antiemetic takes effect.


• Allow to eat any food that is tolerated; avoid forcing food during
  nausea episode.
  Support parents and family with coping and with grieving process, when
  indicated:


• Expect stages of grief, with anger expression.


• Help parents work through feeling of guilt related to late diagnosis
  and feelings earlier action should have been taken.
  Assess for adequate nutritional intake:


• No weight loss.


• Lab work reveals protein levels within normal range.

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CHAPTER 8/ Oncology Conditions^167