Leukemia in Children

Leukemia in Children

Introduction

Childhood leukemias are malignant disorders of the bone marrow and lymphatic system in which genetic abnormalities give rise to a proliferation of cells causing disruption of normal marrow function and, ultimately, resulting in marrow failure. Education about childhood leukemia involves teaching parents and other family members about the child's specific leukemia diagnosis, common symptoms, diagnostic tests and treatments, prescribed medication regimens, potential adverse effects, symptom management, and nutrition. Emphasis is placed on safety considerations and strategies for coping with the complexities of the child's care. A variety of learning and motivational activities (e.g., face-to-face instruction, written materials, videos, demonstrations and return demonstrations) can be utilized when teaching parents and families about childhood leukemia. Education about childhood leukemia begins in the hospital or physician's office and continues in a pediatric cancer center or home care setting. Education about childhood leukemia can be given by healthcare professionals (e.g., nurses, physicians) and should not be delegated to assistive clinical staff.

Desired Outcome When Teaching Parents

Teaching parents and other family members about childhood leukemia can allow them to understand the child's specific leukemia diagnosis, potential symptoms, typical clinical course, and overall prognosis. Realistically consider the risks and benefits of treatments (e.g., bone marrow or stem cell transplantation, irradiation, splenectomy) and prescribed medication regimens (e.g., I.V. or intrathecal chemotherapy), and participate in shared decision-making about their use. Build confidence and skills necessary for caring for a child who has leukemia (e.g., careful monitoring for potential symptoms, providing adequate nutrition) actively participate in practices intended to promote safety and decrease risk (e.g., bleeding precautions such as avoiding unnecessary roughness and sharp objects, strategies to minimize risk of infections such as avoiding crowds and raw foods, safe handling of blood and body fluids affected by chemotherapeutic agents) cope with the psychosocial and emotional aspects of living with childhood leukemia.

Education about childhood leukemia is provided to improve the parents' and other family members' knowledge and skills related to the child's specific leukemia diagnosis, to emphasize safety measures and the importance of prompt reporting of symptoms, and to guide them in coping with immediate and long-term complexities of care. Patient education is required by The Joint Commission (TJC). In 2004, TJC integrated the required patient education elements and standards throughout their accreditation manual instead of keeping them collected in a designated chapter.

Facts

Fewer than 5% of children with ALL have central nervous system (CNS) involvement, while nearly 20% of those with AML have CNS involvement. Use of intrathecal therapy has significantly reduced the incidence of relapse in these patients (Groben, 2011). Although the cure rate for ALL is ~ 80% in developed countries, cure rates in developing nations are often limited to < 35% (Groben, 2011, 1480-1485).

Discussion

Childhood leukemias are classified as acute or chronic and according to the affected cells. Leukemia in childhood primarily consists of acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), and juvenile myelomonocytic leukemia (JMML). For example, ALL, the most common form, occurs when there is a rapid development of ...