course devoted exclusively to cancer nursing at Teachers College at Columbia University in 1947, oncology nursing was recognized as a specialty (Craytor, 1982). The first hospital unit dedicated to pediatric cancer opened in 1939 at Memorial Sloan Kettering Cancer Center. At that time, the nurses who cared for children with cancer were pediatric nurses who had no formal training in oncology. Care of a child with cancer was brief due to limited and unsuccessful treatments. Nursing care was focused on helping the child and family face the child’s certain death. Supportive care treatments were limited. Children were diagnosed most commonly with leukemia and often bled to death because of the unavailability of blood component therapies such as platelets and packed red blood cells. Intravenous therapies were temporary and difficult to administer; there were no central venous catheters or parenteral nutrition in that period. The nurse’s role focused on supporting nutritional needs (nurses themselves often cooked special foods for the child), assessing for the constant threat of infection, managing infections with limited antibiotics, and providing supportive care to the child and family. Struggling to prevent or treat infection with first-generation antibiotics involved working in a reverse isolation environment with patients who had fever and neutropenia. Children with cancer frequently died of overwhelming infection. As treatments for pediatric cancer evolved, so did the role of the nurse. In the 1950s, nurses were “tumor therapy nurses.” They administered chemotherapy, educated parents, coordi- nated care, and continued to provide comfort care as few pa- tients survived longer than a few weeks (Blacken et al., 2019; Foley & Fergusson, 2011). Jean Fergusson was one of the first tumor therapy nurses working directly with Dr. Sidney Farber to improve the care of pediatric oncology patients. Jean pio- neered many of the clinical skills we still employ at the bedside today. The importance of a multidisciplinary team approach to care was introduced during this time by Dr. Farber. Several advances in medicine and nursing occurred during the 1960s. Nurses played a greater role in clinical trials, performing phys- ical assessments and collecting data (Blacken et al., 2019). The need for and the development of an advanced practice nursing role was identified and realized. In addition, family-centered care became a core precept in pediatric care delivery (Foley & Fergusson, 2011). It was not until the mid-1970s that pediatric oncology nursing became recognized as a distinct subspecialty. With the advent of combination cancer therapies in the late 1960s and 1970s, patients developed specific care needs. In addition, the increased survival rates of children treated for cancer required
extensive nursing knowledge of cancer diagnosis and treat- ment, side effect management, and supportive-care strategies. In 1974, the Association of Pediatric Oncology Nurses (APON) was formed by a group of nurses who met at the Association for the Care of Children’s Health conference in 1973 (Greene, 1983). APON was based on the philosophy that pediatric oncology nursing is a specialty that requires specific knowledge and expertise in the care of children who have can- cer. Children with cancer are not small adults but rather indi- viduals who have special and unique needs. Childhood can- cers differ significantly from adult cancers. Pediatric cancers are generally systemic rather than organ based and require distinctly different treatment regimens. Genevieve Foley who served as APON’s third president (1977–1978) described the three key decisions made during her tenure: signing a contract for a textbook on pediatric oncology nursing, approaching the American Nurses Association (ANA) to develop national standards of practice for pediatric oncology nurses, and the decision not to merge APON with the Oncology Nursing Society (ONS) but to remain a separate organization dedicated to pediatric oncology (Foley, 2017). Today, pediatric oncology nursing is recognized as a distinct subspecialty within both oncology and pediatrics. This distinction was formalized with the development of specialty certification in pediatric oncolo- gy nursing in 1993 (Foley & Fergusson, 2011). In the late 1970s and 1980s nursing committees were formed within the established cooperative group structure of the Children’s Cancer Group (CCG) and the Pediatric Oncology Group (POG) (Foley & Fergusson, 2011). Networks were created among pediatric oncology nurses to facilitate their contributions to the disease committees throughout both CCG and POG. Nurses participated as members of protocol, disease, and scientific committees and contributed to concept design, trial analysis, and publications. Nurses were instru- mental in developing teaching tools for patients and families and were involved in writing treatment guidelines, assisting with the completion of protocol roadmaps, and serving as resources for other professionals in the cooperative groups (Ruccione et al., 2005). In 2000, CCG, POG, the National Wilms Tumor Study Group, and the Intergroup Rhabdomyosarcoma Study Group formed a unified group for cancer research named the Chil- dren’s Oncology Group (COG) (Withycombe et al., 2019). Pediatric oncology nurses are maintaining their important roles within COG. Nursing leaders in COG took an active role in structuring nursing research within the cooperative group (Zupanec et al., 2023). This initiative is paving the way
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Essentials of Pediatric Hematology/Oncology Nursing: A Core Curriculum, Fifth Edition
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