Ep. 32 Nursing in Pediatric Cancer with Becky Dolman MSN, RN, FNP-C

Join Neva as she talks to Becky Dolman MSN, RN, FNP-C about pediatric hematology/oncology nursing. How have remission rates improved? What is realistic advice for families dealing with childhood cancer? Childhood cancer prevention?  How does childhood cancer treatment differ from adult cancer treatment? In a field that offers rewards and challenges, adjusting to each patient is a critical team effort, and staying positive because there is, life beyond cancer. Find out more in the episode! 

Transcript

S2 Ep.2 Nursing in Pediatric Cancer with Becky Dolman RN, FNP-C

Neva

00:00:01

Hey, welcome to alphabet soup. This season, we're focusing on cancer through meeting with healthcare workers and patients. Today, we are joined by registered nurse and family, nurse practitioner, Becky Dorman, who has 17 years of experience working in pediatric hematology and oncology to talk about both the rewards and challenges of working in pediatric oncology, how remission rates are improving realistic advice for families dealing with childhood cancer prevention, how adjusting to each patient is a critical team effort. And finally, on staying positive because there is life beyond cancer. Here's Becky Dolman. Hey, how's it going?

Becky Dolman RN, FNP-C

00:00:57

Good. How are you?

Neva

00:00:58

Good. Thank you. Welcome to alphabet soup. I'm very happy to have you on the show. Would you mind telling me and the listeners a little bit more about yourself?

Becky Dolman

00:01:08

Sure. I've been a registered nurse since 2001. I worked in pediatric hematology, oncology bone marrow transplant ICU for 17 years. I was a director for Loma Linda university children's hospital for five of those years. And then I became a family nurse practitioner in 2018 and started working with pediatric surgery, trauma services at Loma Linda in 2019. And I've been with them ever since. Wow.

Neva

00:01:35

So today we wanted to focus on the time where you were a pediatric oncology nurse. So I was wondering what a day in the life was like for you.

Becky Dolman

00:01:47

Well, I mean, I stayed in pediatric hematology oncology for 17 years because it was just an amazing experience. Our kids are so resilient and that's so amazing. And a lot of the time we became a part of their family. So it was just a really great, like every day I went to work and it was just such a rewarding experience. And we took care of patients and it's really changed a lot over the years. It used to be that our kids would stay in the hospital for long periods of time. And there were a lot of the oncology treatment is in the outpatient setting in the clinic. And we really now only see oncology clinic kids in the hospital for acute settings when they're first diagnosed, when they're really sick and we get them stabilized and get their chemotherapy started. And once they're stable, then they get to go home and then they, and then it's, I mean, it's not normal life, but it's better than being in the hospital for long periods of time. Like they used to be.

Neva

00:02:42

Do you think remission rates have gone up in the past in recent years?

Becky Dolman

00:02:47

Yeah. So standard risk leukemia is about an 85 to 95% cure rate nowadays where it used to be in the sixties and 70% cure rate. So, oh, that's a lot better. Yeah. So all, all of our, all of our diagnosis have actually really improved and we see really good outcomes in pediatric cancer. Yeah,

Neva

00:03:07

That's great. So it must have been a long journey for you to get where you are today, but at the same time, like you said, your work must be very rewarding. So I'm curious for you, what are some of the rewards and challenges that come with pediatric oncology nursing?

Becky Dolman

00:03:26

There are words in pediatric oncology or that our kids do really well and that we get to see them. They come back and they have kids and they're married and they come and check in with us and see how we're doing. And I'm still really good friends with a lot of the oncology nurses that still work on 4,800 at Loma Linda. And so I get to see all of our kids that are now adults and having kids and getting married. One of the most difficult challenges is that we do have kids that don't do well. And we have to add a point, decide to tell the family that we can no longer offer therapy and give them a peaceful death. And sometimes that can be hard, but it can also be rewarding because it needs to be closure for the family as well as for the patient. And for them to be able to say goodbye and be able to let go and to have closure for everyone that's involved.

Neva

00:04:19

I'm sure it's hard, not only for those kids, but also for those parents. So with your expertise, working with them, how, what would be your message or advice for those parents?

Becky Dolman

00:04:34

That's difficult because it's a difficult scenario and every patient and family are different and how they handle difficult situations. And so I think the most important thing is to be realistic and have expectations that are realistic for the family and for the parents. And just to do one day at a time. I mean, I had a nephew that was also diagnosed with a bone cancer osteosarcoma in 2015. And so I had to go through his journey as well, being an oncology nurse. You think, you know that you shouldn't have a family member with cancer, but we did. And so we got through it and he's, you know, surviving and he's cancer free for the last two years, but when you're in it, it's different. And so I think you just have to try to stay as positive as possible and live one day at a time and just do the best that you can. And that's all you can do.

Neva

00:05:30

Well, I'm glad your nephew is doing better. And I wanted to know if there are preventative measures that parents should be aware of that may lower the risk of their child developing cancer.

Becky Dolman

00:05:44

Yeah. So there's not really anything that's been identified that has shown that causes cancer in pediatric patients. One thing that we know that may cause cancer or increase the risk for is radiation. And so decreasing the amount of CT scans or x-rays or things that increases radiation exposure in pediatrics has been a focus for primary care and pediatricians and also surgeons. And so one thing that we are doing as a surgical group is we're decreasing the amount of CT scans we use to diagnose acute appendicitis and pediatric patients because we know exposure to radiation can cause cancer in pediatric patients. And the more exposure, the more risks they have, we don't know what type of cancer it can cause any type of cancer. And so one thing I think for parents to know, and to recognize is that when a provider is saying, Hey, we really don't want to do this x-ray or do this CT scan because it's not helpful. And it exposes them to radiation that could therefore cause them to have a pediatric cancer in the future. That, that that's a good knowledge to have so that they can say, oh, I get it. I don't, we don't need to have that x-ray or that CT scan or radiation exposure.

Neva

00:07:02

How does pediatric cancer differ from adult cancer?

Becky Dolman

00:07:07

They're treated very differently. There's a pediatric oncology group for the United States. There's also a pediatric group in your, we differ a little bit. There's a database that all the information for all pediatric cancers go into and their roadmaps that treat each individual cancer. So if you have a leukemia, that's a standard risk leukemia. If you're diagnosed in Eddy children's hospital in the United States, you'll be treated the exact same way by the exact same protocol, anywhere by any pediatric oncologists, adult cancers are different. And normally they're caused by exposure from toxins exposure from the world and other things around them where pediatric cancers, we don't know what causes them. They just happen. I mean, we have, we have pediatric cancer in infants in one or two week old infant. So it's very different from adult cancers.

Neva

00:08:03

Yeah. So what role do you think genetics, if any, has to do with childhood cancer?

Becky Dolman

00:08:12

So we do know that there are some genetic components to all cancers and we're trying, we're starting to find out that, you know, with immunotherapy and targeted therapy in pediatric cancers, we're seeing better outcomes. So we do know there's a genetic component, not necessarily that it's been passed on by the mother or father, but that there is a genetic component in that it's at the cellular level and we're, we need to start fighting cancers at that level.

Neva

00:08:40

Okay. So more treatment will be directed towards fighting cancer at a cellular level cellular level. Yes. Okay. That's cool. Well, you've served so many patients throughout your career and we know that every child is different and we, we celebrate that individuality, but does that sometimes make it harder for you to do your job? Like, like maybe you needed to be creative in getting kids to take their medication or something. I'm not sure, but how do you adjust your nursing to each patient?

Becky Dolman

00:09:16

Yeah. So you do have to adjust every day to each individual patient. And it is definitely a group effort. We have child life and we have social work and we have, you know, a registered nurses. And so as a group, we decide and we talk about each individual patient and decide what the best approach is. Sometimes child life has to work with a patient to teach them how to swallow pills or teach them how to swallow liquids. And we have to have conversations. And if they're too little, then we just have to get them to take the medications or be creative or have distracting elements to it so that they take their medications because a lot of, especially in leukemia and when they're in their later phase, there's a medication retractor period, which is very, very important in their success in staying in remission. And if they don't take it or not consistent and taking it, then the increase of relapse is really high.

Becky Dolman

01:10:11

And so we do have to be very creative and make sure that these kids take their medication. So each patient is yes individual and it does make it difficult, but it also makes it for an interesting day because you try to create, you know, find creative ways so that, you know, it's not such a hard thing for them to do, but that they have to do it, but they also give them choices. You know, Hey, you don't have a choice that you don't, can't take this medication, but you can have a choice of when or how or what you take it with. And so that's kind of what you do is you come up with solutions and different ways for them to do it. So they feel like they have some control.

Neva

01:10:48

Do you think that's one of the most important parts of your job?

Becky Dolman

01:10:52

Yes. As a pediatric oncology nurse, your most important job as well, you care for the patient and for the family and you make sure that they are taking their medications and you give their medications, their, you know, all their chemotherapy on time. So there are different aspects in every stage of their therapy or what's important at the beginning, it's all there. I became a therapy and their steroids and everything on time. And, and then at the beginning, the middle and the end, it's a lot of their oral medications and kids don't tend to like to take oral medications, especially when it's not their choice. It's something that they're made to be doing. So it's definitely a challenge in that, in this, in the pediatric oncology world.

Neva

01:11:34

Why do kids not like taking oral medications compared to the other?

Becky Dolman

01:11:39

A lot of the time they don't taste very good. We haven't come up with a creative way to make them taste better, even as a, in a pill form. And the liquid form definitely is the worst. And so you have to find creative ways to mask and pharmacies have not done a good job of it. And so you just have to find ways of things that they'll take it with. So it doesn't taste as bad.

Neva

01:12:02

Okay. Well, I saw that according to the national cancer Institute, over the past 20 years, there's been an increase in the number of children diagnosed with cancer, but also the death rate has decreased and the five-year survival rate has increased. So in, in general, childhood cancers have a better prognosis. So what do you think is the reason for that advancement?

Becky Dolman

01:12:30

Yeah, the reason for that advancement is better is better therapy chemotherapy, and the way we treat cancer has improved. And so our outcomes have improved because of the database, everything that, all the medications that we give go into that database and there, and they track the survival. And anytime we see anything bad happening, when any of those medications are dropped off and other medications are added or changed. So because of that, we have seen an increase in survival.

Neva

01:13:00

That's good. Well, thank you for all that you do. Was there anything else you wanted to share?

Becky Dolman

01:13:10

Pediatric cancer? You know, a lot of people always when I say, or when I used to say I work pediatric oncology, but also, Aw, that's so sad and it's, it really, isn't sad. I mean, yeah. We have sad times and we have kids that die and it's, it's a sad time, but we also have kids that do really well and they do amazing and they get through therapy and they survive and they go on living lives like it never even happened. And so I think that that is one of the most amazing parts of pediatric oncology.

Neva

01:13:40

Yeah. People tend to focus more on the negatives, but neglect how much positive you're giving people and how much that pediatric pediatric oncology is changing people's lives. So thank you for what you do. You've earned my deepest respect and I'm sure many others as well. I wanted to ask, I ask every one of my guests, if they have a favorite quote, and if you wouldn't mind sharing,

Becky Dolman

01:14:08

I don't really have a favorite quote. I, I just live for like being positive and knowing that there's hope and, and hoping to instill hope in other people like being positive and showing them that this is not a death sentence, that there is life after cancer and that, you know, it's just being positive and being hopeful.

Neva

01:14:32

That's so nice. Well, it's been great talking with you and I'm very happy that you came onto the show today. So thank you.

Becky Dolman

01:14:39

Yeah. Thank you. Thank you very much for having me.

Neva

01:14:48

I'll be back next week with a new episode of alphabet soup on cancer. In the meantime, share this episode with your friends and family and people who need to hear this information. Thanks for listening and stay tuned.