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Acute Lymphocytic Leukemia:. An Exercise In Real Life. Jessica Brandt Sarah Palmer Shannon Manning. Neoplastic disorder of the blood and bone marrow Occurs in all age groups Incidence ~10x higher in adults Clinical manifestations often nonspecific Malaise Weakness.

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acute lymphocytic leukemia

Acute Lymphocytic Leukemia:

An Exercise In Real Life

Jessica Brandt

Sarah Palmer

Shannon Manning

what is leukemia
Neoplastic disorder of the blood and bone marrow
  • Occurs in all age groups
    • Incidence ~10x higher in adults
  • Clinical manifestations often nonspecific
      • Malaise
      • Weakness
  • Unexplained fever
  • Recurrent infections
What is Leukemia?

http://leukemiafundraising.com/shopsite_sc/store/html/index.html?gclid=CO2Zq4jji5ICFRrLiQod-Xa2bw

myeloid leukemias
Myeloid Leukemias

http://seer.cancer.gov/statfacts/html/clyl.html

lymphoid leukemias
Ching-Hon, P. & Evans, W.E. (2006). Treatment of Acute Lymphoblastic Leukemia. NEJM, 354, p166-178.

http://seer.cancer.gov/statfacts/html/clyl.html

Lymphoid Leukemias

http://www.emedicine.com/MED/topic937.htm

other related diseases in the leukemia family
Other Related Diseases in the Leukemia Family

http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_multiple_myeloma_30.asp?rnav=cri

http://www.emedicine.com/med/topic2695.htm

subtypes of all
Subtypes of ALL

http://www.cancer.gov

www.fhcrc.org/patient/brandnewlife.html

how was d l diagnosed
Complete Blood Count
    • Elevated WBC’s, Decreased H&H, Platelets
  • Bone marrow biopsy
    • Definitive Diagnosis
  • Spinal tap
    • CNS involvement
  • Cytogenic analysis/

Immunophenotyping

    • Determine subtype
How was D.L diagnosed?
prognostic factors what are my chances
Greatest prognosticator is the patients response to Chemotherapy
    • Best outcome if complete remission achieved during or on completion of induction therapy with MRD <0.01
  • Others Include:
    • Age
    • Initial WBC count
    • ALL subtype
    • MRD
Prognostic Factors:What are my chances?
treatments long term chemotherapy
Cranial irradiation is used less often since research indicated it may cause second cancers and late cognitive deficits.Treatments- long term chemotherapy

Ching-Hon, P. & Evans, W.E. (2006). Treatment of Acute Lymphoblastic Leukemia. New England Journal of Medicine, 354, p166-178.

cost of treatment
Cost of Treatment

http://www.cancer.org/docroot/MIT/content/MIT_3_2X_Costs_of_Cancer.asp; http://www.benzene-illness.com/html/medical-expenses.html; http://www.jlsfoundation.org/expect/parents.html; http://www.moh.govt.nz/moh.nsf/indexmh/cancercontrol-faqs#23

leukemia affects all aspects of life
Leukemia affects ALL aspects of life

McGrath, P. Positive outcomes for survivors of haematological malignancies from a spiritual perspective. International Journal of Nursing Practice 2004; 10: 280-91.

McGrath, P. Findings on the impact of treatment for childhood acute lymphoblastic leukaemia on family relationships. Child and Family Social Work 2001; 6: 229-237.

case study what is it like to live with all

Case Study: What is it like to live with ALL?

Kevin Evans, a 38 year old RN from Perth, Australia was encouraged to write of his experiences while having treatment for ALL. He is married and a father of a 9 and 12 year old boy.

You will be the nurse caring for Kevin from his initial diagnosis to the end of his treatment 2 years later.

diagnosis
#1: If you were the nurse in the room during his diagnosis, what are 3 interventions you could implement for Kevin?

#2: At the time of diagnosis, what are 3 immediate interventions you could implement for his family?

#3: What services or policies might you want in place in your clinic or hospital to assist patients during the diagnosis phase of cancer treatment?

#4: Name some resources either that you would suggest to the family or that you could use as a nurse to learn about ALL (can be online, books, organizations)

#5: What emotions might you expect Kevin and his family to be experiencing?

A

Diagnosis
admission
Set aside the technical aspects of nursing for a moment and reflect on your experiences as a student nurse.

Identify times when giving of your self was the most therapeutic intervention.

B

Admission
nursing care beyond the hospital setting
#1: Identify 3 coping strategies you could suggest to Kevin during procedures.

#2: Identify 3 coping strategies for dealing with complications.

#3: What stress might Kevin have as a father of two sons (12yo & 9yo) in this situation and how can you as a nurse help him manage it?

#4: Do you as a nurse support alternative therapies? Is this in conflict with your personal views? How might you go about supporting alternative therapies in a professional setting?

#5: Discuss the experience Kevin had with oxygen masks in the ER. How would you have handled the situation? Does this change your approach to potentially frightening patient experiences?

C

Nursing Care beyond the hospital setting
life long treatment
#1: Discuss potential emotions Kevin might be feeling about the frequent remissions. How might you instill hope and optimism in this situation? Do you support this, or might you be giving false reassurances?

#2: When and how would you address end-of-life issues with Kevin and his family?

#3: How would you support a struggling spouse during this process, from diagnosis to frequent remissions?

#4: What can you do if you witness a doctor’s (or other professional’s) behavior that is not supportive or understanding about the emotional aspects of cancer care?

#5: What can you do to support the spiritual needs that Kevin and his family might have?

D

Life-long treatment
slide25
After two years of chemotherapy, remission, relapses and a bone marrow transplant, Kevin’s prognosis was poor. He died suddenly on April 2nd, 1995, while this article was being prepared for publication and only four days after the cover photograph was taken. His family was with him on the day he died.
references
www.cancer.gov

www.cancer.org

Copstead, L-E.C. and Banasik, J.L. (2005) Pathophysiology. 3rd Ed. Elsevier: St. Louis, MO.

Evans, K. The other side of the coin. Australian Nursing Journal 1995; 2(10): 24-27.

Jabbour, E.J., Faderi, S., and Kantarjian, H.M. Adult Acute Lymphoblastic Leukemia. Mayo Clin Proc 2005; 80(11): 1517-1527.

Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G., and Bucher, L. (2007) Medical-Surgical Nursing: assessment and management of clinical problems. Mosby Elsever: St. Louis, MO.

McGrath, P. Positive outcomes for survivors of haematological malignancies from a spiritual perspective. International Journal of Nursing Practice 2004; 10: 280-91.

McGrath, P. Findings on the impact of treatment for childhood acute lymphoblastic leukaemia on family relationships. Child and Family Social Work 2001; 6: 229-237.

Morris, M.E., Grant, M., Lynch, J.C. Patient-reported family distress among long-term cancer survivors. Cancer Nursing 2007; 30(1): 1-7.

Pui, C-H, Evans, W.E. Treatment of Acute Lymphoblastic Leukemia. N Engl J Med 2006; 354(2): 166-178.

Tierney, D.K., Facione, N., Padilla, G., and Dodd, M. Response Shift: A theoretical exploration of quality of life following hematopoietic cell transplantation. Cancer Nursing 2007; 30(2): 125-137.

References
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