To achieve accurate diagnosis and sub classification, it is necessary to identify the immunophenotypic, cytogenetic and morphology features of ALL.5
Investigations used to confirm a diagnosis of ALL include:11
- full blood count - red cells, platelets, white cells and blast count
- bone marrow aspiration - histochemistry, immunophenotyping and cytogenetics
- chest x-ray
- blood chemistry - electrolytes, blood urea, uric acid, liver function tests, immunoglobulin levels
- cerebrospinal fluid examination - chemistry and cells
- coagulation profile
- cardiac function
- infectious diseases profile - varicella antibody titer, cytomegalovirus status, herpes simplex antibody and hepatitis antibody screening
- immunological screening - immunoglobulin levels.
In children presenting with lymphadenopathy, tissue specimens may be collected if a distinction between leukaemia and lymphoma is required.5
List the diagnostic procedures and investigations commonly used to confirm a diagnosis of ALL, and discuss nursing interventions for a child undergoing these procedures.
Outline the immediate clinical and supportive care interventions required for a child who presents with:
- indicators of tumour lysis syndrome.
Case study: Meet Ellie
Ellie is a 4-year-old female diagnosed with ALL. This case study follows Ellie from diagnosis to recovery.
After watching the first video, work through the learning activities.
Ellie’s story 1: Ellie is diagnosed
Access relevant research on responses of parents to diagnosis of cancer in their child, and discuss how Renee's response may be explained by this evidence.
Explain how the SCN can support Renee and Sean in dealing with their emotional responses at the time of diagnosis.
Experience of diagnosis
The family's needs for support are substantial at the time of diagnosis, as they cope with a serious physical illness and the fear that their child will not be cured.12
At diagnosis, parents must adjust to the emotional realisation that their child is living with a life-threatening disease, while simultaneously receiving a large amount of information on how to manage and care for their child during treatment. Parents are very vulnerable during this time, and have an intense need for support from partners, families, friends, employers, hospital staff, and other parents.13
How parents respond to their child's diagnosis can also have a profound effect on how the child develops and responds to his/her illness. Factors which may influence how parents react include:12
- reactions to previous crises
- reactions of the child
- child rearing practices and attitudes
- available support systems
- perception of the illness
- previous knowledge or experience with cancer
- cultural and religious beliefs
- beliefs about the cause of the disease
- effects of the disease on the family
- concurrent stresses in the family.
Characteristics which affect children's responses include:12
- age (most vulnerable - six months to four years)
- development level
- social skills and self-concept
- pre-existing conditions and previous experiences
- intelligence level
- type of disease
- reactions of significant others.
Primary caregivers, who are important to the well-being of the child during treatment, need to understand the nature of the disease, treatment options and prognosis in order to participate in treatment decisions and to take on the care roles expected of them.10, 14 Nurses working with children who have cancer have a significant supportive role in:12, 14
- providing information and supportive care
- helping the family understand the various therapies
- preventing or managing side effects or toxicities
- observing for early and late effects of treatment.
Access a paediatric oncology text and the following resource:
Improving outcomes in children and young people with cancer14
- Summarise key principles in providing supportive care for people affected by childhood cancer during the diagnostic phase.
- Discuss the role of hope in the childhood cancer journey and the role of the SCN in maintaining hope.
Ellie’s story 2: Experience of diagnosis
Outline how you would respond to Sean's questions about what to say to Ellie about her illness.
Access the following resources:
- Improving outcomes in children and young people with cancer14
- Clinical practice guidelines for the psychosocial care of adults with cancer15
Utilising principles of age and development appropriate education, describe possible strategies to work with Ellie and her parents in the provision of information about her treatment and care requirements.
Identify sources of information and resources available from the major cancer organisations in your area that might be used to assist Sean, Renee and Ellie at this time. Discuss the quality, usefulness, and developmental appropriateness of this material.
Outline the key social and emotional issues Ellie's family may face over the next three months related to Ellie's diagnosis with ALL, and the role of the SCN within the multidisciplinary team (MDT) to respond to these issues.