Examining Existential Distress in Adolescents with Advanced Cancer (205-3)

The life-threatening nature of advanced cancer has many psychosocial effects on both the patient and the family. Adolescents are mature enough to understand death and to have developed life goals, yet are also experiencing a period of distinct developmental challenges and psychosocial dynamics. As a result, existential distress may be highly significant and uniquely experienced by adolescents with advanced cancer. Existential distress and its impact on symptom management, suffering, and other patient outcomes have not been well-studied in adolescents with cancer.

This purpose of this paper is to analyze the concept of existential distress, highlighting and raising awareness of how existential distress may impact adolescents with advanced cancer and their families

 

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Prior Authorization: Where was that in Nursing School? (207-1)

The world of healthcare has been dominated by discussion about COVID-19 over the past 2 years. At the same time, the field of pediatric hematology-oncology has continued to move forward with new therapies which offer hope for enhanced outcomes, specifically in the field of precision medicine. The topic that is not often recognized in those discussions is the growing complexity of payment for these therapies, as well as therapies that have been considered “standard” for many years. Nurses may be seeing increased requirement to participate in discussions about the cost or prior authorization of medications for their patients. In addition to these requirements, third party payors have growing expectations for prior authorization. At the same time, there are more third-party payor options on the market for families to choose, and unfortunately, some families are choosing plans that may not provide adequate coverage. The political climate has changed, as well, and the individual mandate for coverage, which was originally a part of the Affordable Care Act, was rescinded. New legislation has now created the No Surprises Act, which requires up-front estimate of the cost of care for specific situations. There was a time when care was scheduled as expected, and there was no need to worry about prior authorization, but in today’s world, nurses are likely hearing more and more about the status or need for “approval” of care in advance. This session will provide an overview of what pediatric hematology-oncology nurses may be experiencing as a part of daily operations in the care of these patients and families. An evolving model of multidisciplinary involvement to assure timely care in the face of growing third party payor expectations will be shared. Read more...

Onco-Critical Care 101 (209-2)

Pediatric Oncology nurses are frequently exposed to patients with oncologic emergencies and who become critically ill requiring transfer to the PICU. They are familiar with conditions requiring transfer but happens to these patients while they are in the PICU? When the patient is transferred back to the regular oncology floor or presents back in clinic, it is helpful for the nurse to know what happened to their patient in the PICU. Common oncology critical care interventions such as CRRT, vasopressors, respiratory support, ect are largely unfamiliar to oncology nurses but can be helpful to understand for post PICU care and in situations where care must be initiated by the nurse on the floor. This presentation will cover the basics of Oncology Critical Care including recognizing oncologic emergencies that should trigger transfer to PICU and how these conditions are treated once the patient is in the PICU. Read more...

CBD, THC, GVH, MMJ: Practical Ways to Make Sense of the Alphabet Soup (203)

Many pediatric oncology patients report medical marijuana (MMJ) and hemp-based CBD use. Hemp is now federally legal under the Farm Bill since December 2018 and hemp-based cannabinoid products are widely available. Research focused on cannabis and its’ use in oncology, hematology, and bone marrow transplant is continuing to grow. A study in Israel looks at adding cannabis to the treatment of graft versus host disease following bone marrow transplant. Read more...

Using Their Own Words: AYA Cancer Patients as Influencers in COG Clinical Trials (C216)

Adolescent and young adult (AYA) cancer patients continue to be a conundrum for providers, researchers, and health care systems. Previous challenges for AYA oncology care have been identified as delayed diagnosis, lack of insurance, limited clinical trial availability and enrollment, tumor biology, unique toxicity profiles, distinct psychosocial issues, and more. While there has been advancement in the treatment of AYAs with cancer, there is a paucity of information about how that treatment impacts the AYA cancer patient’s life, both during treatment and beyond. Read more...

General Session: State of Nursing: Pediatric Hematopoietic Stem Cell Transplantation: A Glimpse of the Past, Current State, a Glance of the Future (102)

Over the last 60 years, significant advances in in hematopoietic stem cell transplantation (HSCT) has provided improvements in effective treatment or cure and overall survival for many patients. There has been considerable HSCT progress and success in a variety of pediatric malignant and non-malignant diseases. This state of the science presentation will be providing the evolution and current and future highlights of Pediatric HSCT as it relates to disease conditions, stem cell sources, conditioning regimens, cellular immunotherapy, toxicity related treatments and supportive care. Read more...

Strategies in Survivorship Care: Addressing Current Long-term Follow-up Surveillance Gaps Through Individualized Survivorship Care Plans And Specialty Survivorship Clinics (234) 

With current 10-year survival rates greater than 80% for pediatric, adolescent, and young adult (AYA) cancer patients there exists and ever-increasing population of pediatric and AYA cancer survivors. Pediatric and AYA survivors who finish cancer-directed treatment are often burdened with significant risks for long-term complications. This includes risks of secondary cancers and accelerated development of usual age-related comorbid conditions such as heart failure, kidney disease and osteopenia. Given these risks, cancer survivors require specialized health care monitoring and surveillance. The Childhood Cancer Survivor Study has identified significant, suboptimal adherence to COG screening guidelines for secondary malignancies (breast, colorectal, and skin) and cardiac disease amongst this high-risk population. Many survivors and their caregivers also report that they feel uninformed yet worried about potential late effects. This current gap emphasizes the importance of individualized survivorship care post cancer treatment, both short and long term.

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Renewed Hope for the Future: Menin Inhibitors for Relapsed/Refractory Leukemia (233)

Prognosis for pediatric patients and adolescents with multiple relapsed/refractory leukemia remains grim. Many have received relapsed protocols, CAR-T therapies, stem cell transplants and yet, the disease returns. In the past, the next discussion in this patient population would lead towards palliation and quality of life, with little hope for cure. Recent advancement in therapy for children with refractory leukemia has introduced the use of menin inhibitor in patients with KMT2A/MLL and NPM1 mutations, providing a number of young patients with another chance of remission and a chance at a cure. Read more...

Nutritional Support: Best Practices for Pediatric Blood and Marrow Transplant Patients (226)

Nutrition is vital for children to grow and thrive. This is especially important in children with conditions requiring blood and marrow transplantation (BMT) who receive prolonged, intensive therapy requiring optimal overall health and nutritional status (Baumgartner, 2017). Chemotherapy is associated with nausea, vomiting, diarrhea, poor appetite, taste changes, mucositis, and increased catabolic demands (McMillen et al., 2020). Malnutrition rates in the pediatric oncology/BMT population range from 6 to 50% (McMillen et al, 2020), and this can have significant consequences. Read more...

You Deserve to Preserve: A Proposal to Offer Fertility Preservation to All Eligible Pediatric Oncology Patients (221)

Fertility preservation, the opportunity to preserve one’s ability to have genetically-related children prior to damaging or destroying the reproductive system, is a young but rapidly expanding field. Historically, fertility preservation has only been available to postpubertal male and female cancer patients via oocyte, embryo, and sperm cryopreservation. Read more...