Building a support group for parents of children with brain tumors

When parents are faced with the possibility of death or disability from their child's brain tumor, it manifests as a daily crisis. Some seek comfort and reassurance in sharing similar experiences within a support group. These groups have much to offer people who derive support from group interaction. Pediatric neuroscience nurses are in a unique position to coordinate and facilitate the development of a support group for parents of children with brain tumors. Although the literature identifies many reasons people join support groups, little has been explored among parents of children with a life-threatening illness. The literature stresses that the success of a group is in knowing why people attend groups and the ability to address the group's needs.

Metastatic spread and common symptoms. Part One: Introduction, bladder cancer, and brain cancer

This is the first of a multi-part series detailing the metastatic spread and natural history of 18 common tumors. The introduction summarizes (1) the concept of symptom/problem anticipation and early identification; (2) the process of cancer metastasis; and (3) the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder cancer is discussed, with information included on tumor types, metastatic spread and invasion, and common symptoms. Obstructive uropathy is the oncologic emergency most commonly associated with bladder cancer. Sites of spread, resulting problems, and assessment parameters are presented as a table. Brain cancer (and brain metastasis) is discussed, with information included on tumor types, invasion (the primary means of spread in primary brain cancer), and common symptoms. Increased intracranial pressure and, to a lesser extent, spinal cord compression are the oncologic emergencies most commonly associated with brain cancer. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as a table.

Use of a quality of life instrument to improve assessment of brain tumor patients in an outpatient setting

Persons with brain tumors experience their illness in a way that is much larger than the sum of their symptoms. Using a QOL tool to improve assessment can assist the patient, family and clinician in considering all aspects of the experience of having a brain tumor. The tool selected should be easy to use, brief and address the major dimensions of quality of life. The Quality of Life Index is one such tool. The Quality of Life Index assists the clinician in assessing five major categories of a person's illness experience. These include the impact of the brain tumor diagnosis on work-related activities, activities of daily living, general health, support systems and outlook or mood. By using a quality of life instrument such as the Quality of Life Index to improve assessment, clinicians will be able to provide brain tumor patients with focused care to improve their daily lives.

Blood-brain barrier disruption for the treatment of malignant brain tumors: The National Program

Chemotherapy delivery for the treatment of malignant brain tumors is markedly enhanced when given in conjunction with osmotic opening of the blood-brain barrier. Osmotic opening or disruption of the blood-brain barrier is achieved while the patient is under general anesthesia, by the infusion of mannitol into the internal carotid or vertebral artery circulation. The mannitol infusion is followed by administration of intraarterial chemotherapy. A National Blood-Brain Barrier Program now exists and includes six universities. Within the National Program over 4200 blood-brain barrier disruption procedures have been performed in over 400 patients. Patients with primary central nervous system (CNS) lymphoma, glioma, primitive neuroectodermal tumor (PNET), germ cell and metastatic cancer are eligible for treatment. Results in patients with primary CNS lymphoma, recently reported in the Cancer Journal, include the first example of a durable response in a primary brain tumor without loss of cognitive function and without use of radiotherapy. Results with PNET and germ cell tumors are also very encouraging. Advanced practice nurses coordinate the care of blood-brain barrier disruption patients. Care includes patients selection, education, close neurological observation, maintenance of fluid and electrolyte balance and managing effects of high-dose chemotherapy. Both acute and long-term medical and psychological follow-up are an essential component of the program, as well as patient and family support.

Central nervous system tumors in children

OBJECTIVES

To examine how pediatric and adult central nervous system (CNS) tumors differ and to discuss the unique aspects of diagnosis, treatment, and long-term effects of brain tumors in children.

DATA SOURCES

Research, review articles, book chapters, and abstracts.

CONCLUSIONS

A child's growing and developing body and brain place him or her at great risk for permanent damage as a result of traditional treatment methods. A family-centered nursing approach assists the child and family in coping with the impact of a brain tumor.

IMPLICATIONS FOR NURSING PRACTICE

Children have unique needs during and following treatment for CNS tumors. All oncology nurses need to be fully informed about and help monitor for intellectual, endocrinologic, and oncogenic late effects from the disease and treatment.

Selected complications in neuro-oncology patients

OBJECTIVES

To identify the causes of and discuss nursing management of those complications that are unique to the brain tumor patient population.

DATA SOURCES

Published articles and books related to neurological and nonneurological complications in the neuro-oncology patient.

CONCLUSIONS

Seizures, cerebral edema, thromboembolism, and endocrine dysfunction are several complications experienced by the neuro-oncology patient. These complications can be caused by the tumor or treatment of this disease.

IMPLICATIONS FOR NURSING PRACTICE

Care of the neuro-oncology patient is complex. Knowledge of the potential complications that patients may experience and how to manage these problems serves to enhance their quality of life.

Central nervous system metastases

OBJECTIVES

To provide an overview and up-to-date information on the presentation and treatment of central nervous system (CNS) metastases, including brain metastases, spinal cord compression, and leptomeningeal metastases.

DATA SOURCES

Published articles, research reports, and book chapters pertaining to CNS metastases.

CONCLUSIONS

Most patients with CNS metastases have a limited life expectancy. Therapies are palliative, except in select patients who have improved chances for long-term control or occasional cures. In general, early detection and treatment of CNS metastases prevents devastating neurological disabilities.

IMPLICATIONS FOR NURSING PRACTICE

Nurses across all health care settings can play an important role in early recognition of signs and symptoms of CNS metastases, and assist patients and families in preventing devastating neurological disabilities. Nurses are also frontline care providers for patients requiring various treatments and rehabilitation for metastatic CNS disease.

Quality of life of brain tumor patients

OBJECTIVES

To provide a review of the quality of life (QOL) and to delineate nursing implications to increase QOL in brain tumor patients.

DATA SOURCES

Review articles and research studies pertaining to quality of life and brain tumor patients.

CONCLUSIONS

In general, patients maintain a high physical functional level for a majority of time during their illness. The main problems include memory loss, fatigue, and loss of concentration. QOL is decreased with several debilitating symptoms relating to the tumor or recurrent disease, and increased when being actively treated or in remission.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must be able to listen carefully to patients with brain tumors and take action when symptoms arise. By assisting the patients to decrease the symptoms and to access support services, QOL is increased.

Neurosurgical management of patients with central nervous system malignancies

OBJECTIVES

To provide an introduction to and description of the neurosurgical technologies used for the diagnosis and treatment of central nervous system (CNS) malignancies.

DATA SOURCES

Published articles, books, and other reference materials.

CONCLUSIONS

Recent advances in the development of assessment tools and surgical techniques have improved the outcome and quality of life for patients with brain and spinal cord tumors. Further improvements in intraoperative instrumentation and postoperative adjuvant therapy are expected to increase the safety and effectiveness of treatments for CNS malignancies.

IMPLICATIONS FOR NURSING PRACTICE

Preoperative education for the patient with a CNS malignancy is a special challenge to nurses. Management of these aggressive tumors requires multiple treatment modalities and continued vigilance to detect and palliate recurrent tumors.

Chemotherapy of astrocytomas: an overview

OBJECTIVES

To provide an overview of the use of chemotherapy in the treatment of malignant brain tumors, with an emphasis on malignant gliomas.

DATA SOURCES

Published articles, research studies, and reference books.

CONCLUSIONS

Chemotherapy has primarily been used in a adjuvant setting after radiation therapy for primary brain tumors. This focus has not had a significant effect on survival. In an effort to more effectively treat the tumor, innovative chemotherapy treatments have been developed. These include the use of neoadjuvant chemotherapy, changes in timing of administration, new classes of chemotherapeutic agents, new routes of delivery, and augmentation of the body's own immune system to treat the tumor.

IMPLICATIONS FOR NURSING PRACTICE

It is the challenge of the oncology nurse caring for the patient with a malignant brain tumor to gain knowledge of the disease process, side effect management, and the most up-to-date treatment regimens.

The role of advanced practice nurses in surgical services

Many of the changes in health care delivery systems have had detrimental effects on nurses; however, some of these same changes are providing opportunities for acute care advanced practice nurses. Advanced practice nurses ensure continuity of care, manage use of resources, and coordinate patient services, which often results in cost savings. This article describes how advanced practice nurses in the department of surgery at Memorial Health Care, Worcester, Mass, are caring for surgical patients with acute and chronic conditions.

Stereotactic biopsy procedures for brain tumor diagnosis

Stereotactic biopsy procedures, in which a computer-based, three-dimensional-image-guided system accurately locates patients' brain tumors, are relatively new diagnostic methods. Complications from stereotactic biopsy procedures are minimal compared with open craniotomy procedures because they are performed with local anesthesia. Perioperative nurses should have knowledge of and be trained in stereotactic biopsy procedures to ensure optimal care for patients undergoing these procedures.

[Developing a language for nursing. Interview with Patricia Benner]

This (shortened) interview from 1995 contains Patricia Benner's thoughts on the relationship between nursing practice, language and nursing science. Benner alludes to the philosophical and theoretical sources of her work and uses a narrative in order to show her method of interpretation.

Current practices and advances in pediatric neurosurgery

Advances in the field of neuroscience are enhancing outcomes for pediatric neurosurgical patients. Innovative diagnostic tools that include ventriculoscopy for hydrocephalus; long-term monitoring with subdural and epidural electrodes for seizures; and intraoperative computer-assisted, three-dimensional imaging for tumors are currently aiding neurosurgeons. These advances in the care of pediatric patients require the perioperative nurse to reevaluate and expand the nurse's role to optimize patient outcomes.

Management of intracranial hemodynamics in the adult: a research analysis of head positioning and recommendations for clinical practice and future research

Head elevation is a conventional nursing intervention used to control raised intracranial pressure and avoid complications in patients with neurotrauma or other conditions requiring management of intracranial hemodynamics. This therapy, however, provides a particular dilemma for health care providers. While elevating the head of the bed does decrease intracranial pressure, it may put some patients at risk for intracranial hypertension and cerebral ischemia due to decreases in cerebral perfusion pressure. This article analyzes research on head positioning that provides individual outcome measurements versus group means in adult patients with various conditions. The risk/benefit method of analysis used in this review revealed that in addition to only monitoring and controlling for ICP, we must also monitor and control CPP with a greater emphasis on this particular measurement. This analysis also revealed that optimal head positioning to manage intracranial hemodynamics should be decided upon on an individual basis using both ICP and CPP measurements.

Brain tumor support group: content themes and mechanisms of support

PURPOSE

To describe the experiences and needs of patients with brain tumors as evidenced in analysis of themes from support group discussions and to increase knowledge of supportive mechanisms operant in support groups for medically vulnerable populations.

DESIGN

Descriptive, exploratory.

SETTING

An urban medical center on the U.S. West Coast.

SAMPLE

Participants in a brain tumor support group, including patients, families, friends, and facilitators.

METHODS

Researchers analyzed observational field notes and videotapes of a brain tumor support group's meetings over a six-month period using grounded theory methods to develop inclusive conceptual categories of themes and to document mechanisms of support.

FINDINGS

Five thematic categories emerged: telling the story, managing medical advice, seeking and exchanging information, the long haul, and family life changes. Two major categories of supportive mechanisms emerged: finding a safe haven and maintaining morale, each of which contained several contributing dimensions.

MAIN RESEARCH VARIABLES

Discussion topics, dialogue, and interaction among participants during the support group meetings.

CONCLUSIONS

The support group provided a specific therapeutic forum for patients with brain tumors and their families, especially regarding the difficulties of survival and maintaining quality of life after initial treatment.

IMPLICATIONS FOR NURSING PRACTICE

Findings generated knowledge that can guide patient care, particularly follow-up care after initial treatment. Support group facilitation by expert nurse clinicians can provide health-care guidance and emotional support to medically vulnerable patients and their families through symptom assessment and management, timely referral, therapeutic group process, promotion of self-care, and adaptive coping.