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What is supportive care and why is it important?
Journal of Pediatric Oncology Nursing Vol 17, No 3
July 2000
GUEST EDITORIAL
What Is Supportive Care and Why Is it Important?
T
REATMENT ADVANCES during the past 10 years have dramatically increased survival for children with cancer. More than 60% of children who are treated for cancer are now cured. However, at what cost to the patient has survival improved? Supportive care is a term that describes the side effects that are caused by chemotherapy and radiation. These side effects may be both physical and psychological in nature. Supportive care includes, but is not limited to, the treatment of emesis, nausea, depression, alopecia, oral complications, fatigue, and myelosuppression. These side effects adversely affect the patient’s quality of life and may interfere with ultimate treatment success if the symptoms require significant chemotherapy dose reduction. Although the pediatric oncology research groups maintain statistics on the incidence of side effects experienced while patients are on treatment protocols, comprehensive reviews of these incidences in the literature are scarce. However, one would expect an increase in the incidence of side effects to follow with the increasing intensities of the treatment regimens for pediatric malignancies. Furthermore, the shift in medical care to the outpatient setting makes it more difficult to assess the side effects that patients experience in the home. Tanghe, Evers, and Paridaens (1998) ex娀 2000 by Association of Pediatric Oncology Nurses doi:10.1053/jpon.2000.8164
amined the issue of symptom occurrence after chemotherapy. They measured the level of agreement between patient and nurse concerning symptom occurrence (189 adult oncology patients and 51 nurses). Nurses underestimated the incidence of symptoms reported by patients. Youngblood, Williams, Eyles, Waring, and Runyon (1994) compared the number of symptoms identified by 91 adult oncology patients with those documented in the patient’s medical record. The mean number of symptoms reported by the patient was significantly higher than that documented in the medical record (p ⫽ .001). Both of these studies show that patients are suffering more than we realize. Nurses are instrumental in assessing and managing treatment-related side effects. This issue of the Journal of Pediatric Oncology Nursing focuses on supportive care. It highlights selected side effects and adverse events and provides suggestions to improve their management and treatment. Kathy Forte and Thomas Abshire and Casey Hooke discuss agents that are vital to supportive care efforts: Hepzyme (Dade, Miami, FL), which is used to eliminate heparin in blood samples, and recombinant tissue plasminogen activator, which is used to clear occluded central venous access devices. Carol Rossetto and Julie McMahon provide a comprehensive review of transfusion practices, including nursing management of transfusion reactions and future trends in transfusion support. Assessment and management of
Journal of Pediatric Oncology Nursing, Vol 17, No 3 (July), 2000: pp 133-134
133
134
Guest Editorial
chemotherapy extravasation injury set the oncology nurse apart from other nurses, and these issues are reviewed by Elizabeth Kassner. Melody Brown Hellsten discusses obstacles that limit adequate pain management, as well as the impact of inadequate pain management on children and families. Andrea Bakke and Deborah King discuss the often forgotten aspect of caring for the emotional dimension of the child and family with cancer. Finally, but most importantly, we glimpse the patient’s perspective of chemotherapy side effects in this issue’s Roadmaps, written by Sonia Fuentes. Cancer treatment and supportive care are closely intertwined. Success in one area cannot be achieved without attention to the
other. Aggressive treatments designed to cure pediatric malignancies will not be tolerated by patients unless research studies to improve the treatment and management of the related side effects are undertaken. Children should be able to expect—and deserve—an optimal quality of life during cancer treatment. What is important about supportive care? The answer is everything! Jill E. Brace O’Neill, MS, RN-CS, PNP, CPON Guest Editor Coordinator of Clinical Research Children’s Hospital Boston, MA
References Tanghe, A., Evers, G., & Paridaens, R. (1998). Nurses’ assessments of symptom occurrence and symptom distress in chemotherapy patients. European Journal of Oncology Nursing, 2(1), 14-26.
Youngblood, M., Williams, P.D., Eyles, H., Waring, J., & Runyon, S. (1994). A comparison of two methods of assessing cancer therapy-related symptoms. Cancer Nursing, 17(1), 37-44.
July 2000
GUEST EDITORIAL
What Is Supportive Care and Why Is it Important?
T
REATMENT ADVANCES during the past 10 years have dramatically increased survival for children with cancer. More than 60% of children who are treated for cancer are now cured. However, at what cost to the patient has survival improved? Supportive care is a term that describes the side effects that are caused by chemotherapy and radiation. These side effects may be both physical and psychological in nature. Supportive care includes, but is not limited to, the treatment of emesis, nausea, depression, alopecia, oral complications, fatigue, and myelosuppression. These side effects adversely affect the patient’s quality of life and may interfere with ultimate treatment success if the symptoms require significant chemotherapy dose reduction. Although the pediatric oncology research groups maintain statistics on the incidence of side effects experienced while patients are on treatment protocols, comprehensive reviews of these incidences in the literature are scarce. However, one would expect an increase in the incidence of side effects to follow with the increasing intensities of the treatment regimens for pediatric malignancies. Furthermore, the shift in medical care to the outpatient setting makes it more difficult to assess the side effects that patients experience in the home. Tanghe, Evers, and Paridaens (1998) ex娀 2000 by Association of Pediatric Oncology Nurses doi:10.1053/jpon.2000.8164
amined the issue of symptom occurrence after chemotherapy. They measured the level of agreement between patient and nurse concerning symptom occurrence (189 adult oncology patients and 51 nurses). Nurses underestimated the incidence of symptoms reported by patients. Youngblood, Williams, Eyles, Waring, and Runyon (1994) compared the number of symptoms identified by 91 adult oncology patients with those documented in the patient’s medical record. The mean number of symptoms reported by the patient was significantly higher than that documented in the medical record (p ⫽ .001). Both of these studies show that patients are suffering more than we realize. Nurses are instrumental in assessing and managing treatment-related side effects. This issue of the Journal of Pediatric Oncology Nursing focuses on supportive care. It highlights selected side effects and adverse events and provides suggestions to improve their management and treatment. Kathy Forte and Thomas Abshire and Casey Hooke discuss agents that are vital to supportive care efforts: Hepzyme (Dade, Miami, FL), which is used to eliminate heparin in blood samples, and recombinant tissue plasminogen activator, which is used to clear occluded central venous access devices. Carol Rossetto and Julie McMahon provide a comprehensive review of transfusion practices, including nursing management of transfusion reactions and future trends in transfusion support. Assessment and management of
Journal of Pediatric Oncology Nursing, Vol 17, No 3 (July), 2000: pp 133-134
133
134
Guest Editorial
chemotherapy extravasation injury set the oncology nurse apart from other nurses, and these issues are reviewed by Elizabeth Kassner. Melody Brown Hellsten discusses obstacles that limit adequate pain management, as well as the impact of inadequate pain management on children and families. Andrea Bakke and Deborah King discuss the often forgotten aspect of caring for the emotional dimension of the child and family with cancer. Finally, but most importantly, we glimpse the patient’s perspective of chemotherapy side effects in this issue’s Roadmaps, written by Sonia Fuentes. Cancer treatment and supportive care are closely intertwined. Success in one area cannot be achieved without attention to the
other. Aggressive treatments designed to cure pediatric malignancies will not be tolerated by patients unless research studies to improve the treatment and management of the related side effects are undertaken. Children should be able to expect—and deserve—an optimal quality of life during cancer treatment. What is important about supportive care? The answer is everything! Jill E. Brace O’Neill, MS, RN-CS, PNP, CPON Guest Editor Coordinator of Clinical Research Children’s Hospital Boston, MA
References Tanghe, A., Evers, G., & Paridaens, R. (1998). Nurses’ assessments of symptom occurrence and symptom distress in chemotherapy patients. European Journal of Oncology Nursing, 2(1), 14-26.
Youngblood, M., Williams, P.D., Eyles, H., Waring, J., & Runyon, S. (1994). A comparison of two methods of assessing cancer therapy-related symptoms. Cancer Nursing, 17(1), 37-44.