In Conversation with Dr. David Hodgson: A Progress Report of His First Five Years

And Looking Ahead to His Next Five as POGO Medical Director and Chair in Childhood Cancer Control

In November 2021, Dr. David Hodgson (DH) began a second five-year term as POGO Medical Director and Chair in Childhood Cancer Control at the University of Toronto. In conversation, he shares highlights of his very productive first term, 2016 – 2021.

Q: Data-driven quality improvement is one of the five goals of POGO’s Childhood Cancer Care Plan. What initiatives have you undertaken to tackle this pressing priority?

DH: Well, for POGO to drive forward improvements in the childhood cancer system, we need to listen to our clinical partners and families to understand what the needs are, help develop and improve programs that meet those needs, and measure how well we are doing in that mission.

I felt that while POGONIS and our other data holdings are among POGO’s strengths, they were underutilized. So, over the last five years, we published and made available significantly more childhood cancer data to help clinical stakeholders and researchers understand the current state of childhood cancer in Ontario. 

POGONIS is POGO’s active cancer registry initiated over 30 years ago to capture diagnosis, treatment and outcome data for children treated at the five specialized childhood cancer programs in Ontario.

We’ve also taken steps to strengthen data quality by implementing automated quality checks to immediately identify possible errors. 

POGO produced two provincial childhood cancer surveillance reports (2018 and 2020) making Ontario the only province to publish searchable data regarding the incidence, prevalence and outcome of childhood cancer for different childhood cancer subtypes. In 2020, we saw the first-ever inclusion of POGONIS-derived childhood cancer statistics in the Ontario Cancer Statistics report, and we contributed to the national Cancer in Young People in Canada (CYP-C) Data Tool.

For hospitals, we provided the first POGO Quality Indicators Report, which allowed them to see information such as the type of cancers they care for, wait times and clinical outcomes compared to the province as a whole.

As a result of this work, data is much more available to hospitals, system planners and researchers to undertake activities such as assessing the feasibility of conducting a research study, or understanding the provincial patterns and trends of childhood cancer so the system can be prepared for the future.

Q: What other improvements have been made to POGO’s data?

DH: We have improved the data for specific POGO programs to ensure they are serving children with cancer and survivors in the best way possible.  For over 20 years POGO has managed a long-term follow-up program for survivors of childhood cancer through the POGO AfterCare Program delivered in seven clinics across Ontario. We worked with these clinics to update the data collected so that we can assess the impact that these clinics have on survivor care and inform continuous improvement.

Q: Looking ahead, what are your plans for further improvements in data-driven quality? 

DH: It is important that we continually work with our clinical and research partners to ensure that we are facilitating their work. Now that we have made these changes to our data collection and reporting, we have to be sure that we are not just collecting data for its own sake. We want to be able to inform clinical programs and research that have a clear path to improving the outcome for children with cancer. This means building collaborations that enhance the clinical and policy relevance of our data.

One great example is the work that the POGO analytics team and our Technology Advisory Committee is doing with Dr. Pechlivanoglou at SickKids to facilitate access to innovative new treatments for children with cancer by developing policy advice for government. This work involves input of clinical experts, access to high-quality data and analytic expertise, and an understanding of the regulatory environment. Any one of these on its own would not be enough, but working together with our clinical and research partners across Ontario, we can make progress that would not be possible without bringing together all the pieces of the puzzle.    

I would also like to increase the utility and variety of data holdings we can use and make available to others, and redesign the POGO Research Unit to better support the deliverables of our Childhood Cancer Care Plan.

Q. Survivorship is near and dear to your heart. Tell us about your future focus for the POGO AfterCare Program for childhood cancer survivors.

DH: The POGO AfterCare Program was formally established in 2001 with clinical collaboration of seven clinics throughout Ontario. Developed at a time when few survivors were receiving adequate follow-up care, the initial strategy was to recall and retain as many survivors as possible. More recently, we have worked to integrate the concept of “right care in the right place” into the model of AfterCare.

We recognize that during treatment, POGO Satellite Clinics can provide excellent care for selected patients and problems without requiring the patients to travel to their primary treating hospital. The same can be true for AfterCare. Very few of the tests required by survivors are so high-tech that they need to be done in the primary treating hospital. But the major challenge is ensuring that we can provide the multidisciplinary care that some survivors need, particularly access to mental health supports, which I think are in very short supply. My goals are to ensure survivors with the highest risk for complications are able to access the clinics and receive care appropriate to their situation, and develop a sustainable strategy that better incorporates patients’ primary care providers so that the ever-growing number of survivors have sustained access to appropriate care.  

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In addition to his role as POGO Medical Director and POGO Chair in Childhood Cancer Control at University of Toronto, Dr. David Hodgson is also a radiation oncologist at Princess Margaret Cancer Centre with a cross-appointment to the Division of Hematology/Oncology at The Hospital for Sick Children. He is a professor in the Department of Radiation Oncology at the University of Toronto. He was first appointed as POGO Chair in Childhood Cancer and Medical Director in November 2016. Read his bio

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