Journal ofPediatric Oncology Nursing

Vol 17, No 3 July 2000

GUEST EDITORIAL

What Is Supportive Care andWhy Is it Important?

TREATMENT ADVANCES during the past10 years have dramatically increased

survival for children with cancer. More than60% of children who are treated for cancerare now cured. However, at what cost to thepatient has survival improved? Supportivecare is a term that describes the side effectsthat are caused by chemotherapy and radia-tion. These side effects may be both physicaland psychological in nature. Supportive careincludes, but is not limited to, the treatmentof emesis, nausea, depression, alopecia, oralcomplications, fatigue, and myelosuppres-sion. These side effects adversely affect thepatient’s quality of life and may interfere withultimate treatment success if the symptomsrequire significant chemotherapy dose reduc-tion.

Although the pediatric oncology researchgroups maintain statistics on the incidence ofside effects experienced while patients are ontreatment protocols, comprehensive reviewsof these incidences in the literature are scarce.However, one would expect an increase inthe incidence of side effects to follow with theincreasing intensities of the treatment regi-mens for pediatric malignancies. Further-more, the shift in medical care to the outpa-tient setting makes it more difficult to assessthe side effects that patients experience inthe home.

Tanghe, Evers, and Paridaens (1998) ex-

amined the issue of symptom occurrenceafter chemotherapy. They measured the levelof agreement between patient and nurseconcerning symptom occurrence (189 adultoncology patients and 51 nurses). Nursesunderestimated the incidence of symptomsreported by patients. Youngblood, Williams,Eyles, Waring, and Runyon (1994) com-pared the number of symptoms identified by91 adult oncology patients with those docu-mented in the patient’s medical record. Themean number of symptoms reported by thepatient was significantly higher than thatdocumented in the medical record(p � .001). Both of these studies show thatpatients are suffering more than we realize.

Nurses are instrumental in assessing andmanaging treatment-related side effects. Thisissue of the Journal of Pediatric OncologyNursing focuses on supportive care. It high-lights selected side effects and adverse eventsand provides suggestions to improve theirmanagement and treatment. Kathy Forteand Thomas Abshire and Casey Hooke dis-cuss agents that are vital to supportivecare efforts: Hepzyme (Dade, Miami, FL),which is used to eliminate heparin in bloodsamples, and recombinant tissue plasmino-gen activator, which is used to clear occludedcentral venous access devices. Carol Ros-setto and Julie McMahon provide a compre-hensive review of transfusion practices, in-cluding nursing management of transfusionreactions and future trends in transfusionsupport. Assessment and management of

� 2000 by Association of Pediatric Oncology Nursesdoi:10.1053/jpon.2000.8164

Journal of Pediatric Oncology Nursing, Vol 17, No 3 (July), 2000: pp 133-134 133

chemotherapy extravasation injury set theoncology nurse apart from other nurses, andthese issues are reviewed by Elizabeth Kass-ner. Melody Brown Hellsten discusses ob-stacles that limit adequate pain manage-ment, as well as the impact of inadequatepain management on children and families.Andrea Bakke and Deborah King discuss theoften forgotten aspect of caring for the emo-tional dimension of the child and family withcancer. Finally, but most importantly, weglimpse the patient’s perspective of chemo-therapy side effects in this issue’s Road-maps, written by Sonia Fuentes.

Cancer treatment and supportive care areclosely intertwined. Success in one area can-not be achieved without attention to the

other. Aggressive treatments designed to curepediatric malignancies will not be toleratedby patients unless research studies to im-prove the treatment and management of therelated side effects are undertaken. Childrenshould be able to expect—and deserve—anoptimal quality of life during cancer treat-ment.

What is important about supportive care?The answer is everything!

Jill E. Brace O’Neill, MS, RN-CS, PNP, CPONGuest Editor

Coordinator of Clinical ResearchChildren’s Hospital

Boston, MA

ReferencesTanghe, A., Evers, G., & Paridaens, R. (1998). Nurses’

assessments of symptom occurrence and symptomdistress in chemotherapy patients. European Journal ofOncology Nursing, 2(1), 14-26.

Youngblood, M., Williams, P.D., Eyles, H., Waring, J.,& Runyon, S. (1994). A comparison of two methods ofassessing cancer therapy-related symptoms. CancerNursing, 17(1), 37-44.

Guest Editorial134