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CANCER IN THE CLASSROOM : PROVIDING A SAFE ENVIRONMENT Lisa Bashore, PhD, RN, CPNP, CPON Life After Cancer Program.

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Presentation on theme: "CANCER IN THE CLASSROOM : PROVIDING A SAFE ENVIRONMENT Lisa Bashore, PhD, RN, CPNP, CPON Life After Cancer Program."— Presentation transcript:

1 CANCER IN THE CLASSROOM : PROVIDING A SAFE ENVIRONMENT Lisa Bashore, PhD, RN, CPNP, CPON Life After Cancer Program

2 OBJECTIVES  Review the various treatment modalities given to children and adolescents with cancer  Discuss how cancer treatment influences attendance and / or re entry into school  Evaluate how safe the school environment is for children and adolescents with cancer

3 CHILDHOOD CANCER Incidence by Diagnosis

4 Treatment  Surgery  Radiation  Chemotherapy  Biotherapy  Stem Cell Transplant  Alternative therapy

5 Chemotherapy  Affects rapidly dividing cells Hair GI tract Mucous membranes Bone marrow  Anemia  Thrombocytopenia  Neutropenia

6 CHEMOTHERAPY  Halts the growth of cancer cells  Affects normal cells as well Inability to differentiate between normal/cancer cells

7 CHEMOTHERAPY  Given in different routes  May dictate the extent of acute effects Orally Intravenously Intrathecally Intraosseous Intramuscularly

8 RADIATION  Delivery of high energy beams  Damage both cancer cells and normal cells Thankfully only in area radiated are normal cells affected  Given alone or in combination with chemotherapy

9 RADIATION  Given by different methods  Types: 3-dimensional conformal Intensity modulated Proton beam Stereotactic radiosurgery

10 BIOTHERAPY  Immunotherapy  Very targeted and used body’s immune system  Like Targeted minimizes damage to healthy cells

11 ALTERNATIVE THERAPY  Many can interfere with efficacy of treatment  Unsafe in general Reduce blood counts Have bacteria or fungi Unacceptable side effects

12  Massage  Probiotics Contains bacteria Could colonize the GI tract  St John’s Wort Bleeding potential Interaction with immunosuppressant's

13 COMPLEMENTARY  Yoga  Imagery  Art and Music Therapy  Meditation  Massage  Aromatherapy (??)

14 PALLIATIVE CARE  Provides symptom management throughout the continuum of care  Comprehensive, holistic care Physical, emotional, spiritual, social aspects of living with cancer

15 IMMEDIATE EFFECTS OF CANCER THERAPY

16 TREATMENT EFFECTS  Due to damage to normal cells/blood cells Marrow  All blood lines impacted Skin Mouth or whole GI tract Immune system

17 SIGNS, SYMPTOMS, AFFECTS  Fever (INFECTION)  Fatigue  Paleness  Easy bruising  Bone/joint pain

18 PANCYTOPENIA  Neutropenia: A White cell count < 1,000 with an Absolute Neutrophil Count (ANC) low Associated with infections ANC ValueRisk for Infection Less than 500Highest 500-1,000Moderate > 1,000Lowest

19  Thrombocytopenia Low platelets and risk for bleeding Normal: 150, ,000 High threshold in oncology

20  Anemia  Hemoglobin: Responsible for Oxygen transport to cells  Normal is g/dl depending on age  High threshold Symptom dependent

21 GASTROINTESTINAL EFFECTS  Nausea & Vomiting  Diarrhea  Dehydration  Constipation

22 OTHER  Stomatitis  Esophagitis

23 IMPACT ON THE CHILD  Short to extended hospitalizations Administration of therapy Infection management Recovery in-between

24 EMOTIONAL RESPONSE TO CANCER  Feelings of: Guilt Anger Sadness and loneliness Age / Developmental responses to cancer

25  Responses  1. Dependency  2. Regression of development  3. Inability to cope at all

26 DEALING WITH RESPONSES  School-Age Children IssuesSupporting the Child Being isolated (inpatient) Stay in touch (web, Skype), letters Visits from friends Loss of ControlAttendance at school Do school work

27  Teens IssueSupporting the Teen Body ImageAllow chance to talk about physical/emotional health Having feelings are normal Self EsteemPoint out positives Allow teen to do things – make them feel good

28 ATTENDING SCHOOL  Children on cancer treatment can/do attend school  Important for social development…NORMALCY  Good communication is KEY to safe and successful school environment

29 INFECTION PREVENTION  Germs exist…exposure happens  Good Hygiene Hand washing (frequently) Hand sanitizer Keep hands as clean as possible

30 VACCINES  Children with cancer CANNOT receive live vaccines  No specific recommendations for exposure to others  Best they are NOT exposed to others having just received live vaccines

31 INFECTION PREVENTION  NOT share pens, cups, utensils, etc…with the patient  NOT be near or in contact with the infected person  Education of parents of classmates

32 INFECTION PREVENTION  May be asked to avoid large crowds  Classmates can visit but not all together (1-2 at a time)  Child may be asked to eat restricted diet

33 RE-ENTERING SCHOOL  Notify parent if contagious diseases present  Offer rest times  Hand Hygiene  Offer gentle play options

34 SCHOOL INFECTION CONTROL POLICY  Classmates with: Fever Runny nose, cough Diarrhea Rash NOT play with child with cancer

35 Cont.  Wash hands after using bathroom  Have wipes handy for door knobs

36 HEALTHY SCHOOL ENVIRONMENT  Have emergency contacts handy  When to call: Fevers > 101 F Exposure to chicken pox Bleeding (active) Central line problems Not drinking or voiding sufficiently

37 Central Lines & Nursing Responsibility

38 IDENTIFYING CVL INFECTION  INSPECT SITE  LOOK FOR: REDNESS SWELLING DRAINAGE INCREASED PAIN/TENDERNESS

39 CLASSMATE RULE  Wash hands or use hand gel  Gentle play  Avoid close interaction if they don’t feel well  Treat the child like they always have

40 SUPPORTING THE CHILD  Encourage relaxed environment Wear a hat Take naps (leave class) Drink fluids Trips to rest room Snacks Indoors all times Changes rooms alone

41 SCHOOL AND EMOTIONS  May be hard to return Body changes and appearance  Visits from staff can reduce fears  May need special care Education support

42 EMOTIONAL SUPPORT  Children need to have a normal routine  Feel hopeful and good about future  Talk to classmates Changes in the child with cancer Myths about cancer

43  Encourage talking and provide support  They may need an emotional break  Treat them like others….NORMAL

44 SUMMARY  Children and adolescents with cancer are at risk for serious acute effects…including emotional turmoil  Children and adolescents with cancer may attend school when feeling well and physician approved  They need normalcy in a safe and healthy environment

45 QUESTIONS

46 Resources    

47 References  Association of Pediatric Hematology/Oncology Nurses. (2003). Foundations of Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review Course.  Association of Pediatric Hematology/Oncology Nurses. (2005). APON/PBMTC’s Foundations of Pediatric Blood and Marrow Transplantation: A Core Curriculum.  Kupst, M. J. (2009, October). Cancer Impact on the Child: Putting the Experience into Perspective. Presented at the Association of Pediatric Hematology/Oncology Nurses, Wisconsin.  Family Handbook for Children with Cancer


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