Foundations of Pediatric Hematology/Oncology Nursing

FOUNDATIONS OF Pediatric Hematology/Oncology Nursing

A Comprehensive Orientation and Review Course, 3 rd Edition

Kathleen B. Adlard, MN RN CNS CPON® Karyn Jean Brundige, MSN CPNP Susie Burke, MA RN CPNP CPHON® Christine S. Yun, MSN PNP CPON®

Program History This course is designed to give participants an overview of nursing practice matters in caring for children, adolescents, and young adults with cancer and blood disorders. Common pediatric hematological and oncological diagnoses are presented, along with the clinical nurse’s role in implementing treatment approaches. Supportive care principles are also introduced. Case studies providing clinical scenarios are included to enhance the learning process. Knowledge check questions are included in each module to assist the nurse educator in measuring the effectiveness of the program and learning outcomes. The idea for the first edition of this course occurred in 2001 when then-APHON member and past president of APHON Joetta D. Wallace, MSN RN FNP-C CPON®, invited

nursing educators and advanced practice nurses from several institutions across Southern California to join her in forming an educational consortium. The impetus for this project was Joetta Wallace’s observation that, at any one time, most institutions have only a limited number of nurses requiring a formalized pediatric hematology/ oncology orientation program or refresher course; nevertheless, it is incumbent on each institution to meet the educational needs of these nurses. She believed that pooling resources would be possible to provide a high-quality program that would meet the educational needs of these nurses while at the same time reducing the investment of resources required by individual institutions to provide ongoing educational programs. Therefore, the goal of the educational consortium was to develop a comprehensive, standardized pediatric hematology/oncology orientation course that would be

helpful both for nurses new to pediatric hematology/ oncology and for current pediatric hematology/oncology nurses who want to refresh their knowledge. The original APHON Foundations of Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review Course consisted of an 18.5- hour course comprised of 19 modules, offering 22.2 nursing continuing education units (CEUs), which provided the basis for pediatric hematology/oncology nursing practice. Now in the third edition, the program has grown to a recommended 20.7-hour course of 21 modules with the new addition of the Immunology

module. The number of continuing nursing education (CNE) contact hours offered for the program will depend on the total number of hours of presentation time. The modules are provided in Microsoft PowerPoint® presentations and are available by downloading the files from the APHON ACE Center once purchased. The modules are accompanied by extensive notes and references for the nurse educator/instructor’s use. Nurse educators/instructors may provide a course syllabus of the PowerPoint® handouts for each module. The modules ideally would be taught by an experienced pediatric hematology/oncology nurse but can also be used as an independent self-study program.

1 The Big Picture: Hematologic & Oncologic Diseases in Children 46 Slides | 45 Minutes to Teach Author Christine S. Yun, MSN PNP CPON® Learning Objectives Table of Contents This course contains 21 modules that can be used as individual lectures or as part of a comprehensive course taught by a nurse educator/instructor. They appear in the recommended order of presentation as a 2–3-day course. Contributing authors and suggested teaching times are indicated for each module. The actual length of each module can be modified depending on the audience, presentation detail, and discussion degree.

6 Neuroblastoma

50 Slides | 60 Minutes to Teach

Learning Objectives • Describe neuroblastoma and the factors affecting prognosis • Discuss the clinical presentation and diagnostic procedures specific to neuroblastoma • Define current multimodal strategies utilized in the treatment of neuroblastoma with regards to staging and risk

Author Jennifer Saggio, MSN CRNP

• Identify the most common blood disorders and pediatric malignancies • Describe the major differences between cancer in adults and children • Identify professional and clinical trial organizations for pediatric hematology and oncology nurses

7 Pediatric Solid Tumors

96 Slides | 120 Minutes to Teach

Learning Objectives • Identify the most common pediatric solid tumor malignancies • State characteristics of common solid tumors in children • Discuss treatment modalities for common pediatric solid tumors • Discuss complications associated with common pediatric solid tumors and treatment

Authors Margaret Bottcher, MN RN CPNP-PC CPON® Colleen Nixon, MSN RN CPHON®

2 Nursing Assessment in Pediatric Oncology

55 Slides | 75 Minutes to Teach

Learning Objectives • Recognize abnormal assessment and laboratory findings and associated nursing implications • Discuss the special aspects of the role of the nurse in caring for infants, children, and adolescents and young adults with a suspected cancer and their families • Implement practices designed to improve the quality of life for patients and families affected by childhood cancer

Author Kimberly Duback, MS APRN PCNS-BC CPN CPHON®

8 Hematologic Diseases of Childhood Author Beth Savage, PhD CPNP CPON®

105 Slides | 120 Minutes to Teach

Learning Objectives • Discuss care of children and adolescents with hematologic conditions • Identify abnormal laboratory results and associated nursing implications • Recognize common hematologic emergencies

3 Childhood Leukemias Authors Kathleen B. Adlard, MN RN CNS CPON® Sue Zupanec, MN NP Christine S. Yun, MSN PNP CPON®

118 Slides | 150 Minutes to Teach

9 Research and Treatment Protocols Author Sharon Bergeron, BSN RN CPON®

Learning Objectives • Describe the clinical presentation of acute leukemias in infants, children, and adolescents • List the laboratory and diagnostic tests commonly used in the diagnostic work-up for childhood leukemias • Discuss the high-risk features associated with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) in infants, children, and adolescents • Provide the treatment modalities used in ALL, AML, and chronic myeloid leukemia (CML) • Discuss the supportive care of infants, children, and adolescents receiving treatment for acute and chronic leukemias

41 Slides | 45 Minutes to Teach

Learning Objectives • Discuss the impact of research on the survival of children with cancer • Describe the specialized nursing role in the development and ongoing monitoring of pediatric oncology clinical trials • Interpret a therapy delivery map (TDM), also known as a “roadmap,” utilized for a child enrolled on a clinical trial • Describe the ethical principles governing the conduct of pediatric oncology research • Discuss the implications of nursing research and evidence-based nursing practice to advance the clinical care of children with cancer

4 Childhood Lymphomas Authors Sharon Bergeron, BSN RN CPON® Lindsay Vander Woude, DNP CPNP-PC

75 Slides | 75 Minutes to Teach

10 Immunology in Pediatric Hematology and Oncology Author Elaine Kulm, BSN MS CRNP CPNP-PC CPHON®

Learning Objectives • Describe the differences between Hodgkin lymphoma and non-Hodgkin lymphoma • Identify primary modalities of lymphoma treatment • Describe essential elements of nursing care for children and adolescents with lymphoma

65 Slides | 75 Minutes to Teach

Learning Objectives • Identify and describe the three parts of the immune system • Identify the main cell markers used in the TBNK and correlate the markers with their respective cells • Discuss why hem/onc/HSCT nurses need a knowledge base in immunology

5 CNS Tumors in Children, Adolescents, and Young Adults

78 Slides | 90 Minutes to Teach

Learning Objectives • Identify the classic symptoms associated with childhood CNS tumors • List common types, locations, and anatomies of CNS tumors that occur in children and adolescents and young adults (AYA) • Understand basic components of CNS nursing assessment and neurological exam • Discuss primary modalities of diagnosis and treatment of CNS tumors • Discuss the role of the nurse in the care of the child, adolescent, or young adult with a CNS tumor

Authors Kasey Rangan, MSN CPNP CPHON® Kaaren Waters, DNP RN CPNP CPHON®

11 Principles of Chemotherapy and Biotherapy

64 Slides | 60 Minutes to Teach

Learning Objectives • Define the history of chemotherapy and biotherapy • Describe how chemotherapy and biotherapy work • Discuss the classifications of chemotherapeutic agents and biotherapy agents and their mechanisms of action

Author Mary Lynn Rae, MSN RN NPD-BC BMTCN® CPHON®

The actual length of lectures can be changed, depending on the audience, detail of presentation, and degree of discussion.

12 Radiation Therapy Authors Michael Diaz, RN Desirae Clark, BSN RN CPHON®

17 Pain Management

42 Slides | 45 Minutes to Teach

85 Slides | 90 Minutes to Teach

Learning Objectives • List the types of radiation therapy and various treatment modalities • Describe the basic radiobiology principles of radiation therapy • Discuss side effects and supportive care approaches for patients undergoing radiation therapy • Recognize late effects associated with radiation therapy for cancer in childhood

Learning Objectives • Describe pain and its effects if inadequately managed • List components of a thorough pediatric pain assessment • Describe key components of both nociceptive and neuropathic pain • Identify pharmacological therapies used to relieve pain

Author Amy Haskamp, MSN RN PCNS-BC CHPPN CPON®

18 Pediatric Palliative Care and End-of-Life Issues

13 Hematopoietic Stem Cell Transplant (HSCT) and Chimeric Antigen Receptor (CAR) T-Cell Therapy

63 Slides | 60 Minutes to Teach

Learning Objectives • Describe the philosophy of pediatric palliative care (PPC) • Compare and contrast pediatric palliative and hospice care • Describe key components of Section 2302 of the Patient Protection and Affordable Care Act (ACA), known as Concurrent Care for Children

Author Amy Haskamp, MSN RN PCNS-BC CHPPN CPON®

76 Slides | 90 Minutes to Teach

Learning Objectives • Describe the differences between autologous and allogeneic HSCTs and the indications for each • Discuss the complications related to conditioning regimens, infections, and alloreactivity • Discuss the special aspects of the role of the nurse in the care of the child, adolescent, or young adult undergoing HSCT • Describe immune effector cellular therapy and specifically chimeric antigen receptors (CAR T cells) for treatment in B cell malignancies

Authors Misty D. Evans, DNP APRN CPNP-AC BMTCN® Nancy Tena, MSN RN CNS-BC BMTCN® CPHON®

• Describe physical, emotional, social, and spiritual symptoms experienced in palliative care and describe appropriate care for children and their families • Explain the role of the nurse in end-of-life care 19 Childhood Cancer Survivorship: Long-Term Effects of Treatment 58 Slides | 60 Minutes to Teach Author Meredith Foxx, MSN MBA APRN PCNS-BC PPCNP-BC NEA-BC CPON® Learning Objectives • Recognize late effects associated with treatment for cancer in childhood/ adolescence • Discuss the special aspects of the role of the nurse in long-term follow-up care after childhood/adolescent cancer treatment • Implement practices designed to improve the quality of life in childhood/adolescent cancer survivors • Recognize the risk factors for late effects associated with treatment for cancer in childhood/adolescence 20 Fertility Preservation 41 Slides | 45 Minutes to Teach Author Barbara Lockart, DNP APRN PC/AC CPHON® Learning Objectives • Describe types of therapy that have the potential to affect fertility

14 Central Venous Access Devices Authors Mary Lynn Rae, MSN RN NPD-BC BMTCN® CPHON®

52 Slides | 145 Minutes to Teach

Learning Objectives • Identify appropriate central venous access devices (CVADs) for different clinical situations and diagnoses • Describe key nursing interventions in the care of CVADs • Discuss complications and management of CVADs, including infections, occlusions, and mechanical obstruction • List the key elements of the central line-associated bloodstream infection (CLABSI) prevention insertion and maintenance bundles

15 Management of Treatment Side Effects: Supportive Care Issues

72 Minutes | 90 Minutes to Teach

• Discuss fertility preservation options available to pre- and post-pubertal patients • Implement nursing practices designed to improve the knowledge of patients and families regarding the effect of treatment on fertility

Learning Objectives • Recognize the potential side effects of cancer treatment in infants, children, and adolescents • Identify supportive care approaches related to toxicities of therapy • Discuss the special aspects of the role of the nurse in caring for infants, children, or adolescents with cancer and their families

Authors Nancy King, MSN RN CPNP CPON®

21 AYAs with Cancer

29 Slides | 45 Minutes to Teach

Learning Objectives • List common types of cancers occurring in the adolescent and young adult population • Recognize unique needs of AYAs diagnosed with cancer • Identify practices that improve quality of life and care in the AYA population

Authors Kristin Stegenga, PhD RN CPON® Lisa Bashore, PhD APRN CPNP-PC CPON®

16 Oncologic Emergencies Author Colleen Nixon, MSN RN CPHON®

76 Slides | 90 Minutes to Teach

Learning Objectives • Identify the most common oncologic emergencies and important nursing interventions • Understand the pathophysiology and clinical presentation including abnormal laboratory results • Recognize risk factors and interventions for prevention and treatment

The actual length of lectures can be changed, depending on the audience, detail of presentation, and degree of discussion.

Editors

Kathleen B. Adlard, MN RN CNS CPON® Clinical Nurse Specialist Chan Soon-Shiong Institute for Medicine El Segundo, California Lisa Bashore, PhD APRN CPNP-PC CPON® Advanced Practice Registered Nurse Cook Children’s Health Care System Fort Worth, Texas Sharon Bergeron, BSN RN CPON® Research Nurse Educator CHOC Hyundai Cancer Institute Clinic Orange, California Karyn Jean Brundige, MSN CPNP Pediatric Nurse Practitioner Dana-Farber/Boston Children’s Cancer and Blood Disorders Center Boston, Massachusetts Desirae Clark, BSN RN CPHON® Registered Nurse Children’s Hospital Los Angeles Los Angeles, California Michael Diaz, RN Registered Nurse Children’s Hospital Los Angeles Los Angeles, California Kimberly Duback, MS APRN PCNS-BC CPN CPHON® Clinical Nurse Specialist Advocate Children’s Hospital—Oak Lawn Oak Lawn, Illinois Misty D. Evans, DNP APRN CPNP-AC BMTCN® Nurse Practitioner/Assistant Professor Kathleen B. Adlard, MN RN CNS CPON® Clinical Nurse Specialist Chan Soon-Shiong Institute for Medicine El Segundo, California Karyn Jean Brundige, MSN CPNP Pediatric Nurse Practitioner Dana-Farber/Boston Children’s Cancer and Blood Disorders Center Boston, Massachusetts

Susie Burke, MA RN CPNP CPHON® Medical Director Camp One Step Chicago, Illinois Christine S. Yun, MSN PNP CPON® Oncology Nurse Practitioner CHOC Hyundai Cancer Institute Clinic Orange, California

Contributing Authors Meredith Foxx, MSN MBA APRN PCNS- BC PPCNP-BC NEA-BC CPON® Executive Chief Nursing Officer Cleveland Clinic Cleveland, Ohio Amy Haskamp, MSN RN PCNS-BC CHPPN CPON® Advanced Practice Nurse Riley Hospital for Children Indianapolis, Indiana Barbara Lockart, DNP APRN PC/AC CPHON® Advanced Practice Registered Nurse Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago, Illinois Colleen Nixon, MSN RN CPHON® Clinical Educator Boston Children’s Hospital Boston, Massachusetts Mary Lynn Rae, MSN RN NPD-BC BMTCN® CPHON® Nursing Professional Development Practitioner/Clinical Educator Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago, Illinois Kasey Rangan, MSN CPNP CPHON® Nurse Practitioner Children’s Hospital Los Angeles Los Angeles, California Jennifer Saggio, MSN CRNP Advanced Practice Nurse Neuroblastoma Developmental Therapeutics Center for Childhood Cancer Research and Division of Oncology Children’s Hospital of Philadelphia Philadelphia, Pennsylvania

Beth Savage, PhD CPNP CPON® Assistant Professor Rutgers School of Nursing Newark, New Jersey Kristin Stegenga, PhD RN CPON® Nurse Researcher Children’s Mercy Hospital Kansas City, Missouri Nancy Tena, MSN RN CNS-BC BMTCN® CPHON® Clinical Nurse Specialist University of Michigan CS Mott Children’s Hospital Ann Arbor, Michigan Lindsay Vander Woude, DNP CPNP-PC Pediatric Nurse Practitioner Seattle Children’s Hospital Seattle, Washington Kaaren Waters, DNP RN CPNP CPHON® Pediatric Nurse Practitioner Children’s Hospital Los Angeles Los Angeles, California Christine S. Yun, MSN PNP CPON® Oncology Nurse Practitioner CHOC Hyundai Cancer Institute Clinic Orange, California Sue Zupanec, MN NP Nurse Practitioner The Hospital for Sick Children Toronto, Ontario

CNE Eligibility Each 60 minutes of educational content is worth a total of 1 CNE contact hour and is eligible to claim through the participant’s continuing education provider system. APHON is not the provider of continuing education credits for this program. The Association of Pediatric Hematology/Oncology Nurses (APHON) APHON is the professional organization for pediatric hematology/oncology nurses and other pediatric hematology/oncology healthcare professionals. Its members are dedicated to promoting optimal nursing care for children, adolescents, and young adults with cancer and blood disorders, and their families. APHON’s mission is to support and advance nurses in optimizing outcomes for children, adolescents, young adults, and their families throughout the continuum of care for their blood disorders and cancers. APHON provides and promotes expertise in pediatric hematology/oncology nursing practice to its members and the public through educational conferences, the bimonthly Journal of Pediatric Hematology/Oncology Nursing , the quarterly newsletter APHON Counts , textbooks, patient-family educational materials, an online community that shares practice-related questions, and more. To learn more about APHON membership, products, and services, visit aphon.org, e-mail info@aphon.org, or call 855.202.9760 (US residents only) or 847.375.4724.

Vanderbilt University Nashville, Tennessee

Terms of Use The APHON Foundations of Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review Course, 3rd Edition (“APHON Foundations Courses”), including copyright therein, are owned exclusively by APHON and may not be used except for the limited license as provided below. APHON grants Purchaser of the APHON Foundations Courses a limited license to use the APHON Foundations Courses in a classroom setting and for the individual Purchaser’s independent study. Without limiting the specific nature of the license above, APHON only grants Purchaser the permission to use the APHON Foundations Courses to teach employees in Purchaser’s institution in an in-person or virtual instruction setting. The APHON Foundations Courses may not be loaded into Purchaser’s or their institution’s learning management system, and Purchaser may not create any derivative works of the APHON Foundations Courses including any modifications, recorded voiceovers, or other additions or changes to the APHON Foundations Courses. Purchaser may place the PowerPoint® slides contained within the APHON Foundations Courses exactly in their original form on the institution’s shared network to allow central access within the institution only. Purchaser may print the presenter notes and slide handouts within the APHON Foundations Courses for use in conjunction with instruction within Purchaser’s institution. Purchaser may offer continuing nursing education (CNE) contact hours by working with an ANCC-accredited provider/approver of CNE contact hours such as their institution or elsewhere. APHON does not grant CNE contact hours for completion of the course material within Purchaser’s institution. All other use of the APHON Foundations Courses is expressly prohibited. © 2023 Association of Pediatric Hematology/Oncology Nurses. All rights reserved.

System Requirements The lectures are presented in Microsoft PowerPoint® format. Extensive notes and references accompany the lectures for the instructor’s use and are in PowerPoint® files. The current version of Microsoft Office is recommended for the optimal experience. Viewing the files with a previous version of PowerPoint® may result in formatting errors and reduced functionality. Printing Handouts The presentation files may be distributed to participants as handouts. Follow the steps below to print the handouts: 1. Open the module file. 2. Select “File,” then select “Print.” 3. Under the “Slides” section, select the preferred option