Preconference Courses (Wednesday, September 12)

Each pre-conference course is an extra-fee event that is available to APHON members only and requires an additional application in order to enroll. Please click on each course title to view the full description and access the appropriate application form.

10 am – 4 pm

Leadership Series: Inspirational Leadership and Taking Care of You! (002)

5CNE  Do you ever feel like your career is stuck in a rut? These engaging and inspirational sessions target this dilemma by generating professional momentum and maximizing leadership opportunities. The Leadership Course sessions are designed to remind nurses why they chose nursing and to inspire them to face each day with passion and purpose. It has been said that “You only have one chance to make a good first impression.” This is true! Etiquette competency has the potential to make or break a career. You will learn how to handle awkward and challenging situations that could diminish your confidence, tarnish your reputation, and derail your career aspirations. In addition, you will also learn how to modify your personal and professional lives to handle numerous decisions and demands that can lead to an unbalanced life.

Preconference Workshops (Thursday, September 13)

Each pre-conference course is an extra-fee event. Please click on each course title to view the full description.

8:15 am – 11:45 am

Creating a Pediatric Hematology/Oncology Manuscript to Submit for Publication in a Nursing Journal (003)

3.25CNE  Increasing numbers of pediatric oncology nurses are completing advanced degrees, including the DNP and PhD. These nurses are advancing nursing discipline, science, evidence, and clinical practice by publishing their scholarly work. The experience of publishing in a professional nursing journal can be confusing and overwhelming to both novice and seasoned authors.
8:15 am – 11:45 am

Consulting, Arranging and Referring: How to Create the Connections Needed for a Successful CAR T Patient Experience (004)

3.25CNE  Leukemia is the number one cause of pediatric cancer mortality. In addition, there are poor outcomes for second and greater relapses of ALL, so there is a need for new novel therapies (Novartis, 2015). Chimeric antigen receptor-engineered T cells (CAR T cells) have yielded unprecedented efficacy in B cell malignancies, most remarkably in anti-CD19 CAR T cells for B cell acute lymphoblastic leukemia (B-ALL) with up to a 90% complete remission rate. (Wang, Wu Han, 2017). Because CAR-T therapy success can be contingent on factors such as disease burden and previous therapy, communication between referring and referral centers to facilitate rapid consultation is essential.

8:15 am – 11:45 am

The Self-Care Connection: Resiliency, Health, and Wellness (005)

3.25CNE  While the caring professions reap an abundance of benefits in the realms of compassion satisfaction and relationship building, they are also at risk for a multiplicity of professional pitfalls, such as moral distress, vicarious trauma, compassion fatigue, and burnout. Oftentimes individuals fail to make the connection between self-care and professional satisfaction. This workshop will discuss the importance of resiliency and self-care through lecture, hands-on activities and reflection.

8:15 am – 11:45 am

Bone Marrow Transplant for Hematology Patients: Caring for the Patient from Diagnosis to Long Term Follow Up (006)

3.25CNE  There are an increasing numbers of patients with hematologic transplant as a curative therapy, for previously life-threatening and life-limiting diagnosis. There continues to be advancement in this area on options available to patients to allow for overall increased survival and improved outcomes. With these new advancements, there presents a challenge to manage these patients effectively pre- and post-transplant to improve outcomes and survival. This presentation will provide an overview of transplant for hematology patients, which will include indications for transplant, criteria to qualify for transplant, pre- and post-transplant considerations (infectious, social, etc.), an overview of medications specific to hematologic conditions prior to transplant; types of transplants used, hematologic specific complications pre- and post-transplant, long-term follow up considerations in the post-transplant patient, and new and emerging therapies in the hematology patient and transplant.

8:15 – 11:45 am

Integrative Medicine in Pediatric and Adolescent Oncology: An Overview for the Nurse and Nurse Practitioner (008)

3.25CNE  The journey through cancer therapy is complex. While no two patients experience it the same way, there are predictable similarities when considering patient age, diagnosis, and therapy that is administered. Common problems encountered by many patients include diminished energy and physical stamina, neuropathy, disturbed sleep, poor appetite, weight loss, and exaggerated nausea.

Integrative medicine combines mainstream medical therapies with complementary therapies for which there is high quality scientific evidence of safety and effectiveness. In the setting of active treatment for children and adolescents with cancer, it consists primarily of complementary therapies intended to support general health or to limit specific treatment related toxicity. Numerous modalities may fall within this category, including dietary modification, nutrient and botanical supplements or applications, guided imagery, aromatherapy, acupuncture, and massage. It is estimated that 30–70% of pediatric patients use integrative medicine strategies; since this is by parental report, many studies likely underestimate their use.

2 – 3:15 pm

Opening Keynote: Never Ever Give Up! (101)

1CNE  Erik Rees has dedicated himself to empowering people to find and fulfill their purpose in life. During this session Never Ever Give Up! Erik will share the story if his eleven-year-old daughter, Jessie, and her inspiring tale of spreading joy to other kids fighting cancer and encouraging them to never ever give up or "NEGU" while battling an inoperable and incurable brain tumor (DIPG). If you have faced a hurdle in life and thought about giving up, don’t miss this opportunity to be encouraged and inspired by Jessie’s daddy, Erik Rees, to NEGU. You will not only walk away inspired but receive practical tips to stay encouraged to NEGU no matter what you face at work or in life!

Erik Rees
3:30 – 4:30 pm

Going Viral: Review of Viral Illness and Antiviral Therapy in Hematopoietic Stem Cell Transplant Pediatric Patients (200)

1CNE  Hematopoietic stem cell transplant (HSCT) recipients are at significant risk for developing serious and sometimes fatal infectious complications. Common viral infections post-transplant occur from reactivation of a dormant virus, including herpes simplex (HSV), Varicella (VZV), cytomegalovirus (CMV), BK virus and Ebstein Barr Virus (EBV). Immunocompromised patients may also experience significant morbidity and mortality from common respiratory viruses, such as influenza, parainfluenza, adenovirus, and respiratory syncytial virus (RSV). Interventions vary greatly and can include prophylaxis, preemptive therapy or treatment of active infection. A variety of antiviral agents are now used including cellular immune therapy. A pharmacologic review will show that antiviral agents often have different dosage schemes, complex side effect profiles, and the need for supportive care.

3:30 – 4:30 pm

Management of Retinoblastoma in 2018: A Nursing Perspective (201)

1CNE  Retinoblastoma (RB) is the most common primary ocular malignancy of young children. Approximately 8,000 children are diagnosed with RB worldwide annually. If caught early RB can be cured, preserving life, vision, and the eye(s). At our institution, the treatment of retinoblastoma has evolved dramatically over the past decade. Utilization of focal therapies has transformed our treatment algorithms, patient outcomes and nursing care; our RB overall survival exceeds international rates. Localized treatments include chemotherapy administered directly into the eye via the ophthalmic artery or intra-vitreously, laser photocoagulation, cryotherapy, and, in cases of very advanced eyes, plaque brachytherapy or enucleation.

3:30 – 4:30 pm

Introduction to Radiation Therapy: What Should a Nurse Know? (202)

1CNE  Radiation therapy is an integral component of the overall management for many children with cancer. Better understanding of radiation therapy will improve the ability of nurses and advanced practice providers to care for these children. Review will include the underlying mechanisms of radiation in treating cancer and provide an overview of the common clinical indications for radiation. The presentation will provide an overview of the radiation planning and treatment process including dosing and fields using several case studies of children with different diagnoses. Common acute toxicities and management approach will be covered. Finally, common late effects and recommended follow-up care will be discussed.
3:30 – 4:30 pm

Putting the Horse before the CAR–T! Educating Nurses on Algorithms to Recognize Cytokine Release Syndrome and CAR–T Related Encephalopathy Syndrome (203)

1CNE  Chimeric antigen receptor (CAR) therapies, recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of hematologic malignancies in pediatric and adult populations, offer remarkable promise for patients with previously treated-refractory disease. Kymriah™, the first FDA-approved agent for the treatment of children and young adults up to 25 years of age with relapsed or refractory B–cell acute lymphoblastic leukemia, demonstrates an overall remission rates 83%. Significant, potentially life-threatening toxicities accompany these promising outcomes, most notably cytokine release syndrome (CRS) and CAR–related encephalopathy syndrome (CRES). Early identification and strategic management of symptoms are critical to support positive patient outcomes. An interprofessional team developed evidence-based algorithms for the diagnosis and management of CAR therapy-related toxicities.

3:30 – 3:50 pm

Paper Presentation: Supporting Parents Across the Treatment Continuum — Reasons, Hopes, Risks, Expectations: Qualitative Interviews of Parents Consenting to Genomic Sequencing for their Child (204-1)

1CNE  Basis of inquiry: Genomic sequencing is rapidly being incorporated into care for patients diagnosed with cancer. Little is known about why parents of children with cancer consent to sequencing and how they understand and weigh the risks, benefits, and uncertainty inherent in testing.

Purpose/Objectives: This qualitative inquiry was part of the Genomes 4 Kids study which included somatic and germline sequencing in a cohort of 301 prospectively identified pediatric oncology patients with leukemias, central nervous system (CNS), or non-CNS solid tumors treated at St. Jude Children’s Research Hospital. The aims of this aspect of the study were to identify reasons for participation given by parents enrolled in the larger study and perceived risks, benefits, expectations, and hopes.

3:50 – 4:10 pm

Paper Presentation: Supporting Parents Across the Treatment Continuum — Change in Genetic Knowledge of Parents Consenting to Clinical Genomic Sequencing for their Child with Cancer Following a Two-Phase Consent (204-2)

1CNE  Basis of inquiry: During informed consent, providers often present information in a complicated manner and may not differentiate between standard cancer treatment and the research objectives of a clinical trial. While clinical genomic sequencing is complex, it is important to understand how parental genetic knowledge may influence future decisions, including study participation and comprehension of test results. To increase parental understanding, this study utilized a two-phase consent process.

Purpose/Objectives: Evaluate change in parental genetic knowledge at the completion of a two-phase consent process.

4:10 – 4:30 pm

Paper Presentation: Supporting Parents Across the Treatment Continuum — Adding a Parent to the Brain Tumor Team: Evaluation of Peer Support Intervention for Parents of Children with Brain Tumors (204-3)

1CNE  The physical and neurocognitive symptoms of childhood brain tumors present profound challenges to patients and families. Parents and caregivers of children diagnosed with brain tumors experience numerous stressors due to the complexities and uncertainties associated with treatment, long-term effects, and risk of relapse (Hutchinson, Willard, Hardy, & Bonner, 2009). To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support to parents of children with brain tumors from a Veteran Parent (VP). A mixed-methods, cross-sectional study was designed to evaluate the effectiveness of this intervention utilizing validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not.

3:30 – 4:30 pm

Are Your Patients with Advanced Cancer Suffering? A Nurse-Led Study Utilizing Technology to Measure Symptoms (C205)

coglogo1CNE  Nurses and nurse practitioners have the opportunity to be at the forefront of supportive care research using current technology. Through collaboration between the COG Nursing Research Subcommittee and Alex’s Lemonade Stand Foundation, a mentored nursing grant funded a multisite study investigating how children with advanced cancer experience symptoms. Minimizing suffering, including effective symptom management, in children with advanced cancer is a central value for pediatric oncology clinicians (Nuss et al., 2005). Patient-reported outcomes have been used in pediatric oncology symptom-related research (Baggot et al., 2012); however the majority of literature specific to symptoms during palliative or end-of-life care for children with advanced cancer is based upon medical record reviews and to a lesser extent, patient self–report (Hinds et al., 2007; Wolfe et al, 2015). The study purpose was to prospectively describe symptom frequency, severity, and distress level in children and adolescents with advanced cancer using patient self-report and parent proxy.

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).

4:45 – 5:05 pm

Paper Presentation: Engaging Patients and Providers in the Research Process — Engaging Children and Healthcare Providers in the Co-Design of a Mobile, Technology-Based Symptom Assessment App (210-1)

1CNE Basis of inquiry: Mobile technology supports child-centric approaches to symptom reporting by incorporating game-based features to support children in reporting symptoms.

Purpose/Objectives: We describe the development of a child-centric symptom assessment app using school-age children (6–12 years) receiving treatment for cancer and pediatric oncology healthcare providers as co-designers. 

5:05 – 5:25 pm

Paper Presentation: Engaging Patients and Providers in the Research Process — KAM: Kids are Moving—An Exercise Program for Children with Cancer (210-2)

1CNE  Basis of inquiry: During cancer treatment, children are significantly less active than their healthy peers. Inactivity persists into survivorship, negatively influencing health and quality of life. Children with cancer report that fatigue is one of the most distressing, treatment-related symptom impacting their quality of life; yet children with increased physical activity (PA) have less fatigue. In this study, we sought to evaluate if children could decrease their level of fatigue over the trajectory of treatment by increasing their physical activity.

5:25 – 5:45 pm

Paper Presentations: Engaging Patients and Providers in the Research Process — The Influence of Pediatric Oncology Summer Camp Attendance on Physical Activity, Fatigue, and Oxidative Stress (210-3)

1CNE  Basis of Inquiry: Childhood cancer patients and survivors are less physically active and report increased fatigue. Improved physical activity may reduce fatigue. Over 130 summer camps serve pediatric oncology patients and survivors. Camps promote physical activity and offer a unique opportunity to explore the relationship between physical activity and fatigue.

Purpose: This study was conducted to determine if summer camp attendance increased physical activity in childhood cancer patients and survivors and how physical activity interacts with fatigue. An exploratory aim was to examine changes in oxidative stress which is hypothesized to impact fatigue.

Methods: A repeated measures study design was utilized. Accrual of 60 children over 2 years planned (data collection ends June 2018).

Eligibility: (a) 8–17 years; (b) English speaking; (c) current diagnosis or history of cancer; (d) willingly wear physical activity monitor daily x 2 weeks (beginning 7 days before camp); (e) complete surveys and provide urine samples x 2; (f) attend a 6 day Oncology Summer Camp (g) no neurological disorders/syndromes; (h) without physical limitations. Physical activity was reported as steps/day and intensity level as minutes/day. Oxidative stress measured as urine isoprostane. Paired t-test were conducted to examine change in scores for the Pediatric PROMIS measures, steps/day and isoprostane levels. Pearson’s r was used to calculate correlation coefficients.

Findings/Outcomes: Thirty children enrolled in year 1.

Demographics: 57% male; 70% Caucasian, 20% Asian, 7% African American; 77% off therapy; 40% Leukemia/Lymphoma, 20% Solid tumors, 20% CNS tumors, 20% Unknown. Mean steps/day increased during camp by 7709 (p < .001; 95% CI; 6209 to 9210). Fatigue (p=0.47), anxiety (p=.021) and depression (p=.005) all decreased during camp. Weak non–significant negative correlation, in first 24 samples, between change in oxidative stress and physical activity (r = –.144; p=.50).

Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.

4:45 –5:45 pm

A Tale of Two MABs: Blinatumomab and Inotuzumab in COG Clinical Trials for Relapsed B ALL (C211)


1CNE  Survival for pediatric patients with relapsed B lineage acute lymphoblastic leukemia (ALL) is sub-optimal. Traditionally, treatment protocols for relapsed ALL have relied on cytotoxic chemotherapy. Despite substantial acute and long-term toxicity, there has been no significant improvement in survival in patients treated on these protocols over the past several decades. Chemoresistance is commonly cited as a reason for treatment failure. Treatment failure is defined as either the inability to achieve clinical remission post-relapse or a subsequent relapse following traditional therapy that includes intensified chemotherapy with or without stem cell transplant. The ideal therapy would be the use of a cellular targeted approach that destroys leukemia cells but spares other cells and improves response and survival while minimizing distressing and sometimes life-threatening toxicities. Early phase clinical trials with the synthetic antibodies Blinatumomab (BiTE) and Inotuzumab (INO) have shown great promise in achieving clinical response in heavily pre-treated pediatric and adult patients with relapsed and refractory ALL. This session will detail the targeted approach of these novel antibodies and their unique mechanisms of action: Blinatumomab modulates the immune system to destroy cancer cells, while Inotuzumab provides a link to deliver cytotoxic treatment directly to the cancer cell. These two novel agents will be compared, including their reported efficacy from early phase trials, toxicity profiles, and administration principles. Highlights from the current COG clinical trials AALL1331 and AALL1621 will be reviewed, with a focus on the uniqueness of each trial, including phase type and eligibility criteria. Additionally, AALL1331 has been activated since December 2014, providing an opportunity to share clinical examples and practical tips regarding the nursing care of patients receiving Blinatumomab.

7:15 – 8:15 am

Roundtable: How to Begin Nursing Research (RT8)

Roundtable discussions will take place in the networking area of the exhibit hall. Roundtable leaders will facilitate substantive discussions exploring various professional development topics with small groups of attendees in a more personal and interactive format. Attend this roundtable discussion to learn more about how to begin nursing research.
7:15 – 8:15 am

Roundtable: Challenges of CPHON® Certification (RT7)

Roundtable discussions will take place in the networking area of the exhibit hall. Roundtable leaders will facilitate substantive discussions exploring various professional development topics with small groups of attendees in a more personal and interactive format. Attend this roundtable discussion to learn more about the challenges of CPHON® certification.
7:15 – 8:15 am

Roundtable: Evidence Based Practice Projects (RT4)

Roundtable discussions will take place in the networking area of the exhibit hall. Roundtable leaders will facilitate substantive discussions exploring various professional development topics with small groups of attendees in a more personal and interactive format. Attend this roundtable discussion to learn more about evidence-based practice projects.
7:15 – 8:15 am

Roundtable: Establishing an Independent Nurse Practitioner Practice (RT2)

Roundtable discussions will take place in the networking area of the exhibit hall. Roundtable leaders will facilitate substantive discussions exploring various professional development topics with small groups of attendees in a more personal and interactive format. Attend this roundtable discussion to learn more about establishing an independent nurse practitioner practice.
7:15 – 8:15 am

Roundtable: Fertility Preservation (RT1)

Roundtable discussions will take place in the networking area of the exhibit hall. Roundtable leaders will facilitate substantive discussions exploring various professional development topics with small groups of attendees in a more personal and interactive format. Attend this roundtable discussion to learn more about fertility preservation.
9:45 – 10:45 am

General Session: Oral Medicine for Pediatric Hematology/Oncology Nursing (102)

1CNE  Pediatric hematology/oncology nurses are responsible for the comprehensive care of children with diverse and complex medical conditions, including both non-malignant and malignant diseases. For reasons related to both underlying disease pathology as well as treatment-related toxicities, this unique patient population is at risk of developing a wide spectrum of oral complications that can significantly impact patients.

8:15 – 9:15 am

Town Hall: APHON Pediatric Chemotherapy and Biotherapy Instructors (TH1)

1CNE  More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to APHON Pediatric Chemotherapy and Biotherapy Instructors.
8:15 – 9:15 am

Town Hall: Inpatient Nursing (TH2)

1CNE More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to inpatient nursing.
8:15 – 9:15 am

Town Hall: Outpatient Nursing (TH3)

1CNE More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to outpatient nursing.
8:15 – 9:15 am

Town Hall: Outpatient APN (TH5)

1CNE  More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to outpatient APNs.
11:00 am – Noon

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.

11:00 am – Noon

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.

11:00 am – Noon

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.

7 – 10 pm

APHON After Dark Party (OE1)

Optional event image

Join your fellow APHON Colleagues for a charming evening along the banks of the Savannah River on the river lawn of the Westin Savannah Hotel for our APHON after Dark Event. Make some lifelong memories at an unforgettable night of dancing, entertainment and much more! You do not want to miss it!

11:00 am – Noon

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.

11:00 – 11:20 am

Paper Presentation: Assessing Symptoms and Symptom Trajectories — Symptom Trajectories among Adolescents during Hematopoietic Stem Cell Transplantation (216-1)

1CNE  Basis of inquiry: Symptom management is major role of pediatric hematopoietic stem cell transplant (HSCT) nurses and a thorough understanding of symptom experiences is needed. Symptoms are complex and their frequency, severity, and distress change over time. Research is needed to identify symptoms over time (trajectories) among adolescents undergoing HSCT.

The aim of this study was to describe symptom trajectories including symptom frequency, severity, and distress among adolescents from pre-HSCT to 100 days post HSCT.

11:20 – 11:40 am

Paper Presentation: Assessing Symptoms and Symptom Trajectories — Effect of Proton Therapy on Patient Reported Health-Related Quality of Life and Symptoms in Patients with Craniopharyngioma (216-2)

1CNE  Basis of inquiry: Craniopharyngioma is a brain tumor located near the hypothalamic-pituitary axis. Surgery and conventional photon-based radiation therapy result in long term tumor control; however, survivors are known to have disruptions in patient sleep, endocrine and neurocognitive function, as well as health related quality of life (HRQOL). Proton therapy is a newer form of radiation therapy. Little is known about its effect on patient–reported HRQOL and symptoms when used in the management of craniopharyngioma.

Purpose/Objectives: To describe patient-reported HRQOL and symptoms before and during proton therapy in patients with craniopharyngioma.

11:40 am – Noon pm

Paper Presentation: Assessing Symptoms and Symptom Trajectories — Assessment Tools for Peripheral Neuorpathy in Pediatric Oncology Patients: A Systemic Review (216-3)

1CNE  Chemotherapy agents used for the treatment of pediatric cancer cause many side effects including peripheral neuropathy. Using appropriate assessment tools to accurately identify peripheral neuropathy is an important part of pediatric oncology care. A systematic review was performed to determine reliable assessment tools to identify peripheral neuropathy in children receiving vincristine.

Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.

11:00 am – Noon

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.

12:15 – 1:30 pm

Annual Business Meeting and Awards Lunch (BUS)

Join your fellow members for a lively lunch and hear what's new from APHON leaders at our Annual Business Meeting. Be a part of the celebration as we recognize the hard work of your peers during our annual awards presentation.

Please note that while this optional event is included in the conference fee, selecting the event on the registration form is required to attend. Space is limited. 

3:15 – 4:15 pm

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.

3:15 – 4:15 pm

Evidence-Based Practice & Research Grant and Award Recipients Session (RA)

1CNE  More informal in nature than our concurrent sessions, our Evidence-Based Practice & Research Grant and Award Recipients Session provides 2018 grant and award recipients the opportunity to present their project plans and gain insight from participants as they embark on their projects.
3:15 – 4:15 pm

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.

3:15 – 4:15 pm

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.

3:15 – 4:15 pm

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).

3:15 – 3:35 pm

Paper Presentations: Professional Practice Issues — Moral Distress Among Pediatric Oncology Nurses: A National Sample (222-1)

1CNE  Because of the unique nature of nurse-patient relationships and the role of the nurse, nurses are routinely put into situations that expose them to the development of moral distress. Moral distress has been identified as the psychological disequilibrium, negative feeling state, and suffering experienced when nurses make a moral decision and then either do not or feel that they cannot follow through with their chosen course of action. This session will describe results of a mixed-methods study of APHON members, examining moral distress and its relationship to prognosis-related communication.

Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.

3:35 – 3:55 pm

Paper Presentations: Professional Practice Issues — Nurse-Patient Connectedness and Nurses’ Professional Quality of Life: Experiences Volunteering at a Pediatric Oncology Camp (222-2)

1CNE  Nurses working in pediatric oncology can experience unique stressors that are both professionally and personally demanding. Many pediatric oncology nurses volunteer with their local oncology camp, where there are unique opportunities for shared experiences between nurses and cancer patients/survivors outside of the clinical setting. In this session, we present findings from a mixed methods study exploring the impact of volunteering at an oncology camp on pediatric oncology nurses’ professional quality of life.

Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.

3:55 –4:15 pm

Paper Presentations: Professional Practice Issues — Evidence-Based Interprofessional Palliative Care Education: Lessons for Pediatric Oncology Clinicians (222-3)

1CNE  Basis of inquiry: Clinician education and expertise in palliative care varies widely across pediatric oncology programs, creating disparities in accessing and delivering much needed services to children and their families. Providing interprofessional, onsite team training, as well as institution-wide support for ongoing palliative care education is critical to improving quality of life for pediatric oncology care recipients.

Purpose/Objectives: To describe an evidence-based practice approach for delivering comprehensive interprofessional palliative care education for pediatric oncology clinicians.

3:15 – 4:15 pm

Beyond the Cure: The Children’s Oncology Group’s Efforts to Improve Outcomes for Pediatric Cancer Patients Long after Treatment has Finished (C223)

coglogo1CNE  Childhood cancer survivors are living longer than ever before, with overall survival rates exceeding 80%. As a result, survivors also are living with chronic late health effects related to their curative treatments, with 40% of survivors experiencing a severe, disabling, and life-threatening or fatal late effect at 30 years post-treatment. Late effects may include second malignancies, endocrinopathies, cardiomyopathy, infertility, pulmonary function deficits, renal/ocular/auditory disorders, neurocognitive deficits, and metabolic syndrome. Recent studies report that cumulative incidence of late effects may be even higher than previously reported, with survivors having 3 to 5 treatment-related chronic health conditions by the age of 50.

5:30 – 6:30 pm

General Session: Social Media and Nursing......Where are we now? (103)

1CNE  In today’s world, social media has become a prominent form of communication, networking, and social interaction. As access to these platforms of communication and information expand, so must our understanding of the benefits and impact on the delivery of healthcare. As patient advocates, nurses have an obligation to explore the current climate and prevalence of social media use and its impact on patients, families, and the entire healthcare team.

7:00 – 8:15 am

Strengthening the Local Chapters of APHON through Shared Experiences (LCM)

1CNE  The Local Chapter Committee Liaisons and Chapter Leaders will convene to discuss topics such as fundraising, community service, education, and recruitment and retention that affect the functioning of Local Chapters. These will be discussed in a round table manner and then presented to the whole group. Attendees will be able to take this knowledge back to their local chapters and continue forward thinking momentum, recruitment of new members, retain seasoned members, and implement a variety of fundraising and community projects for pediatric hematology and oncology families. APHON members interested in starting a new chapter will be exposed to the “Getting Started” process and a new bylaws mentoring round table will be added. All liaisons will be able to network with their local covered chapters to discover any potential issues and helpful knowledge in navigating rules and requirements for local chapters. We will discuss how to reformat and include innovative measures in the strategy meeting to encourage participation from new and seasoned members and to meet National APHON vision and goals.

9 – 10 am

Town Hall: Sickle Cell (TH8)

1CNE  More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to sickle cell.
9 – 10 am

Town Hall: Challenges of Opioid Prescribing Under New Federal Guidelines (TH10)

1CNE  More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to the challenges of opioid prescribing.
9 – 10 am

Town Hall: Stem Cell Transplant (TH11)

1CNE More informal in nature than our concurrent sessions, our Town Hall sessions give attendees the opportunity to engage in a lively discussion with industry experts covering the hottest topics in pediatric hematology/oncology. Attend this town hall to participate in discussions related to stem cell transplant.
10:15 – 11:15 am

General Session: Communicating with Adolescents at End of Life: Ethical Dilemmas and Practical Solutions (104)

1CNE  Background: Discussing advanced illness and end-of-life with adolescents and young adults (AYAs) is difficult due to complexities of family and medical systems, developmental issues and the challenges of addressing grief of patients, families, and staff. Ethical dilemmas often present as barriers to good palliative communication.

11:30 am – 12:30 pm

Impact of Donor Selection in Hematopoietic Stem Cell Transplant Outcomes (224)

1CNE Hematopoietic stem cell transplant (HSCT) is an important therapeutic option for children with malignant and nonmalignant disease. Over the past 50 years, there has been an increasing number of indications for HSCT. Human leukocyte antigen (HLA) matched related donors offer the best outcome and frequently donors are siblings that are children. Haploidentical and unrelated donors have expanded the pool of donors. Improved HLA typing and posttransplant supportive care has improved the outcome of HSCT from alternative donors. The American Academy of Pediatrics published a statement regarding pediatric patients undergoing HSCT. The policy recommended new standards that had significant impact on both pediatric stem cell transplant physicians and parents. Choosing the appropriate donor depends on the patient and donor’s degree of HLA matching, sex, parity, blood type, CMV status, HLA directed antibodies, and the health of the donor.

11:30 am – 12:30 pm

Connecting Fun with Purpose: Interactive Teaching Strategies to Improve Bedside Care (225)

1CNE  The complex field of pediatric hematology/oncology truly demands clinical expertise of the bedside nurse to safely care for patients. Nurse educators are challenged more than ever to provide education in the classroom that will translate to meaningful application at the bedside (Curran, 2014). Current literature promotes learner preparation prior to class coupled with in-class interactive learning to apply and solidify knowledge (Galway, Corbett, Takaro, Tairyan, & Frank, 2014; Vujovic, 2016).

11:30 am – 12:30 pm

Comprehensive Care for Thalassemia (226)

1CNE  Thalassemia is becoming a more common diagnosis seen in pediatric hematology/oncology centers. The term thalassemia describes a group of very complex diseases that requires thorough, comprehensive care to improve outcomes and quality of life for these patients. A complicating factor is that patients often are immigrants or refugees with language and cultural barriers and other socioeconomic issues. The care of these patients require a multidisciplinary approach and a strong understanding of the pathophysiology, specific complications, current treatments, and new and emerging therapies.

11:30 am – 12:30 pm

Therapeutic & Prognostic Impact of Medulloblastoma Molecular Subgroups (227)

1CNE  Medulloblastoma is an embryonal tumor of the central nervous system (CNS). It is the most common malignant CNS tumor in children with peak incidence between 5–9 years of age. Patients typically present with cerebellar deficits and headaches with vomiting, specifically in the mornings. Prognosis varies according to multiple factors including histology, age at diagnosis, and metastases. Medulloblastoma treatment is an intense, multi-modality therapy that can have many resulting late effects. Recent findings have shown medulloblastoma to be a heterogeneous disease which includes multiple subgroups.

11:30 am – 11:50 am

Paper Presentations: Clinical Care Issues — Use of a Clinical Care Pathway for the Evaluation and Treatment of Children with Acute Chest Syndrome (228-1)

1CNE Acute chest syndrome is the leading cause of death and hospitalization among patients with sickle cell disease. Nurses have an important role in providing prompt evaluation and treatment of the child with acute chest syndrome. Evidence-based clinical care pathways are recommended to improve quality of care and to help reduce the length of hospitalization. This presentation will review the development of a standardized clinical care pathway which includes recommendations for management, diagnostic work up, and treatment strategies.

11:50 am – 12:10 pm

Paper Presentations: Clinical Care Issues — Implementation of an Inpatient Oncology Resource Nurse to Standardize and Improve Chemotherapy Admission Workflow (228-2)

1CNE  Basis of inquiry: Our 32-bed inpatient oncology unit identified delays in initiating chemotherapy for scheduled patients. With an increased census and tightened staffing ratios, the chemotherapy admission process became increasingly inefficient. These delays resulted in frustration for both patients and healthcare providers.

Purpose/Objectives: The aim of this project was to devise and evaluate a more efficient and consistent admission process through the use of a resource nurse. We sought to develop a workflow to deliver “on time” chemotherapy, defined as prior to shift change at 7 pm. This would reduce delays and increase satisfaction of patients, families, and providers.

12:10 – 12:30 pm

Paper Presentations: Clinical Care Issues — Improving Patient Identification Practices in a Central American Pediatric Cancer Hospital (228-3)

1CNE  Participants will identify the nurse’s unique role in promoting a culture of safety and continuous quality improvement through the implementation of a correct patient identification quality improvement project in a Central American pediatric cancer hospital.

Disclaimer: [1 CH] will be awarded for attending all three paper presentations presented during this timeslot. Partial credit is not available.

11:30 am – 12:30 pm

COG Clinical Trials: Empowered Nurses the Key to their Success (C229)

coglogo1CNE  In pediatric oncology, clinical trials are conducted to improve survival rates, understand disease biology, and prevent or improve management of treatment-related acute and long-term side effects. The majority of children newly diagnosed with cancer in North America are treated on Children’s Oncology Group (COG) clinical trials. In the last 50 years clinical trials in pediatric oncology have increased the overall 5-year survival rate from under 10% to over 80% today. Nurses are an integral part of the success of these trials.

2:15 – 3:15 pm

DSRCT: A Pediatric Oncology Rarity (230)

1CNE  Desmoplastic small round cell tumor (DSRCT) is one of the rarest pediatric tumors and was only recently classified in 1989. Categorized under sarcomas, DSRCT under the microscopic is a fusion of a both a wilms and ewing sarcoma gene. Although known as a mostly surgical tumor, chemotherapy, radiation, and new treatments like immunotherapy are vital in the battle against this fatal disease. DSRCT is known mostly in the adolescent and young adult population, where the rate of occurrence is predominantly in males. In a retrospective cohort analysis published in 2014 from the Journal of Cancer Epidemiology, the 5-year survival rate was found to be just 33.3% (Lettieri, Garcia-Filion, Hingorani, 2014). Factors impacting survival rate are the overall oncology role to treatment and management.

2:15 – 3:15 pm

Transfusions in Pediatric Hematology/Oncology Patients: As Easy As ABO (231)

1CNE  Transfusion of blood products is an essential part of caring for children with benign hematologic disorders, malignant diseases, and those undergoing hematopoietic stem cell transplants. One challenge in pediatric patients is the broad age range for patients that span from neonates to young adults. Recent studies have shown that there is a wide variability in practice among pediatric programs in the indications for transfusions, CMV prevention, and management of patients who become refractory to transfusions.

2:15 – 3:15 pm

They Just Don’t Get It! Unconscious Bias in Caring for Children with Cancer and Blood Disorders (232)

1CNE  Caring for a child with serious illness, especially when cure is uncertain, may be one of the most difficult and yet most rewarding experiences for all members of the healthcare team. This presentation examines how unconscious bias, or our personal “blind spot”, from the perspectives of the hematology/oncology team, family members, and palliative care team interferes with the ability of the to accept and integrate palliative care for children with high-risk and advanced hematologic or oncologic diagnoses.

2:15 – 3:15 pm

Patient and Family Education for Newly Diagnosed Pediatric, Adolescent, and Young Adult Oncology Patients: Development of an Interdisciplinary Education Roadmap (233)

1CNE  The education of newly diagnosed pediatric, adolescent, and young adult (AYA) oncology patients and their caregivers is a critical component of successful oncology care. Patient education affects patient safety, timeliness and cost of care, treatment and research compliance, and the patient and family experience. Successful delivery of patient education is challenging because of the complex medical content conveyed, logistical challenges of healthcare delivery across multidisciplinary service lines (e.g. inpatient v. outpatient with providers from medicine, nursing, psychology, social work), and patient and family variables that impact health and access to care (e.g. language, health literacy, coping skills, family and community support, insurance, financial stability, housing, transportation).

2:15 – 3:15 pm

Are You an APN Searching for COG Supportive Care Guidelines? COG Guideline Development/Endorsement Process with Practical Applications (C234)

coglogo 1CNE Since the 1970s survival rates for most types of pediatric cancer have continued to improve, with about 80% of patients now expected to become long-term survivors. However, this incredible success requires intensive treatments that are often associated with significant acute and long-term side effects. These side effects of pediatric cancer therapy can negatively impact a patient’s symptom experience and quality of life. Lack of effective symptom management can potentially impact outcomes through delays in proven curative treatments, dose reductions, and patient nonadherence to the treatment plan.

3:15 – 4:30 pm

Closing Keynote: Nurses Caring For Nurses: Changing the Culture of Nursing (105)

1CNE  In my 40+ years in nursing, I watched the nursing culture change, in some ways positively, in some ways, negatively. The negative changes I see worry me because they will not help us address important and challenging issues in the future, nor will they enhance the professional practice of nursing. Webster’s Dictionary defines “culture” as “ways of dressing, thinking, talking and acting...” and “the ideas, language, actions, and behaviors that define a given people.” When people look at nurses today, what do they see? When they listen to us talk, what do they hear?