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POGO Satellite Manual

1.0 Introduction

1.1 History and Overview

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Early recommendations for a formal pilot study of satellite care were put forward in POGO’s “Childhood Cancer Services Study” (C. Greenberg, 1988) and in subsequent POGO blueprints for childhood cancer care in Ontario (“Integration of Oncology Care for the Children of Ontario into a Provincial Cancer Strategy,” C. Greenberg, 1992; “Provincial Pediatric Oncology Working Group Report,” C. Greenberg and M. Greenberg, 1994).

Between 1983 and 1997, the pediatric oncology programs of The Hospital for Sick Children (SickKids), Children’s Hospital of Western Ontario (CHWO) and Children’s Hospital of Eastern Ontario (CHEO) managed the care of some patients living at distances from the hospitals in an ad hoc fashion.

In 1994, at the invitation of the Ministry of Health and Long-Term Care (MOHLTC) and its instrument, the Provincial Cancer Network (PCN), POGO struck the Provincial Pediatric Oncology Working Group (PPOWG) and charged it to submit a comprehensive report on childhood cancer control to the PCN by the end of that year. A formal proposal was made by POGO to the MOHLTC to fund a Provincial Pediatric Oncology Satellite Program in 1994, following extensive consultation on the subject from a cross-section of caregivers and parents geographically distributed across Ontario.

In 1995, the development of a pilot Pediatric Oncology Satellite Program, defined by a consensus-driven specification of the components of care that might effectively and safely be located outside the specialized childhood cancer programs, was approved by the MOHLTC. Funding, initially for blueprint development and later for implementation, was phased in during the period 1995–1997.

The POGO Provincial Pediatric Oncology Satellite Manual outlines a formal, well-integrated satellite level of pediatric oncology practice and has been regularly updated. The original document was the result of the collaboration of POGO-affiliated specialized childhood cancer programs and potential satellite partners as the Clinical Oncology Committee (CLOC) Working Group and its task forces, 1995–1997. The group worked within the terms of reference of POGO’s proposal for an integrated system for the care of children with cancer, as presented in the PPOWG Report (November 1994). It was informed by:

  1. An in-depth review and analysis of the literature on international experiences with partnered practice in the care of children with cancer – its scope, division of labour and inherent strengths and risks;
  2. Consultation with prominent specialized childhood cancer programs;
  3. A survey of Ontario’s childhood cancer community and specialized childhood cancer program-based physicians who then shared care of this population via informal arrangements (POGO, 1988);
  4. Proceedings from pilot satellite site visits; and
  5. Input of a widely representative Satellite Cluster Group, appointed by POGO (1994) to advise and inform the Blueprint submitted by the PPOWG to the MOHLTC.

The POGO Satellite Program and the Satellite Blueprint continued to evolve. In 2014, a multidisciplinary panel was struck to perform an in-depth review and update of the Blueprint. As a result of the efforts of over 100 healthcare professionals, a new document was born. Recognizing that the POGO Satellite Program was now far beyond the planning stage and instead represented a mature and sophisticated system, this new document has been dubbed the POGO Satellite Manual. 2016 saw the first publication of the manual online. This web-based resource will serve as the definitive source for POGO Satellite Program clinical and research practice guidance. The electronic format will permit rapid review, update and turnaround as practices change.

Welcome to the POGO Satellite Manual!

Disclaimer: Source Accuracy

You are welcome to download and save a local copy of this document in the Word and/or PDF formats provided. As the POGO Satellite Manual is subject to ongoing revisions and updates by POGO, we recommend you regularly check the online version posted at https://www.pogo.ca/satellite-manual/ to ensure you have the most up-to-date content. In the event of any inconsistency between the content of a local copy and the online version of the POGO Satellite Manual, the content of the online version shall be considered correct. Please see also the POGO Satellite Manual Disclaimer.

Record of Updates
Version NumberDate of EffectSummary of Revisions
17/13/2021Original version posted.
1.2 Acknowledgements
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In this Section

  • 1.1 History and Overview
  • 1.2 Acknowledgements
  • 1.3 Committees and Working Groups
  • 1.4 POGO Satellite Manual Disclaimer
  • 2.1 Principles of POGO Satellite Clinic Care
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a POGO Satellite Clinic
    • 2.2.2 Children Eligible for the Management of Complications in a POGO Satellite Clinic
    • 2.2.3 Children Eligible for Supportive Care in a POGO Satellite Clinic
  • 2.3 Scope of POGO Satellite Clinic Practice
  • 2.4 Expanded POGO Satellite Clinic Practice
  • 3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents
    • 3.1.1 Personal Protective Equipment
    • 3.1.2 Preparation, Transport and Storage
    • 3.1.3 Administration of IV Hazardous Drugs
    • 3.1.4 Administration of Oral Hazardous Drugs
    • 3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs
    • 3.1.6 Safe Handling for Pharmacy
    • 3.1.7 References
  • 3.2 Accidental Exposure/Spills
  • 3.3 Extravasation Management
    • 3.3.1 Prevention and Management of Extravasations
    • 3.3.2 Antidotes and Treatments for Extravasation
    • 3.3.3 Sample Extravasation Documenting Tool
    • 3.3.4 References
  • 3.4 Injecting SC Medication Via an Insuflon
  • 3.5 Chemotherapy Administration Reference List
  • 3.6 Central Venous Catheter Care
  • 3.7 Chemotherapy Quick Reference
    • 3.7.1 Rapid Hydration
    • 3.7.2 Provider Guide: Prevention and Management of Irinotecan-Induced Diarrhea
    • 3.7.3 Capizzi Methotrexate
    • 3.7.4 Erwinia Asparaginase
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Sample Fever Cards
    • 4.1.3 Criteria for low-risk designation. Risk categorization refers to risk of bacteremia and serious complications, including mortality.
  • 4.2 Pentamidine Administration
    • 4.2.1 Inhaled Pentamidine
    • 4.2.2 Intravenous Pentamidine
  • 4.3 Antiemetics
  • 4.4 Treatment of Varicella-Zoster Infections
  • 4.5 Immunization of Children with Cancer
  • 4.6 Transfusion
  • 4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program
  • 5.1 Palliative Care Overview
  • 5.2 Communication
  • 5.3 Settings of Care
  • 5.4 Symptom Management
  • 5.5 End of Life
  • 5.6 When a Child Dies at the POGO Satellite Clinic
  • 5.7 Appendix: Sample Bereavement Materials
    • 5.7.1 Reconciling Your Grief
    • 5.7.2 Funeral Arrangement Checklist
    • 5.7.3 Helping Children Who Grieve
    • 5.7.4 Coping with the Holidays
    • 5.7.5 The Grief Experience
  • 5.8 References
  • 6.1 Goals and Objectives
  • 6.2 Participant Site Selection
    • 6.2.1 Tertiary Hospital Site Selection
    • 6.2.2 Community Hospital Site Selection
  • 6.3 POGO’s Roles
    • 6.3.1 PHIPA, Privacy and Research
  • 6.4 Funding
    • 6.4.1 Funding Support for Tertiary Hospital Activity
    • 6.4.2 Funding Support for Community Hospital Activity
  • 6.5 Infrastructure and Formal Requirements
    • 6.5.1 Specialized Childhood Cancer Program Partners’ Role in the POGO Satellite Program
    • 6.5.2 POGO Satellite Clinic Partners’ Role in the POGO Satellite Program
  • 7.1 Preamble
  • 7.2 Investigator Responsibilities
  • 7.3 Training Requirements
    • 7.3.1 General Training for Conduct of Research
    • 7.3.2 Protocol-Specific Training
  • 7.4 Research Activities That May Be Completed in POGO Satellite Clinics Under Supervision of DSI
  • 7.5 Research Activities to be Completed in Specialized Childhood Cancer Programs Only
  • 7.6 Recognition and Reporting of Adverse Events (AEs)
  • 7.7 Data Transfer
  • 7.8 Pharmacy Drug Accountability
  • 7.9 Site Inspections and Quality Assurance
  • 8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet
  • 9.1 POGO Satellite Clinic Preparedness Checklist
  • 9.2 POGO Satellite Clinic Quality Assurance Checklist
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