The Nurse’s Role in Childhood Leukemia From Disease Recognition to Survivorship Care

Nurses are often the first health care providers to suspect leukemia in their young patients, and the significance of their role continues throughout the disease process. This is important; leukemia is the most common type of cancer in children. A group of nurses in the United Kingdom recently presented a review on the trajectory of a leukemia diagnosis, and the information can benefit oncology nurses worldwide.¹

Childhood leukemia represents 25% of all new childhood cancer cases. According to 2012-2016 US SEER statistics, 4.6 new cases and 0.6 deaths occur per 100,000 children per year. Eighty-four percent of patients survive 5 years.² Although chronic leukemias can affect children, the types that develop most often in pediatric patients are acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).

Clinical Presentation

Childhood leukemia is most frequently diagnosed in children aged 1 to 4 years.² Earlier recognition and diagnosis of leukemia in a child is better, because an emergency or late diagnosis can have a deleterious effect on patient outcome and survival. Differentiating between AML and ALL may be difficult because some symptoms denote both diseases, such as low or dysfunctional platelets, white blood cells, or red blood cells. However, patients with AML may experience extreme weakness and fatigue, gum hypertrophy, and skin infiltration, whereas those with ALL often present with lymphadenopathy.

In addition to the typical symptoms of bruising, abnormal bleeding, and fever, many children present with abdominal, musculoskeletal, and other nonspecific symptoms or even those that mimic common childhood illnesses. Therefore, following up on parents’ reports that their child “just isn’t right” is important.¹