Anna Evans

Pregnancy in a Patient With a Malignant Brain Tumor Taking Temozolomide: Case Report and Review of the Literature.

Temozolomide (TMZ), an alkylating agent used in the treatment of malignant gliomas, is a pregnancy category D medication that is not advised for use in pregnant women. We report the case of a 19-year-old woman with anaplastic oligodendroglioma (high-grade glioma) who became pregnant during maintenance chemotherapy consisting of TMZ 200 mg/m2 administered 5 days monthly. The TMZ was immediately discontinued after she developed a positive pregnancy test. She delivered a full-term healthy baby boy with no prenatal or perinatal complications. Adolescents and young adults with brain tumors are often sexually active and should receive intensive and repeated anticipatory guidance regarding contraception while receiving chemotherapy. Pediatric oncology nurses are in a unique position to provide this education for patients and ensure that young women have appropriate pregnancy testing prior to chemotherapy administration.

The Use of Aromatherapy to Reduce Chemotherapy-Induced Nausea in Children With Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial:

Introduction: Chemotherapy-induced nausea can be distressing and difficult to manage in children with cancer. The purpose of this study was to investigate the utility of ginger aromatherapy in relieving chemotherapy-induced nausea in children with cancer. Method: This randomized, double-blind, placebo-controlled study of 49 children with cancer explored whether inhalation of the aroma of essential oil of ginger during chemotherapy decreased nausea compared with a placebo (water) or control (Johnson’s baby shampoo) measured by prechemotherapy and postchemotherapy assessment with the Pediatric Nausea Assessment Tool (PeNAT). Results: While well received, well tolerated, nontoxic, and noninvasive, ginger aromatherapy did not significantly decrease nausea in patients enrolled in this study. Among 21 patients who indicated feeling nausea prechemotherapy, 67% reported improvement, 5% worsening, and 28% no change in their postinfusion PeNAT score. We failed to detect a statistical significant difference in the change in PeNAT scores among the three groups.

Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience

This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized. The NPPL helped create an empowering environment for continued nurse practitioner professional growth.

Vincristine and Vinblastine: Is checking bilirubin mandatory in children with Brain Tumors?

Vinca alkaloids are commonly used in pediatric patients with brain tumors. Other types of pediatric cancers (leukemia) have reported abnormal liver functionwith vinca alkaloids.1,2 The experience in these cancers has influenced the care of patients with brain tumors by requiring the bilirubin result before administration of vinca alkaloids. Vinca alkaloids are common in pediatric brain tumor regimens, especially in two of the most common diagnoses: low-grade glioma and medulloblastoma.3,4 Although patients with brain tumors are more likely to have neurotoxicity with vinca administration,5 they are not historically thought tohave liver abnormalitieswith thesemedications. Wewanted to examine the risk of liver toxicity in pediatric patients with brain tumors receiving vincas in order to reduce the time and cost of weekly bilirubin testing. Therefore, we completed a multisite retrospective chart review of all pediatric neuro-oncology patients receiving vinca alkaloids and their incidence of abnormal liver laboratory values (bilirubin levels). Over the course of 3 years, at three sites, there were a total of 113 patients with brain tumors with 1,752 incidences of vinca administration and concurrent bilirubin levels. Of these, there were 10 (0.6%) abnormal bilirubin levels in 7 of the 113 (6%) patients: 1 on bone marrow transplant, 1 in multisystem organ failure, 2 with abnormalities not requiring dose adjustment, 1 on high-risk medulloblastoma therapy requiring dose omission, and 1 with known sensitivity to all chemotherapy. In the absence of evidence of abnormal bilirubin levels in the vast majority of patientswith brain tumors, a vinca alkaloid could be administered weekly without a bilirubin level. Our findings are similar to those of Bouffet et al.,3 who did not report any liver abnormalities in 2,020 doses of vinblastine for low-grade gliomas. We recommend reverting to the historical practice of monthly liver function testing whileonvincaalkaloids in this population.However, childrenwithhighrisk disease or on high-dose chemotherapy should be monitored more closely. This initiative could improve patient/family experience, clinic efficiency, and decrease cost.