Child cancer scenarios. GP CME Rotorua 2014

Transcription

1 Child cancer scenarios GP CME Rotorua 2014

2 Scenario 1 Chickenpox is in the school What is the response when the parent of a child on chemotherapy rings the practice?

3 Scenario 2 -chickenpox Varicella is a significant risk in the immunocompromised patient and can result in severe illness and death (though usually doesn t!) Many calls will not actually involve personal contact of the immunocompromised child with the infectious child and are false alarms There is no requirement to keep the child out of school because there is chickenpox around (it always is!)

4 Scenario 1-chickenpox Zoster immune globulin (ZIG) or pooled immunoglobulin (Intragam) can be given early or a course of 7 days aciclovir (80mg/kg/day in 4 divided doses) beginning 7 days after exposure (the period of potential viremia) These will be given at the hospital. Regard as potentially infectious for 28 days VZIG or IVIg protection only lasts 4 weeks, then start all over again!

5 Scenario 2 The family presents with a child on chemotherapy. The presenting condition is one that is familiar to the GP, commonly occurs in general practice and you are confident to manage the condition. What additional aspects should be considered?

6 Scenario 2- intercurrent illness Is the child unwell/ febrile? Is the child reasonably well but likely to be neutropenic? Does the child have a central venous line? How far away from the hospital are you? Almost always, you will call the local paediatrician for advice.

7 Scenario 2 Occasionally, where a child s home is remote with the likelihood of a significant delay before definitive care can be provided at the hospital, we have provided a febrile neutropenia pack with instruction for the local GP. This includes blood culture bottles, a broad spectrum parenteral antibiotic and where appropriate a special needle to access the portacath.

8 Scenario 3 You are asked to provide care at home to a child who is dying from cancer for which all reasonable curative therapies have been exhausted. You haven t had contact with the child since diagnosis because all treatment has taken place at the local hospital and Starship although you have received regular communication from the hospitals and from the family about what has been happening.

9 Scenario 3 palliative care More than half of the 20% of child cancer patients who are not cured will die at home. While specialist palliative care services are available in many places and the oncology team remains involved, the GP is often asked to take an important role in providing care. This is not expected to be undertaken without suitable support, advice and information.

10 Scenario 4 The Mum of a 7 year old who recently completed treatment for ALL presents to your practice requiring reimmunisation. What is involved?

11 Scenario 4 Immunity returns to normal at 6 months (12 months after stem cell transplant) Often there is no or patchy protection despite earlier vaccination Serology checked and individualized catch up programme provided New immunisation schedule which should make it more straightforward to reimmunise and claim.

12 Scenario 5 A 14 year old boy with AML experienced life threatening toxicity during treatment but is now off treatment and 4 years disease free. He is at risk of late morbidity from his treatment having been exposed to relatively high cumulative doses of anthracycline Do you as his GP have a role in his ongoing care?

13 Scenario 5-late effects follow-up He is now at negligible risk for relapse. His major risk is now from the consequences of his treatment. He will have a Health Passport detailing all his treatment and his surveillance testing to date (including ECG and echocardiogram results) He will also have a list of recommended follow-up investigations and timings for those.

14 Scenario 5 late effects follow-up Is this kind of care appropriate for primary care? Are tests done in secondary care accessible to you?

15 Scenario 6 A young woman of 17 has been discharged from oncology follow-up after treatment for ALL when she was 7. She is cured of leukaemia She had no demonstrable late effects of therapy at discharge from the hospital clinic What is your strategy for her health care?

16 Scenario 6 routine health care In spite of increasingly better tailored treatment for ALL and reduction in anthracycline and alkylating agents, late effects continue to be seen. Early aging and in particular, early onset of metabolic syndrome is being reported in survivorship series. Monitoring for this should be incorporated in well patient care

17 Scenario 7 The parents of an 8 year old child with lymphoma decline the treatment which offers her a 75% chance of cure because of their religious beliefs. What is your role in such a circumstance?