Paediatric Management - Late effects Flashcards
how many have multiple conditions which are life threatening
33%
how many develop at least one chronic condition
75%
how many have serious health conditions
40%
what happens to the incidence of LE
overtime it increases
how many are at risk of depression
40%
how many suffer from anxiety
27%
common side effects from trt
pain: medication/steroids [steroid induced psychosis]
weight-loss/vomiting: feeding tube
hydrocephalus: brain shunt [craniopharyngioma]
fitting: convulsants
risk of infection (neutropenia): sepsis is common
physical LE
growth inhibited, increased risk of fractures, difficulty repairing
fatigue
soft tissue growth
- <10Gy reduction of breast tissue
- >20Gy no development at all, failure to lactate
irradiating penile bulb = risks of erectile dysfunction
hip displacement
infertility, menopause: low libido, vaginal dryness, feeling undesired
cognitive LE
changes in educational ability
memory changes [short term memory loss]
methotrexate damages white matter so slow information porcessing
maintaining information
fatigue
psychological LE
mask
needle phobia
claustrophobia
PTSD
body dysmorphia
survivors guilt
depression
when is support given
at diagnosis
during trt
end of trt
long term follow up
at relapse
palliative care
following bereavement for families
cardiac issues
15x = heart failure
8 x = die from heart related issues
many go on to smoke or engage in extreme sports
what is given to prevent cardiac issues
dexaraxane
if <25 years receiving >300mg/m
of doxyrubicin
what is a child’s biggest fear
abandonment
CNS LE
balance issues
personality changes
subsequent chemo induced leukaemia
hearing loss
vision changes
hormone defects
thyroid cancer
tinnitus
thoracic LE
psychosocial issues
hyperthyroidism
lung fibrosis
breathing difficulties
soft tissue development i.e breast
skeletal development i.e chest wall
secondary cancers
abnormal chest wall development
difficulty eating
cardiac issues
abdominal LE
bowel: weakening, obstruction
soft tissue growth areas
bone weakening
vaginal dryness
erectile function issues
fertility issue [M+F]
liver function issues
kidney inflammation
immune deficiency [spleen irradiation]
urinary dysfunction, fibrosis, weakening
what are the challenges with LE
availability of services
psychological impact
location specialists
cost
QoL impact
life expectancy
pt present >18 referred back to the GP
what is gillick competency
if a parents refuses consent it can be overruled if thought to be in the best interest of the child
what age do they need to consent
any age
HCPC guidelines on consent
2.3, 2.7, 2.8, 2.9, 14.5
what is the eligibility criteria for PBT
to cure
MDT deems appropriate
>25
no distant mets except certain tumours which are curable even with mets: rhabdo, ewings determined on chemo response
referral put in + panel decide
pt choice
excluded if PBT is not superior to photons
adequate PS + fitness
RT for abdominal retinoblastoma
post op RT to bed
21Gy in 14 or
21.6Gy in 12
RT for bifocal germinoma
NO CHEMO
24Gy in 15 [max dose to ant spine = 18Gy]
16Gy in 10 [boosting brain: primary site]
RT for retinoblastoma
single lat field
GA + eye suction cups + mask
45Gy in 25 in 5 weeks
