An Overview of Retinoblastoma and Enucleation in Pediatric Patients.

Retinoblastoma is a rare malignancy of the eye affecting children, most commonly four years old and younger. Although chemotherapy and radiation treatment aim to spare the eye, in some cases, enucleation (ie, removal of the eye) is required to prevent cancer metastases or recurrence. Enucleation procedures are primarily performed at specialty institutions and may involve the surgical placement of an implant in the orbit of the eye. Unique perioperative considerations are required because of the age of the child at the time of the diagnosis and procedure and the involvement of a parent or caregiver who will be caring for the child postoperatively. This article presents an overview of retinoblastoma and enucleation and discusses the care and management of the unique patient population undergoing enucleation.

A longitudinal investigation of parenting stress in caregivers of children with retinoblastoma.

BACKGROUND: Retinoblastoma is typically diagnosed in young children and may present unique parenting challenges. Qualitative research suggests that parents experience distress related to the initial diagnosis and treatment that subsequently resolves. The objectives were to systematically assess parenting stress over time in parents of young children with retinoblastoma and to examine associations between parenting stress and child outcomes. PROCEDURES: Parents of children with retinoblastoma completed the Parenting Stress Index (PSI) during serial psychological assessments scheduled based on the child's age (6 months to 5 years). Caregivers of 92 patients (85.9% mothers) completed the assessments. Child outcomes included developmental functioning and parent-reported adaptive functioning. RESULTS: At baseline and age 5, all subscales on the PSI were within normal limits, and most were significantly below normative means (i.e., demonstrating low levels of stress). All domains remained relatively stable over time. Associations between parenting stress and child outcomes were much stronger at age 5 than at baseline. Child-directed parenting stress was a small but significant contributor to declines in child functioning over time. CONCLUSIONS: Parents of children with retinoblastoma report normal levels of parenting stress while their children are young. However, baseline parenting stress appears to contribute to changes in child functioning over time. Future studies should assess illness-related aspects of adjustment to further understand the parenting experience of young children with cancer and/or having a visually impaired child.

Depression, caregiver burden and social support among caregivers of retinoblastoma patients in China.

The aim of this study is to examine the burden of family caregivers of patients with retinoblastoma in China and the relationships between depression, caregiver burden and social support. A descriptive and correlational survey was conducted with 117 Chinese family caregivers of outpatient patients with retinoblastoma from the Department of Ophthalmology of a tertiary hospital in Shanghai, China. Family caregivers of outpatient patients with retinoblastoma were asked to respond to four questionnaires including sociodemographic questionnaire, Becker Depression Inventory, Caregiver Burden Inventory and Social Support Rating Scale. The incidence of depression in this study was 51.3%; the average score for social support indicated moderate social support available to the caregivers, although their level of caregiver burden was heavy. Depression scores were significantly positively correlated with caregiver burden scores and significantly negatively correlated with the social support scores. Heavy caregiver burden was associated with lower monthly income, low subjective social support and less use of social support.

Retinoblastoma: an overview for advanced practice nurses.

PURPOSE: To provide an overview of the current literature surrounding the detection and management of retinoblastoma as well as care for the long-term survivor to serve as a guide for advanced practice nurses. DATA SOURCES: Comprehensive review of the literature on retinoblastoma including case studies, journal reviews, retrospective studies, and briefs. CONCLUSIONS: Retinoblastoma is a pediatric intraocular malignancy usually detected in the primary care setting. Typically asymptomatic, primary care providers will often identify the presence of retinoblastoma upon routine eye exam. Prompt diagnosis and commencement of treatment are paramount as delay in diagnosis leads to higher morbidity and mortality. Treatment options vary depending on the extent of disease. IMPLICATIONS FOR PRACTICE: Although current survival rates for retinoblastoma exceed 90%, individual visual outcome and survival are dependent upon early detection and prompt referral. In addition to research and education of survivors and families, advanced practice nurses play a key role in early detection and maintaining the current survival rate.

Nurse-initiated retinoblastoma service in New Zealand.

A diagnosis of retinoblastoma is devastating not only for the parents of the children but also for the ophthalmic staff who are involved in the provision of care. In Auckland, New Zealand, the Ophthalmology Department provides specialist ophthalmic care for children and their families diagnosed with retinoblastoma. It became clear to nurses with an interest in retinoblastoma that the service provided was not meeting the needs of patients and families, particularly since the numbers had increased over the past two years. Improving our service was essential, but it had to be done in a cost-effective way. We have been successful in implementing a dedicated support network and service for these patients and families with very little additional resources, and we are extremely proud of these achievements.

Visual impairment in children.

This article examines the paediatric ophthalmic nurse's role in treating and managing several common ocular conditions.

Radiation dose profile in 125I brachytherapy: an 8-year review.

The use of episcleral plaques containing radioactive 125I seeds for brachytherapy treatment of selected retinoblastoma cases of patients is being done in Riyadh, Saudi Arabia since 1994. There are about three to four patients per year. A total of 31 patients were treated with a tumour dose in the range of 40-60 Gy using 8 seeds of 125I each from 1994 to 2002. This study determines the trend of occupational doses received by surgeons, anaesthesiologists and nurses and the dose rate profile around the eyes. Only 3% of the 275 persons monitored for Hp(10) have measurable doses with a weighted average of 4 microSv and 7% of the 175 persons monitored for Hp(0.07) have measurable doses with a weighted average of 0.3 mSv. The dose rate is maximum (110 microSv h(-1)) at the point of contact with the eye plaque and reduces to approximately 40% on the side of the other eye.

Retinoblastoma: care and support of the pediatric patient and family.

This paper presents the holistic approach to the care of the pediatric patient with strabismus. It discusses preoperative management, contemporary surgical procedures including postoperative suture adjustments, complications and the care and management of the patient and family on the pediatric unit. It reviews discharge instructions including pain management, postoperative safety and the follow-up appointment with the surgeon. Methods of determining the level of knowledge of the child's primary caregiver are also a major focus.

The treatment of retinoblastoma: a case study.

Research in the treatment of retinoblastoma and multidrug resistance has led to new treatment protocols for children. This case study introduces information regarding a clinical trial for the treatment of intraocular retinoblastoma. It also highlights important nursing issues in the care of these children and their families.

Hereditary cancers in children and ethical and psychosocial implications.

This article describes the application of genetic testing of children for hereditary cancers and the resultant ethical and psychosocial implications. Basic cancer genetics concepts are reviewed. Specific hereditary cancers that may affect children are described along with case examples and recommendations for nursing practice.

Genetic teaching for the retinoblastoma patient.

Retinoblastoma is the most common primary intraocular tumor in children. Retinoblastoma can be hereditary (familial) or nonhereditary (nonfamilial). Nurses who have an understanding of the genetic patterns for retinoblastoma can participate in the counseling of these patients. A chart is provided as a tool for teaching patients about family patterns of retinoblastoma.

The power of humor and play as nursing interventions for a child with cancer: a case report.

Many benefits of humor and play have been documented in the literature. The purpose of this Case Report was to assess the benefits of humor and play with a 5-year-old retinoblastoma patient in an ambulatory care setting. The use of humor in the forms of tickling, joke-telling, play on words, funny movies, silly stickers, and medical play was found to be helpful in decreasing the anxiety of a pediatric oncology patient during insertion of his Infusaport needle. This article reviews the benefits of humor and play and provides a brief discussion of the developmental aspects of humor and play theory. Implications for further nursing research in the area of humor interventions are also discussed. The promotion of appropriate humor and play use by all health care professionals is encouraged.

Genetic teaching for the retinoblastoma patient.

Retinoblastoma is the most common primary intraocular tumor in children. Retinoblastoma can be hereditary (familial) or nonhereditary (nonfamilial). Nurses who have an understanding of the genetic patterns for retinoblastoma can participate in the counseling of these patients. A chart is provided as a tool for teaching patients about family patterns of retinoblastoma.

Nursing implications of visual fields in successfully treated retinoblastoma patients.

Very little data has been published on the long term peripheral vision of patients diagnosed and successfully treated for retinoblastoma. Nursing should address the patient's response to vision-conserving treatment and their adaptation to decreased peripheral vision. Computerized Humphrey's Central 30/Peripheral 30-60 visual fields were performed on ten patients (all with greater than ten year follow-up) who were successfully treated for retinoblastoma. All ten visual fields revealed an absolute and relative scotoma in the affected eye. Visual field loss was always worse than one would have predicted based upon the fundus examination of the tumor(s). Decisions for treatment must be based upon an interdisciplinary approach of nursing and medicine to evaluate patient survival and visual outcome. Nursing interventions include utilizing the visual field as a teaching aid, preparing the patient and the family for potential future visual loss and adaptation of lifestyle, and providing emotional support and realistic reassurance.

Retinoblastoma: a hereditary tumor in children.

Retinoblastoma, a malignant intraocular tumor of infancy and childhood, originates from primitive embryonal retinal cells. The cause of retinoblastoma is the loss or deletion of genetic information from the long arm of chromosome 13. Retinoblastoma has a hereditary form characterized by bilateral and multifocal tumors, and a nonheritable form that presents with a single tumor.