Getting patients active: Using national data to drive practice

Data from a National Cancer Institute–designated comprehensive cancer center taking part in the ONS Foundation–supported Breast Cancer Care Quality Measures Set pilot study revealed a lack of interventions recommended for patient-reported symptoms of fatigue. A team was formed to address the issue using the steps of the evidence-based practice process and to implement practice changes. This article describes the barriers and challenges faced, in addition to the integration of exercise resources into patients’ plans of care. The authors describe the curriculum for staff education regarding the practice change, implementation of an evidence-based fatigue assessment and interventions, and methods to integrate these resources into patient care

Perspectives of Childhood Cancer Symptom-Related Distress: Results of the State of the Science Survey

Management of symptom-related distress is an important area of pediatric oncology nursing. Participants who attended the Children’s Oncology Group (COG) State of the Science Symposium on symptom distress completed an anonymous survey. The purpose was to explore participant perceptions of symptom distress experienced by children receiving cancer treatment on clinical trials, determine how symptom distress is currently assessed at COG institutions, and to identify what interventions are used to reduce symptom distress for these children. Among the 90 symposium attendees, 72% completed the survey, the majority (92%) of whom were nurses. The five most distressing symptoms in children with cancer enrolled on clinical trials identified by survey respondents were nausea/vomiting, fatigue, pain, anxiety, and sleep disturbances. Results from our survey also suggest that symptom distress may differ by disease type. For example, symptoms associated with leukemia/lymphoma included steroid side effects, procedural pain, and neuropathy. The majority of respondents (90%) also reported that symptoms go unrecognized by health care providers. The most commonly described unrecognized symptoms were behavioral (i.e., sadness, anxiety, fear, depression, and emotional needs; 45%) and fatigue (19%). Key focus areas reported by respondents included informal and inconsistent symptom assessment, the need for uniform measurement tools, and improved documentation of symptom-related distress. Management of symptom-related distress is an important aspect of pediatric oncology nursing. Further exploration of symptom distress experienced by children with specific types of cancers, and the development of standardized symptom assessment processes, will provide a foundation for developing future interventions aimed at alleviating symptom-related distress

Creative arts therapy improves quality of life for pediatric brain tumor patients receiving outpatient chemotherapy

This mixed methods pilot study evaluated the effects of the creative arts therapy (CAT) on the quality of life (QOL) of children receiving chemotherapy. A 2-group, repeated measures randomized design compared CAT with a volunteer\u27s attention (n = 16). Statistical analysis of the randomized controlled phase of the study suggested an improvement in the following areas after the CAT: parent report of child\u27s hurt (P =. 03) and parent report of child\u27s nausea (P =. 0061). A nonrandomized phase, using a different instrument showed improved mood with statistical significance on the Faces Scale (P \u3c. 01), and patients were more excited (P \u3c. 05), happier (P \u3c. 02), and less nervous (P \u3c. 02). Provider focus groups revealed positive experiences. Case studies are included to exemplify the therapeutic process. With heightened interest in complementary therapy for children with cancer, future research with a larger sample size is needed to document the impact of incorporating creative arts into the healing process. © 2010 by Association of Pediatric Hematology/Oncology Nurses

Long-term follow-up of children treated for high-grade gliomas: Children\u27s Oncology Group L991 final study report

Purpose: High-grade gliomas of the CNS are characterized by poor treatment response and prognosis for long-term survival. The Children\u27s Oncology Group (COG) L991 study investigated the neuropsychological, behavioral, and quality of life (QoL) outcomes after treatment on the Children\u27s Cancer Group (CCG) trial for high-grade gliomas (CCG-945). Patients and Methods: Fifty-four patients (29 males, 25 females) with a median age of 8.8 years at diagnosis (range, 0.2 to 19.5 years) were enrolled at 25 institutions in North America, representing 81% of available survivors; median length of follow-up was 15.1 years (range, 9.5 to 19.2 years), and median age at study evaluation was 23.6 years (range, 11.3 to 36 years). Standardized tests of neuropsychological functioning and QoL were performed. Descriptive statistics summarized principal findings, and one-way analysis of variance identified potential predictors of outcomes. Results: With an average follow-up time of 15 years, survivors demonstrated intellectual functioning within the low-average range. Executive functioning and verbal memory were between the low-average and borderline ranges. In contrast, visual memory and psychomotor processing speed were between the borderline and impaired ranges, respectively. Approximately 75% of patient reported overall QoL within or above normal limits for both physical and psychosocial domains. Nonhemispheric tumor location (midline or cerebellum), female sex, and younger age at treatment emerged as independent risk factors. Conclusion: These results serve as a benchmark for comparison with future pediatric high-grade glioma studies, in addition to identifying at-risk cohorts that warrant further research and proactive interventions to minimize late effects while striving to ensure survival. © 2012 by American Society of Clinical Oncology

Reducing pain in children with cancer : Methodology for the development of a clinical practice guideline

Although pain is one of the most prevalent and bothersome symptoms children with cancer experience, evidence-based guidance regarding assessment and management is lacking. With 44 international, multidisciplinary healthcare professionals and nine patient representatives, we aimed to develop a clinical practice guideline (following GRADE methodology), addressing assessment and pharmacological, psychological, and physical management of tumor-, treatment-, and procedure-related pain in children with cancer. In this paper, we present our thorough methodology for this development, including the challenges we faced and how we approached these. This lays the foundation for our clinical practice guideline, for which there is a high clinical demand