Supportive Care

Abstract

The diagnosis and treatment of a pediatric brain or spinal cord malignancy are accompanied by many challenges and stressors for both the child and the extended family. This continues to be true despite ongoing advances in treatments and improvement in survival rates. Supportive care describes the services and multidisciplinary care required to address the needs of the patient and their family in order to meet the physical, informational, psychosocial, emotional, practical, and spiritual needs during all phases of their cancer care. Although some of the supportive care needs are common among families, the diagnosis and treatment of pediatric brain and spinal cord tumors are complex and may be variable throughout treatment. This population may also present some unique challenges with respect to antiemetic management, endocrinopathies, posterior fossa syndrome, and neurocognitive issues. Patient-centered care for these individuals requires a collaborative and multidisciplinary healthcare team that collaborates to effectively assess and address the patient and family’s supportive care needs. Supportive care requirements of these children and families can include the physical (physiotherapy, occupational therapy, speech pathology, dietician, medical, pharmacy), education/informational (often met by nursing and medical team members), as well as psychosocial (social work, psychology, child life, psychiatry) aspects. This chapter discusses some of the most significant supportive care needs of pediatric brain and spinal cord malignancies including role of dexamethasone, endocrinopathies, psychosocial care, nausea and vomiting, pain control, fatigue and physical activity, posterior fossa syndrome, and neurocognitive issues. This chapter focuses on the diagnosis and active treatment phase of their patient journey as long-term follow-up is addressed in another chapter of this textbook. Supportive care needs of pediatric oncology patients that are not unique to pediatric neuro-oncology patients, like fever and neutropenia, infection prophylaxis, fertility preservation, transfusion support, mucositis, and venous thromboembolism, are not covered in this chapter as their management is similar to that of other pediatric oncology patients.