Congress Abstracts 2004

88

TREATING THE DYNAMICS OF HIV-ASSOCIATED NON-HODGKIN LYMPHOMA: A MULTIFACTORIAL NURSING APPROACH. Keli Elizabeth Gaines, RN, BSN, and Mikaela Olsen, RN, MS, OCN^®, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD.

As the life expectancy of patients with HIV is prolonged, the incidence of noninfectious diseases such as B-cell lymphoma has risen dramatically. AIDS-related lymphomas are currently the cause of death for up to 20% of patients with HIV. Although the prognosis is generally poorer than for those patients with similar cancers who have not been diagnosed with HIV, survival has improved significantly with the introduction of highly active antiretroviral therapy (HAART).

In HIV patients in which the CD4 cell count declines to <200/mm, a noninfectious complication, such as non-Hodgkin lymphoma, becomes more prevalent. Specific factors have been determined to be associated with shorter survival rates specific to HIV-associated B-cell non-Hodgkin lymphoma. Clinical factors such as CD4 cell count, disease staging, Karnofsky scores </= 70%, and elevated lactic dehydrogenase (LDH), determine which specific biotherapy and or chemotherapy agents are prescribed for this patient population. The treatment, toxicity management, and nursing care of these patients are unique. Oncology nurses must understand the correlation of CD4 cell counts in direct relation to disease progression, disease staging, Karnofsky scores, and elevated LDH. Clinical challenges such as severe myelopsuppression, opportunistic infections, HAART administration, drug interactions, tumor lysis syndrome, and CNS involvement are often present in this patient population.

The clinical presentation of HIV-associated non-Hodgkin lymphoma, current treatment regimens, HAART, and associated toxicities will be reviewed in this presentation. In addition, specific nursing assessment criteria and related interventions will be detailed in order to prepare a nursing plan of care for the management of this emerging subset of non-Hodgkin lymphoma patients.

An increased understanding of this patient population and their specific care needs will enhance symptom management goals, assist with early identification and intervention of patient symptoms, and thus improve quality of life.

To ensure excellence in patient care and symptom management, providers caring for this specific population of non-Hodgkin lymphoma patients must be knowledgeable and receive frequent updates regarding changes in this field. This presentation will be published in order to update oncology nurses in this field.