The recognition and nursing management of common oncological emergencies in children

An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.

Carotid blowout syndrome: endovascular management of a lesser known oncological emergency: case report

Background Carotid blowout syndrome (CBS) refers to a fatal hemorrhagic complication of cervical carotid arteries that occurs due to rupture of the extracranial carotid artery or one of its major branches in patients treated for head and neck malignancy. In this article, we will discuss two different spectrum of CBS and endovascular approach. Case presentation Two cases of per oral bleeding presented in the emergency department. After patients were hemodynamically stabilized, CT angiography was done which showed type II CBS and type III CBS, respectively. This was followed by transfemoral supra-aortic digital subtraction angiogram coil embolization with scaffolding and anchoring technique, respectively, for the patients. Conclusions Early recognition of the predictors of CBS by a multidisciplinary team is critical. The endovascular treatment approach is relatively safe and effective with low rates of morbidity and mortality compared to surgical approach in CBS.

Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit

Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.

Collaboration and learning in teams of registered nurses and medical doctors: A qualitative descriptive study

Patients with cancer are expected to call an oncological emergency unit when they are unable to manage symptoms of their disease and side effects from treatment at home. Responding to calls from patients with different problems in a team of registered nurses and medical doctors requires interprofessional collaboration and learning. Therefore, this study aimed to explore conditions for team-based collaboration and learning when responding to calls from patients diagnosed with cancer in a specific setting of an oncological emergency unit. Using a frame of qualitative description three focus groups with 16 healthcare professionals from an oncological emergency unit at a Danish University Hospital were conducted. The verbatim transcribed text was analyzed using content analysis, and reported according to the COREQ guidelines. Two main themes emerged: 1) ‘Availability – a precondition for learning and collaboration’ and 2) ‘Sense of responsibility and distribution of roles’. The study demonstrated that interprofessional collaboration and learning were affected by intra and interprofessional and contextual factors. In addition to an awareness of personal attitudes, the environment and the distribution of responsibility and roles as essential preconditions for accomplishing teamwork need to be explicitly articulated if the team-based learning and collaboration are to succeed.

Primary angiosarcoma of superior vena cava: an unexpected diagnosis after an oncological emergency

Angiosarcoma (AS) is a rare malignant tumour representing 1%–2% of all sarcomas. Primary AS of superior vena cava (SVC) was reported in two cases worldwide. We report a 69-year-old woman with neck discomfort, headache and dyspnoea for 3 months. CT angiography showed thrombosis in SVC and brachiocephalic veins resulting in an SVC syndrome. The patient began anticoagulant therapy and underwent balloon angioplasty with clinical improvement. Additionally, a positron emission tomography scan confirmed the presence of a mediastinal mass involving the SVC locally. The tumour was excised and a prosthesis was placed on the SVC. Histology revealed a heterogeneous tumour matrix, either myxoid and composed by fusiform cells with vimentin, homogeneous CD31 and a 30% Ki67 immunoexpression, supporting the diagnosis of an AS. Due to multiple complications, the patient never started chemotherapy, and after tumour recurrence, she died within 5 months after diagnosis.

Bleeding In Head And Neck Malignancy : Institution Based Management And Review

Introduction:Squamous cell carcinoma constitutes for >90% of head and neck cancers. Acute rupture of irradiated, large vessels is life-threatening complication. The distribution of bleeding foci is diverse and can range from internal or common carotid arteries to branches of the external carotid artery. We intend to assess the management of patients presented in our institution with such acute bleeding episodes and also review the management of carotid blowout syndrome which is an oncological emergency.Methods:Retrospective observational study of 27 cases presented in our institution with acute bleeding due to head and neck cancer for period of two years. After resuscitation and necessary consents, emergency open tracheostomy was done with universal precautions. ECA/CCA ligation was done. All the patients were started on low molecular weight heparin 8 hours post surgery. Therapeutic outcomes were assessed based on simple frequencies and proportions.Results:Of the 27 cases presented in our institution, 19 of them underwent ECA ligation while 8 of them CCA ligation for the control of active bleeding. 12 of 27 patients were receiving definitive chemoradiation of which 7 of them were ongoing. Remaining 15 patients were receiving adjuvant radiotherapy following surgery.19 patients who underwent ECA ligation, had no further bleeding episodes. 8 patients who underwent CCA ligation, had only wound related complications and none of them had neurological deficits. 11 patients were operated during covid-19 period. 4 patients turned out covid positive. None of the medical personnel contacted the infection.Conclusion:Radiotherapy is one the major contributor for CBS. Endovascular procedures can be used for local tumour bleed, threatened, impending and stable acute CBS. Surgical CCA ligation done in bleeds unsuccessful by endovascular procedure and in acute unstable CBS. ECA ligation is safe and effective method to control local tumor bleed. Surgical finesse, careful planning, adherence to universal precautions and institutional protocol can reduce Covid-19 transmission to medical personnel in this testing times.

A Shock-Like Pain and Inability to Ambulate: Thoracic Spinal Cord Compression from Hepatocellular Carcinoma

Hepatocellular carcinoma commonly metastasizes to organs, but there are few reports of vertebral metastases causing cord compression. Here, we present a case of thoracic cord compression in a patient with advanced hepatocellular carcinoma. Providers’ and patient’s awareness of this risk is important, as this is an oncological emergency.

Spontaneous tumour lysis syndrome in multiple myeloma with loss of 17p13.1, t(4;14) and monosomy 13

Tumour lysis syndrome (TLS) is a constellation of metabolic derangements caused by lysis of tumour cells. It is an oncological emergency that is considered a rare occurrence in multiple myeloma (MM) and usually occurs after patients have been treated with chemotherapy. We describe a very rare case of TLS occurring before the official diagnosis or treatment of MM. We report infrequent karyotype abnormalities, including loss of 17p13.1 (TP53 mutation), t(4;14) (FGFR3/IGH fusion) and monosomy 13, that have not been explicitly described in association with spontaneous tumour lysis syndrome (STLS) in MM. This case adds to the sparse literature available on STLS in MM, which is a life-threatening situation requiring urgent medical intervention.