Objectives 1. Describe five common oncologic emergencies in pediatric patients who may be receiving home hospice services. 2. Describe three challenges created by integrating palliative care and curative therapies. 3. Describe evidence-based management strategies for five oncologic emergencies, including the use of surgery, chemotherapy, and radiation therapy. Childhood cancer remains the leading cause of death by disease for children and adolescents in the United States. Survival rates are widely variable. Although there have been improvements in the cure rates of some tumors, other tumors have long-term survival rates less than 20%. Palliative care is an essential part of caring for children with advanced cancer. The Patient Protection and Affordable Care Act signed into law in 2010 by President Obama contained a provision to provide simultaneous access to both curative therapy and hospice services for children insured through Medicaid and CHIP. This provision, termed the Concurrent Care for Children Requirement, has resulted in more children receiving aggressive disease directed therapies while simultaneously being cared for by hospice providers. It is important, therefore, for hospice providers to become more familiar with oncologic emergencies that may occur in patients undergoing cancer therapy because parent and patient goals might be to aggressively treat these emergencies and some emergencies may be reversible. Using a case based discussion, we intend to discuss management strategies for common oncologic emergencies, including increased intracranial pressure, superior vena cava syndrome, sepsis, spinal cord compression, and hyperleukocytosis. Available medical literature for treatment options will also be reviewed.
Hwang, J., Kang, T., & Pollack, R. (2014). Pediatric Oncology 911: What Palliative Care and Hospice Providers Should Know About Caring for Children with Progressive Cancer (TH304). Journal of Pain and Symptom Management, 47(2), 388. https://doi.org/10.1016/j.jpainsymman.2013.12.030