Congress Abstracts 2005

86

A DEADLY TRIO: CANCER, AGGRESSIVE CHEMOTHERAPY, AND TYPHLITIS. INCREASING THE ONCOLOGY NURSES KNOWLEDGE OF THIS UNKNOWN COMPLICATION. Tim Eden, RN, BSN, and Mikaela Olsen, RN, MS, OCN^®, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.

Typhlitis, derived from the greek term “typhlon” or cecum, is a rare and serious complication in cancer patients which refers to inflammation of the cecum. This condition may result in necrosis of the cecal portion of the bowel and/or the ileum and appendix. Related terms used in the literature include necrotizing enterocolitis, neutropenic enterocolitis, and ileocecal syndrome. These terms may indicate inflammation in other areas of the bowel whereas typhlitis refers solely to the cecum. Historically, typhylitis has been described as a complication of highly immunosuppressive therapies for lymphoma or leukemia. With the advent of higher doses of chemotherapy this condition now appears in many non-hematologic patients. The etiology of typhlitis is not well understood. The universal predisposing factor for typhlitis is profound neutropenia. It is estimated that as many as 40–50 percent of patients with typhlitis may die due to complications related to bowel necrosis, sepsis or perforation.

The purpose of this presentation is to educate nurses about typhlitis. This presentation covers risk factors, pathophysiology, clinical presentation and a nursing plan of care for the patient with typhlitis. Case studies will be utilized to illustrate the complex nursing care of this life-threatening complication.

A detailed nursing plan of care for the patient with typhlitis was developed and implemented in this designated comprehensive cancer center to guide nurses. Education on typhlitis will be integrated into nursing orientation for new oncology nurses to assist them in the recognition and management of this rare complication.

The goal of this presentation is to increase the nurse’s understanding of oncology patients with typhlitis. Increased knowledge will enhance symptom management goals and assist with early identification and interventions for patient symptoms, thus improving the care of this population.

It is predicted that the incidence of typhlitis will increase in the coming years due to the effects of newer chemotherapy drugs, higher doses of chemotherapy, and an increasing number of patients chronically immunosuppressed. Typhlitis should be considered an oncological emergency. Through this presentation we will share our experience with this complication and provide guidelines for the care of the oncology patient with typhlitis.