Pediatric neuroblastoma

Nurse: As you might know, neuroblastoma is a cancerous tumor in infants and very young children. 90% of the patients are under the age of 6 at the time of the diagnosis, and 30% less than 1 year old. No specific environmental exposure or risk factors have been identified so far.

Trainee: But then, how does this cancer develop

Nurse: The abnormal cells are often found in the nerve tissue that is present in the unborn baby and later develop into a detectable, solid tumor.

Trainee: What are the signs and symptoms of neuroblastoma

Nurse: They include abdominal pain, vomiting, weight loss, anorexia, fatigue, and bone pain.

Trainee: I suppose that children are taken care of in the oncology department, aren’t they?

Nurse: Yes, care is given by a multidisciplinary team involving pediatric oncologists, radiation oncologists, surgeons, and anesthesiologists, as well as nurses, pharmacists, psychologists, and physical and occupational therapists.

Trainee: What is the prognosis and treatment for neuroblastoma?

Nurse: On the basis of age, stage and tumor biologic features, it is classified as low, intermediate, or high risk. In case of low risk, resection may be the only treatment needed. A moderate dose of chemotherapy can be given in addition to surgery for intermediate-risk neuroblastoma. The treatment for high-risk neuroblastoma includes resection, high-dose chemotherapy with bone marrow transplantation and immunotherapy. Radiation therapy is often helpful.

Trainee: But I imagine surgery and chemotherapy would trigger much pain?

Nurse: Actually, apart from the usual nausea, vomiting, weakness, appetite loss and hair loss, there might be muscle pain and abdominal cramps.

Trainee: Effective analgesia should thus be prescribed and side-effects should be monitored.

Nurse: Yes, but pain needs to be assessed to estimate its severity before it can be managed. We usually ask the child to evaluate his pain using the face pain rating scale from zero to five, that is from “no hurt” to “hurts worst”. This scale can then be used to give adapted painkillers.

Trainee: So pain management is a priority and pain relief should be the most important objective. What kind of medication do we give children in this case?

Nurse: We usually prescribe paracetamol and non?steroidal anti-inflammatory drugs, given separately or combined, thus lowering the need for morphine and avoiding the opioid-related side-effects.

Trainee: Is that all?

Nurse: No. We can teach slow breathing and relaxation techniques, but also distraction from pain through art, music, video games and TV. It has also been proven that hypnosis helps reduce stress and pain. The most successful approaches to pain management are those that combine pharmaceutical and non-pharmaceutical therapies.