Concurrent Sessions

11:00 am – Noon Friday, September 14

Managing Depression and Anxiety in Childhood Cancer (212)

1CNE  The period in which children are diagnosed with cancer and undergo treatment coincides with a time of critical physical, cognitive, behavioral, and social development. The mental health of children with cancer is particularly vulnerable due to the inherent uncertainties of the diagnosis, prognosis, therapy, and disruption of their daily lives. Psychiatric diagnoses such as anxiety and depression are often underdiagnosed, undertreated, and extend beyond the conclusion of cancer therapy. This presentation will address appropriate screening and assessment tools to enhance the pediatric oncology nurse’s comfort in identifying pathologic depression and anxiety, exploring treatment modalities such as psychotherapy, psychopharmacology (including appropriate dosing and monitoring), and when to refer patients for further care.

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11:00 am – Noon Friday, September 14

Starvation, Death, and Destruction: The Battlefield of AVN (213)

1CNE  Avascular necrosis (AVN) results from the temporary or permanent loss of blood supply to the bone and can lead to bone destruction, pain, and loss of joint function. Most hematology/oncology nurses are aware that corticosteroid exposure and older age are risk factors for the development of AVN in children treated for acute lymphoblastic leukemia. Are you familiar with other risk factors in children with oncologic disorders? Did you know that AVN of the femoral head is a common complication in children with sickle cell disease? While nonsurgical approaches may be appropriate in the early stages, surgical management is often required for more progressive disease. Through the use of interactive case studies we’ll review the common presenting signs and symptoms of AVN in children with both hematological and oncologic disorders, diagnostic workup and disease staging, and evidence-based management strategies.

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11:00 am – Noon Friday, September 14

Improving Access to Hematopoietic Cell Transplantation Clinical Trials for Patients with Sickle Cell Disease (214)

1CNE  Sickle cell disease (SCD), the most common inherited hemoglobin disorder in the U.S., affects nearly 100,000 people. Yet progress for advancing curative treatments such as hematopoietic cell transplantation (HCT) has been limited in part due to the shortage of clinical trial (CT) participation by individuals most affected. How to improve clinical trial participation for patients is the $1 million dollar question for many healthcare providers. Participants attending this session will be able to identify evidence-based strategies to enhance patients’ trust and increase HCT CT participation.

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11:00 am – Noon Friday, September 14

High Risk Therapy Made Easy: Supporting High Risk Patients Through Complex Therapy (215)

1CNE  High risk (HR) pediatric oncology patients continue to undergo new and emerging treatment protocols, which have multiple complications that patients may encounter. Accurate assessment and early interventions is key to supporting patients through therapy. This session will focus on supportive cares for relapse leukemia and HR neuroblastoma patients; with special focus on the immunotherapy drugs blinatumomab and dinutuximab as well as infection prophylaxis. Most frequent serious adverse events noted in patients treated with blinatumomab are disorders of the nervous system and systemic cytokine release syndrome (CRS). Events are usually reversible and able to be managed with attentive supportive care. Most frequent side effects noted in patient treated with dinutuximab are pain, hypersensitivity reactions, CRS, capillary leak, fevers, and hypotension. We will use case studies of HR patients.

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11:00 am – Noon Friday, September 14

Therapeutic and Supportive Care Protocols Paving the Way to a Brighter Future for Children with AML: Children’s Oncology Group Experience (C217)

coglogo1CNE  Acute leukemia is the most common malignancy in childhood and acute myeloid leukemia (AML) accounts for 15% of childhood leukemias. Survival for children with AML has improved, but overall survival is limited to 65%–70%. Improvement in survival for children with AML has been achieved by advances in knowledge contributed by various international cooperative group clinical trials. The majority of children newly diagnosed with AML in North America receive treatment on a Children’s Oncology Group (COG) clinical trial. The COG clinical trials for AML have investigated the role of risk stratification and intensification of therapy including the use of hematopoietic stem cell transplant. With the increase in intensity of chemotherapy, the COG recognized the limitations in delivering this therapy due to infection. Bacterial sepsis and invasive fungal infections are the leading cause of morbidity and treatment-related mortality in children receiving treatment for AML. To address this challenge, attempts to improve supportive care through COG’s Cancer Control trials have focused on prophylactic antibacterial and antifungal therapies.

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3:15 – 4:15 pm Friday, September 14

Never a Dull Moment: Latest and Greatest Clinical Pearls for the APN (218)

1CNE  Advanced practice providers (APP) are consistently challenged to have the most current information on diagnosis, treatment, therapy delivery strategies, adverse effects management, and nursing led research from throughout the trajectory of a disorder. The purpose of this session is to provide APP-specific education and networking related to the complexities of children diagnosed with a hematological or oncological disorder. First, a quick primer on how to read and interpret peripheral blood smears and bone marrow biopsies, which will help with initial diagnoses of hematology and liquid tumors. After an initial diagnosis is made, genomic profiling of both liquid and solid tumors is increasingly utilized to identify molecular targets. The role of the advanced practice nurse (APN) in the ordering and interpretation of these tests will be explained. Next, the intricate transition from identification of mutations to selection of mutational targets with current medications in brain tumors will be discussed. In addition, the monitoring and treatment of the complex side effect profiles will be reviewed.

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3:15 – 4:15 pm Friday, September 14

Running on Empty: Inherited Bone Marrow Failure (219)

1CNE Inherited bone marrow failure syndromes are a diverse group of hematologic disorders. Despite the name, some children have new, not inherited, genetic mutations. These mutations can result in congenital abnormalities or disease in specific organs or increased cancer predisposition. Through a series of patient vignettes we will follow six patients with common syndromes highlighting clinical presentation, diagnostic evaluation, and evidence-based treatment and monitoring recommendations. We also will explore the impact of a genetic diagnosis on the psychological and social well-being of families as the parents grapple with the decision whether to pursue genetic testing for themselves or their other children.

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3:15 – 4:15 pm Friday, September 14

PTLD: What's That About? (220)

1CNE Post-transplant lymphoproliferative disease (PTLD) is a major complication of solid organ transplantation. PTLD occurs in 2–15% of pediatric solid organ transplant (SOT) patients, depending on the organ transplanted and the immunosuppression used (Llaurador, 2017). The incidence of transplantation in pediatrics is steadily rising making PTLD the most common form of lymphoproliferation in childhood (Llaurador, 2017). Features of PTLD are similar to an immune system malignancy with abnormal proliferation of lymphoid lineage cells, typically B cells, in the setting of immunosuppression and often associated with EBV infection (Dharnidharka, 2017). Presentation and treatment choice covers a wide spectrum. The goal is to preserve the transplanted organ/graft while eradicating the lymphoproliferative disease. Most often the first intervention is reduction of immunosuppression (Dharnidharka, 2017) and is generally managed by the transplant team. Oncology providers become a prominent member of the multidisciplinary team for patients with more aggressive or disseminated disease.

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3:15 – 4:15 pm Friday, September 14

New Hope Through Clinical Trials in Low Grade Gliomas: From Diagnosis, Standard Treatment Modalities, to BRAF/MEK Inhibitors (221)

1CNE  Low grade gliomas (LGG) are the most common type of pediatric brain tumor (Jones et al., 2017). Depending upon tumor location, many patients undergo surgical resection. If a gross total resection is achieved, patients receive MRI imaging. However, patients who have an incomplete resection or a recurrence receive additional therapy. Young patients with developing brains receive chemotherapy. Older patients may receive radiation. There are multiple agents or combination of agents that are administered in patients with LGG. Standard frontline chemotherapies are either Carboplatin and Vincristine or TPCV (Thioguanine, Lomustine, Procarbazine, and Vincristine). Other traditional single-agent therapies include Temodar, Vinblastine, or Vinorelbine. BRAF/MEK inhibitors (trametinib, dabrafenib, vemurafenib, and selumetinib) are currently being used in clinical trials (Penman, Faulkner, Lowis, & Kurian, 2015).

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