Chapter 44: Pediatric Cancer Nursing Care

While childhood cancer is relatively rare, it is identified as the leading cause of disease-related death after infancy in the United States, with survival rates having improved significantly to over 80 percent due to advancements in multimodal therapy. The text establishes that pediatric cancers differ from adult varieties because they are rarely linked to lifestyle factors; instead, they often stem from genetic predispositions, congenital anomalies, or chromosomal alterations. Diagnostic protocols are detailed, involving laboratory analysis of blood counts, imaging like MRI and PET scans, and invasive procedures such as bone marrow biopsies and lumbar punctures to detect metastasis. The chapter outlines the primary treatment pillars: surgical resection, radiation, and complex chemotherapy regimens, while also introducing cutting-edge biotherapies like CAR T-cell immunotherapy and precision medicine. A major focus is placed on nursing management of treatment-induced side effects, including myelosuppression—which leads to infection, anemia, and hemorrhage—as well as nausea, mucositis, and nutritional deficiencies. The discussion also prioritizes recognizing oncologic emergencies such as tumor lysis syndrome, which involves dangerous metabolic shifts like hyperkalemia, and superior vena cava syndrome. Specific malignancies are examined in depth, including acute lymphoblastic leukemia (the most common childhood cancer), Hodgkin and Non-Hodgkin lymphomas, brain tumors categorized by their location above or below the tentorium, and solid tumors like neuroblastoma and Wilms tumor. For Wilms tumor, the chapter emphasizes the critical nursing precaution of avoiding abdominal palpation to prevent tumor rupture. Additionally, bone cancers such as osteosarcoma and Ewing sarcoma are contrasted, highlighting limb-salvage versus amputation options. The chapter concludes by addressing the unique needs of survivors, who require lifelong monitoring for "late effects" involving cardiac, endocrine, or cognitive impairments resulting from their aggressive life-saving treatments.