Congress Abstracts 2006

129

NEUROLOGICAL PARANEOPLASTIC DISORDER (NPND): UNDERSTANDING THE TREATMENT AND SUPPORTIVE CARE OF PATIENTS. Dionne Savage, BSN, RN, Johns Hopkins Hospital/SKCCC, Baltimore, MD.

NPNDs are rare disorders affecting the peripheral or central nervous system as an indirect result of malignancy. High serum and cerebrospinal fluid antneuronal antiibody titers cause neurologic destruction and cause a wide range of symptoms. The onset of neurological symptoms and detection of antibodies often precedes the diagnosis of cancer. Patients with the specific NPND termed "Stiff Man Syndrome " present with upper and lower extremity weakness, gait disturbances, numbness and tingling in hands and feet, and loss of deep tendon reflexes. More extensive involvement produces symptoms such as swallowing difficulties, diminished ability to speak, and paresis. Patients also experience painful muscle spasms that interfere with voluntary movement. Neurologic symptoms may improve with anti-neoplastic treatment, although some neurologic impairment may be irreversible.

This presentation provides an overview of the NPND's and a detailed description of a case study, outlining optimal patient care. Thorough nursing assessment can lead to early targeted supportive therapy for maximum symptom management and enhanced coping strategies.

This case example patient initially presented to healthcare providers with dysphagia, mutism, and progressive ataxia. After exhaustive diagnostic tests, he was incorrectly diagnosed and administered antimicrobials. The patient's symptoms worsened and five months later he was referred to this NCI designated Comprehensive Cancer Center exhibiting total body stiffness with positive neuro-antibodies and testicular cancer. During his hospital stay, nurses were the coordinators of care that involved professionals in physical therapy, occupational therapy, speech and swallowing therapy, respiratory therapy, developmental specialists, and social work. Despite effective anti-neoplastic treatment inducing disease remission, his neurologic symptoms did not resolve and required subsequent mechanical ventilation with related complications that led to his death.

Neurologic experts, physical, and occupational therapy were crucial in providing emergent support of this patient's neurologic symptoms. The pivitol role of the nurse in coordinating these multidisciplinary efforts was at least partly supported by the nurse's knowledge and expertise in management of this unusual complication of malignancy.

NPND can be a debilitating and fatal disorder when detected in its late stages. Educating oncology nurses about NPND can facilitate more timely and focused interventions that could improve clinical outcomes/quality of life.