Uncommon leukemias: implications for clinical practice

The nursing management of patients with rare leukemias involves physiologic, psychologic, and ethical activities. Specific nursing interventions aimed at supporting bone marrow suppressed patients have been addressed in the literature and other reports in this issue. The potential for oncologic emergencies in these rare leukemias is great. These include disseminated intravascular coagulation (DIC), cerebral and pulmonary leukostasis, sepsis, and acute renal failure. Recognition that patients are at risk for these acute events prepares nurses for their assessment, diagnosis, and plans of care. Eleven high-incidence problems for cancer patients have been described, and all can be applied to these patients. Emotionally, patients and their families rely on nurses to assist them in coping with a new diagnosis of cancer, and/or dealing with the chronic nature of their disease. Open communication, firmly based on a thorough knowledge of the particular disease and treatment, will promote trust and a sense of comfort as the patient begins treatment. Finally, it is important for all nurses caring for cancer patients to identify their personal feelings and biases. In the current environment where clinical investigation is a part of everyday care, the nurse must be comfortable with the research process and the participation of human subjects in clinical trials. Nurses play a role in the development of clinical trials and the process of informed consent, and in the management of patients involved in clinical trials. Over the last 5 years, we have witnessed a dramatic increase in the number of therapies available for one particular rare leukemia (hairy cell leukemia). This has resulted in significant improvements in patient outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)