In a survey supported by POGO, chemotherapy-induced nausea and vomiting was identified as one of the top concerns of parents of children receiving chemotherapy. The antiemetic aprepitant—a relatively new and effective drug used to prevent these distressing side-effects in patients receiving chemotherapy—is only available in capsule format in Canada, so children who cannot swallow capsules cannot benefit from this medicine in its current form.

When a liquid form of a drug is not commercially available, pharmacists often manipulate dosage forms that are made for adults so that children can take those drugs. They do this by breaking up capsules or crushing tablets to make a liquid formula that children can swallow. This is called extemporaneous compounding. Some drugs become unstable as soon as you mix them with a liquid. In other words, they degrade so rapidly that the liquid forms are not useful; others might get absorbed into the bloodstream too quickly or not at all. Ideally when a pharmacist makes an extemporaneous compound, they use a formula or a recipe which has been studied so we know the drug’s stability. Even better is to understand how the extemporaneous liquid formulation is absorbed from the stomach into the bloodstream compared to the original tablet or capsule made by the pharmaceutical manufacturer.

In 2016, POGO awarded Dr. Priya Patel, RPh, PharmD, a MSc student with a Clinician Scholar Fellowship for her project: Relative Bioavailability of an Extemporaneous Oral Suspension of Aprepitant in Healthy Adult Volunteers. Priya, her supervisor Dr. Lee Dupuis, and their co-investigators Dr. Paul Nathan, Ms. Sue Zupanec, Ms. Jocelyne Volpe and Mr. Scott Walker, will be studying a liquid form of aprepitant designed for use in pediatric cancer patients to determine how well it is absorbed from the stomach into the bloodstream compared to the original capsule. This study will either give the current “recipe” a stamp of approval or help define what needs to be done to ensure that its performance is comparable to what we see in patients who are able to take a capsule format. 

POGO is recognized as a world leader with regards to the topic of chemotherapy-induced nausea and vomiting in children. In addition to supporting research studies like Priya’s and creating new evidence around the topic, POGO leads in the development of clinical practice guidelines* to help physicians make informed decisions to optimize control of chemotherapy-induced nausea and vomiting for their pediatric patients. Until recently there were no clinical practice guidelines that focused on children for this purpose.

It’s all about creating new evidence-based information so it can be incorporated into the current practice guidelines and then implementing those guidelines so that children don’t experience nausea and vomiting due to chemotherapy. We are trying to get better at that.

*Endorsed by the Children’s Oncology Group, the world’s largest organization devoted exclusively to childhood and adolescent cancer research. 

Sylvie Kozlowskyj is the Pediatric Oncology Satellite Nurse Coordinator in the POGO Pediatric Oncology Satellite Clinic at the Northeast Cancer Centre, Health Sciences North, Sudbury. She shares her insights on the importance to her practice of the POGO Satellite Manual. POGO Satellite Clinics are located in seven Ontario communities and provide some aspects of a child’s cancer care closer to home.

 Q. How does the Satellite Manual impact patient care?

Sylvie: The POGO Satellite Manual directs Satellites in the day-to-day care of our patients/families by providing clear, best-practice documents in such areas as chemotherapy delivery, management of supportive care issues and palliative care. It guides health care professionals (HCPs), ensuring that families who are eligible for some of their care in the Satellite setting can safely receive high-quality care in their community comparable to that received in tertiary hospitals. The POGO Satellite Manual is a great tool for both for in-patient units and outpatient clinics.

Q. What difference does the Satellite Manual make in your job?

Sylvie: The Northeast Cancer Centre uses the POGO Satellite Manual as a reference in the development of our hospital guidelines, standards of care, and policies and procedures. The Manual also provides standard communication tools that can be downloaded for use between Satellites and tertiary centres so that all required information is shared between institutions in a timely, organized manner. Again, this facilitates the seamless, comprehensive delivery of services to our patients.  The Manual also includes tools for Satellites to use in their annual report to POGO. This ensures that POGO receives the required data from the Satellites for its reporting to the Ministry of Health and Long-Term Care, for data collection and research.

Q. What should families know about the necessity of the POGO Satellite Manual in the delivery of pediatric cancer care in the community?

Sylvie: The POGO Satellite Manual is an important tool that enables HCPs to keep pace with the rapidly advancing field of pediatric oncology. The content is regularly reviewed and updated in collaboration with HCPs in tertiary and Satellite centres to ensure that care in both settings is guided by the same principles. Families can be reassured that best-practice guidelines are being followed in their Satellite, much like in their tertiary centre, and that the standard of care is equivalent.

Q. How has the change from a binder and downloadable PDF to a web-based format improved the Satellite Manual?

Sylvie: This new format, including the removal of password protection, has made the information more accessible to HCPs in all settings, outpatient as well as in-patient. Physicians can now refer to the Manual from home, on any device, whenever they need to find information on a particular topic. The online Manual is easy to locate on the POGO website, user-friendly and the information is clear and well organized. This format also allows for easy updating of individual sections of the Manual.

Susan Grace April 5, 1953 – May 4, 2017

From POGO employee to POGO volunteer, Susan Grace was a true champion of kids with cancer and their families. On May 4, 2017, Susan lost her own personal battle with breast cancer.

In 1992, Susan started her journey with POGO as an administrative assistant. Over the years, she was the mainstay for POGO, performing such other roles as receptionist, office manager, controller, assistant to the executive director, publicist, event planner, project manager, and even dish washer! She saw POGO grow from just two employees to its present staff of about 60. Susan worked tirelessly weekdays and many weekends and met every deadline with a smile.

Susan was diagnosed with breast cancer in 2003, and after treatment and surgery, went into remission in 2004.  In spite of her diagnosis, Susan considered herself very fortunate and made the most of every day thereafter.

In 2004, Susan received the POGO Companion Award which recognizes those who have made a prolonged and enduring, exceptional and sustained commitment to advancing state-of-the-art childhood cancer control. 

Susan returned to POGO in June 2005 until March 2006 as the temporary controller until the organization filled the position permanently.

In June 2006, after 15 years with POGO, Susan resigned and began her second career with POGO as a volunteer. Susan’s overall contributions to POGO are invaluable and include work on POGO’s annual staffing study, infrastructure improvements, and POGO’s legacy database tracking milestones in the organization’s history.

A volunteer par excellence, some of Susan’s happiest days were at St. Bartholomew’s Church in Regent Park (Toronto) where she volunteered in the early-morning Breakfast Program from 1987 until recently. When Susan and her husband relocated to Alcona, on the shores of Lake Simcoe, she refused to even contemplate giving up the Breakfast Program and would rise early every Thursday morning, leaving the house at 3:10 a.m. for the drive into Toronto, arriving at the church by 4:30 a.m. to open the doors and welcome all who were waiting. From there, she would make her way to volunteer at POGO.

A lover of life, Susan was a cheerful, positive and optimistic person, always with a ready smile for everybody.

When Susan relapsed in December 2015, she faced this new challenge with the same positive attitude, truly believing that she was going to once again beat the disease. She was determined to meet her life goals, which included more travel, selling her dream home on Lake Simcoe and settling into a new condo in Toronto.      

Susan Grace is a POGO Champion who made lasting, behind-the-scenes contributions that will forever endure across the childhood cancer community and system.

In November 2016, POGO welcomed Dr. David Hodgson as its new Medical Director and Chair in Childhood Cancer Control. Here are Dr. Hodgson’s remarks on the occasion of his welcome reception at the University of Toronto’s Massey College. 

In the summer of 1989 I came to the Associate Dean’s office, about 800m from here, for my medical school admissions interview. At that time, admissions interviews were done after the med school applicants had already accepted, so the stakes were low.

We discussed undergraduate experience, my hopes for medical school, and after about 20 minutes, the Dean asks me, “Are you excited about going to medical school?” I said, “Sure, why do you ask?” He replied, “Well you don’t look very excited.” I told a friend in grad school about this and he said I should have answered, “Are you excited about being Dean?” But I didn’t say that, which in part is why I’m here today.

I learned a lot in medical school, but of course many of the most important lessons were learned afterward, and two in particular I’ll mention today.

Only after some time in practice did I learn the first lesson, which was to appreciate how scared our patients and their families are. The writer James Hollingsworth wrote, “Courage is not the absence of fear, but rather the judgement that there is something more important than fear.”

And what greater fear could there be than to have what one values most – one’s life, or even more so the life of one’s child – taken away? Imagine how it feels to give a group of strangers permission to surgically remove parts of your child’s body, irradiate them, and give them so much chemotherapy that their bone marrow is wiped out, saved only by a plastic bag of stem cells kept in a freezer. But every day we have the privilege of helping families who give us permission to do exactly that, with incredible courage, because they work towards something more important than their fear: a normal healthy life for their child.

The second lesson is that it’s harder than I expected it would be to be a good doctor; to consistently provide high quality care. Now, fortunately, we work in a system that for the most part facilitates good care, and one only needs to talk to our counterparts around the world to see how lucky we are to work where we do.

But our knowledge is incomplete, our treatments imperfect, our resources limited, and we battle inefficiencies and bureaucratic absurdities that can wear us down. Too often we are not able to deliver the healthy life that our patients and their parents hope for.

That is why the work of POGO, in collaboration with the tertiary care centres and satellite clinics that make up the pediatric oncology system, is so important. Work to roll out new treatments in a timely and equitable way, to provide financial support for families being crushed by out-of-pocket costs, to offer academic and vocational support for survivors to succeed long after treatment is over, and to conduct research to further improve system performance. This is critical work that POGO does that benefits patients for sure, but make no mistake, also benefits everyone in this room trying to reduce the burden of childhood cancer care in Ontario.

So I’d like to say that I am very excited to do my part to help with this important work – work that strives to be worthy of the courage of our patients and their families, and that allows us to provide the kind of care we aspired to give when we started school.

And Dean Young, just so you know:  this is what it looks like when I’m excited, in case you didn’t recognize it.

— Dr. David Hodgson, POGO Medical Director and Chair in Childhood Cancer Control, November 28, 2016

Read more about Dr. David Hodgson