Thursday, September 13

Thursday, September 13

4:45 – 5:45 pm

Pediatric Cancer Predisposition: What the Clinician Needs to Know (206)

1CNE  Precision medicine has emerged with the advancement of genetic technologies and knowledge of molecular pathogenesis. A clinical translation of precision medicine in pediatric oncology lies in hereditary cancer predisposition syndromes, which plague approximately 10% of patients and families. Proper identification of these patients, appropriate genetic testing and counseling, and an understanding of short-term treatment implications and long-term screening protocols are all essential to comprehensive care for patients and families with cancer predisposition syndromes. Current knowledge of pediatric cancer predisposition syndromes, referral and identification, and treatment and long-term follow up will be discussed. Moreover, a case series and easy reference tools for clinical practice will be presented.

4:45 – 5:45 pm

Iron Overload: Implications in Hematology, Oncology, and HSCT Patients (207)

1CNE Iron is a vital mineral which is essential for life. Humans obtain iron through ingestion in foods where absorption is tightly regulated. Iron is bound to transferrin for transport due to the ability of labile plasma iron to cause oxidative damage to tissues and organs. Iron loss occurs through desquamation of the small intestine and menses in women and equals 1–2 mg Fe/day, similar to absorption. Blood transfusions are a lifesaving therapy for hematology patients as well as oncology and hematopoietic stem cell transplantation (HSCT) patients. Anemia, a common side effect of cancer and chemotherapy, used to be treated with erythropoietin stimulators until concerns were raised about their effect on tumor growth. Blood transfusions are a safe, readily available method to increase patient’s hemoglobin and can be done easily in the outpatient setting. However, each unit of blood contains 200–250 mg of iron which is released as the transfused blood cells break down.

4:45 – 5:45 pm

DNR, DNET, DNI: The Alphabet Soup of Resuscitation (208)

1CNE  Caring for infants, children, adolescents, and young adults through the end of life is challenging. "Getting the DNR" is terminology that many nurses are used to hearing; they may even be the ones asking for clarification of "code status" as their patients come closer to the end of their lives. This presentation will clarify definitions and abbreviations commonly used including DNR, AND, and DNET, and the meaning these terms have for the hematology/oncology team, patients, and families. How we talk with families will be reviewed, including discussions of data, what we are not going to do, and asking them to make impossible decisions. Finally, suggestions for discussing goals of care and recommendation and the role of hope will be discussed and practiced.

4:45 – 5:45 pm

Low Dose Ketamine Use in the Non-ICU Setting for Pediatric Hematology and Oncology Pain (209)

1CNE  Managing severe pain in children, adolescents, and young adults with oncologic malignancies and sickle cell disease present a challenge to members of the multidisciplinary team. Traditional pain treatment strategies rely primarily on opioid analgesia (Wang, 2015) in addition to complementary therapies to provide comfort. Despite these interventions, many patients report inadequate pain control and adverse effects. These side effects can range from tolerable (pruritis) and dose-dependent (constipation) to life-threatening (respiratory depression, sedation). Refractory pain is a common reason for hospital readmission in this patient population, specifically in patients with sickle cell disease or patients being treated at the end of life. Ketamine, a dissociative anesthetic used for sedation, has traditionally been administered in the operating room or in an intensive care unit (ICU) setting with stringent monitoring parameters. In patients with persistent pain despite traditional analgesic interventions, adjuvant therapy with low-dose ketamine infusions have proven beneficial (Hagedorn, 2016). Low-dose ketamine infusions are associated with opioid-sparing effects, improved pain management, and improvement in the child's ability to interact with their family (Finkel, 2007).