This session will describe a clinical practice guideline for fatigue management in children receiving cancer treatments, developed by POGO.
Lillian Sung, MD, PhD
Staff Physician, Department of Haematology/Oncology
The Hospital for Sick Children
Dr. Lillian Sung is a Full Professor and Senior Scientist at The Hospital for Sick Children in Toronto. She is certified in the specialties of pediatrics, infectious diseases, hematology and clinical investigation. She completed a PhD in Clinical Epidemiology from the University of Toronto in 2004. She has a clinical research program focused on supportive care for children with cancer. Her methodological focus is on randomized and observational trials, meta-analysis, and patient-reported outcomes.
Dr. Sung is the principal investigator on multiple operating grants from the National Institutes of Health (NIH), Canadian Cancer Society Research Institute and the Canadian Institutes of Health Research. She is the co-PI on the NCI Community Oncology Research Program (NCORP) Research Base grant which supports the Cancer Control and Supportive Care program within the Children’s Oncology Group. She is also the co-PI on an NIH R25 grant to support the Clinical Research Training Institute, sponsored by the American Society of Hematology.
Pediatric acute lymphoblastic leukemia (ALL) is the most common childhood cancer. There have been significant improvements in pediatric ALL survival rates over the past 50-60 years. Unfortunately, approximately 15% of patients relapse and cure rates are much lower after relapse. Many of these patients require newer, more novel therapies and targeted immunotherapy using anti-CD19 chimeric antigen receptor T cells (CAR T) is one of those therapies. A patient’s own T cells are collected and then genetically engineered to recognize and attack CD19 + tumors. Benefits of CAR T cell therapy include expansion of the CAR T cells in the patient and potential for long-term persistence for disease surveillance. This therapy has shown encouraging results in patients with refractory and relapsed ALL. With therapies like this becoming more widely available, pediatric oncology nurses will need to understand the concept of these therapies and know the risks and side effects in order to provide care to these patients. Nurses play an important role in providing safe care and patient management. They are often the first clinicians to recognize side effects and problems. There is also a significant role for nurses in providing anticipatory guidance and education for patients and their families.
Colleen Callahan, RN, MSN, CRNP
Nurse Practitioner, Division of Oncology
Children’s Hospital of Philadelphia
Colleen Callahan, MSN, CRNP, has worked in pediatric oncology for 23 years, 18 of which as a nurse practitioner in the Oncology Division at Children’s Hospital of Philadelphia. She has worked in the Cancer Immunotherapy Program for the past five years caring for patients pre, during, and post CAR T-cell therapy in the outpatient setting. She follows these patients from their initial referral to the cancer immunotherapy team, through their T cell collection, T cell infusion, and then after infusion monitoring for side effects, adverse events, and long-term effects and responses.
How can the immune system be modified and engaged to target cancer cells? This is a priority of basic science research and all phases of clinical trials with the goal of improving survival for the most challenging to cure pediatric cancers. Caring for patients receiving new immunotherapies and their families requires new knowledge of how immunotherapies work, and based on this mechanism what and when unique side effects might be expected. This brief quick hit session will describe why immunotherapies might work against pediatric cancer cells with case examples highlighting new agents in current clinical trials.
Sue Zupanec, MN, NP Pediatrics
Nurse Practitioner, Leukemia & Lymphoma
The Hospital for Sick Children
Sue Zupanec is a Nurse Practitioner in the Hematology/Oncology Program at the Hospital for Sick Children. In her clinical practice Sue provides care to children and teens with a diagnoses of Leukemia or Lymphoma and their families.
Sue currently serves as the Education Sub Committee Chair on the Nursing Steering Committee for the Children’s Oncology Group and is an executive committee member for the Garron Family Cancer Center.
Overall survival rates for childhood cancer survivors exceed 80%, thanks to new therapies and the evolution of pediatric cancer clinical trials. Chemotherapy and radiotherapy, in general, have the potential to cause late effects in childhood cancer survivors. The latest data show that 95% of survivors will have a late effect related to their cancer treatment by age 45 and of those, 80% will have a serious/disabling or life threatening condition. Screening for late effects in survivors is generally guided by the Children’s Oncology Group (COG) long term follow up guidelines. These guidelines provide evidenced based rationale for screening. The 5th version of these guidelines will be released in October 2018. Each guideline has been reviewed by a panel of experts to ensure the recommendations are in keeping with current evidence. Modern therapies such as monoclonal antibodies and tyrosine kinase inhibitors are increasingly being used in up front treatments, but the long term side effects of these agents at this time remain unknown. This presentation provides an overview of the major changes to the existing COG Long term follow up guidelines and highlights several new “late effect’” studies open in the COG. There will be a focus on the Late Effects after High Risk Neuroblastoma (LEARHN) study. This is one of the first protocols to prospectively study the late effects of modern neuroblastoma treatment which incorporates immunotherapy.
Eleanor Hendershot, RN(EC), MN, BScN, NP-Ped
Nurse Practitioner, Pediatric AfterCare Program
McMaster Children’s Hospital, Hamilton Health Science
Eleanor Hendershot completed her Master of Nursing in the Pediatric Acute Care Nurse Practitioner program at the University of Toronto in 2003. She received her BSCN from the University of Ottawa in 1994.
Eleanor has worked in pediatric oncology for the last 24 years starting at the Children’s Hospital of Eastern Ontario, then moving to The Hospital for Sick Children and currently works at McMaster Children’s Hospital. She is also cross appointed as adjunct lecturer in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. For the last 5 years, Eleanor has been working as a Nurse Practitioner in Aftercare initially at SickKids and Princess Margaret Hospital and now at McMaster.
Eleanor is a member of Outcomes and Survivorship steering committee in the Children’s Oncology Group. She has published multiple articles and book chapters on a variety of topics pertaining to pediatric oncology and pediatric oncology survivorship.
The management of low grade gliomas is very complex disease. Treatment decisions can be based on the surgical resection, radiological response or progression, visual acuity/preservation, other associated morbidity. Essentially, low grade glioma is a chronic disease and most children will require more than one line of therapy. In the last 30 years clinicians have moved away from treating low grade gliomas with radiation and have used various modalities of chemotherapy to treat these tumours. MEK and BRAF inhibitors have shown excellent promise and response in the Low grade glioma and NF1 population but their length of therapy and side effect management is quite different then “regular” chemotherapy. This presentation will provide a brief overview of low grade glioma’s and highlight the new emerging treatment with BRAF and MEK inhibitors along with the management of the side effects associated with these medications.
Tara McKeown, RN MN NP-Paediatrics
Nurse Practitioner Neuro-oncology Team
The Hospital for Sick Children
Adjunct Lecturer, Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto Tara McKeown completed a Bachelor of Science degree at the University of Western Ontario and then went on to complete a Bachelor of Science in Nursing at the University of Toronto. She worked at the Hospital for Sick Children inpatient Haematology/Oncology inpatient ward as a Registered Nurse for five years and during that time completed a Master of Nursing with Nurse Practitioner in the child stream. Tara has worked as the Nurse Practitioner with the Neuro Oncology team at the Hospital for Sick Children since Jan 2013. She also retains adjunct appointment as an Adjunct Lecturer for the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. Tara has worked closely with the New Agents and Innovative Therapy team at Sick Kids as new drugs, treatments and side effect management is emerging for the Neuro Oncology population.