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POGO Satellite Manual

2.2 Eligible Patients

2.2.1 Children Eligible for Chemotherapy Administration in a POGO Satellite Clinic

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Eligibility criteria for chemotherapy administration in a POGO Satellite Clinic include:

  1. Children who have had a specific diagnosis established and whose treatment has been started on a defined protocol.
  2. It is strongly suggested that all patients referred to a POGO Satellite Clinic have Central Venous Catheter (CVC) access to allow the safe administration of chemotherapy, particularly agents known to be vesicants. Difficulty with peripheral venous access is a contraindication to delivery of IV chemotherapy in a POGO Satellite Clinic. Early conversations and upfront agreement between the specialized childhood cancer program and POGO Satellite Clinic are required prior to referral of patients without CVC access for chemotherapy administration in a POGO Satellite Clinic.
  3. For leukemia patients, eligibility for chemotherapy administration is contingent on evidence of bone marrow recovery from induction therapy. Note: For some families and under special circumstances, exceptions have been made to refer patients on acute lymphoblastic leukemia (ALL) therapy to a POGO Satellite Clinic during induction therapy. Early discussions and agreement between the specialized childhood cancer program and POGO Satellite Clinic and mutual comfort would be required on a case-by-case basis.
  4. Chemotherapy administered in POGO Satellite Clinics should be short-duration infusions. Therapy that requires pre- or post-hydration should be feasible within regular clinic hours.
  5. Pediatric oncology patients requiring selected chemotherapy agents according to a specified route listed in Sub-Section 2.3 Scope of POGO Satellite Clinic Practice. The POGO Satellite Clinic must have adequate expertise to administer the agent and monitor for toxicity, and with the agreement of the specialized childhood cancer program.
  6. Children receiving oral chemotherapy started in the specialized childhood cancer program may have these agents continued in a POGO Satellite Clinic. Furthermore, POGO Satellite Clinics may renew and adjust doses of oral chemotherapies such as corticosteroids, mercaptopurine and methotrexate in consultation and agreement with the referring specialized childhood cancer program.
  7. Early consultation between the specialized childhood cancer program and POGO Satellite Clinic, with agreement of the POGO Satellite Clinic upfront, is required prior to referral of patients requiring chemotherapy not included in the table Chemotherapy Agents That Can Currently be Administered in the POGO Satellite Clinics (below).
  8. As new chemotherapy agents become available and are used on protocol, their toxicities and their appropriateness for use in the POGO Satellite Clinics will be evaluated. New agents may then be added to the table Chemotherapy Agents That Can Currently be Administered in the POGO Satellite Clinics and suitable knowledge transfer undertaken.
  9. POGO Satellite Clinics must have appropriate policies and agents available to manage acute toxicities such as allergy and extravasation.

Chemotherapy Agents That Can Currently be Administered in the POGO Satellite Clinics*

Note: All FIRST doses of chemotherapy agents should be administered in the referring specialized childhood cancer program.

DrugRoute(s)Special ConsiderationsReference
ArsenicIVPlanned monitoring of electrolytes and ECGs should be discussed prior with the referring specialized childhood cancer program. Per-patient drug reimbursement via NDFP.OH (CCO) monograph
BleomycinIVPulmonary function should be monitored by referring specialized childhood cancer program.OH (CCO) monograph
CarboplatinIVClose monitoring required for infusional reactions. Infusional reaction management (including pre-medication and extended infusion times) should be discussed with referring specialized childhood cancer program.OH (CCO) monograph
Crisantaspase (Rylaze) AsparaginaseIMPlatelet count must be >20,000 for IM administration. Be aware of increased risk of allergic reaction. Requires post-administration observation. See Sub-Section 3.7.5 Crisantaspase (Rylaze) Asparaginase for module. Per-vial reimbursement via NDFP.OH (CCO) monograph
Cyclophosphamide2IV/POPOGO Satellite Clinic-administered doses should be capped at 1,200mg/m2/dose. Dose/protocol-specific pre- and post-hydration should be discussed prior with the referring specialized childhood cancer program.OH (CCO) monograph
Cytarabine (Cytosine Arabinoside)IV/SCPOGO Satellite Clinic-administered doses should be capped at 100mg/m2/dose.OH (CCO) monograph  
DacarbazineIV OH (CCO) monograph
Dactinomycin (actinomycin)IV1 OH (CCO) monograph
Daunorubicin  IV1Echocardiogram (ECHO) monitoring is the responsibility of the referring specialized childhood cancer program. ECHOs performed at the POGO Satellite Clinic require review by a Pediatric Cardiologist.OH (CCO) monograph
Doxorubicin (adriamycin)IV1Echocardiogram (ECHO) monitoring is the responsibility of the referring specialized childhood cancer program. ECHOs performed at the POGO Satellite Clinic require review by a Pediatric Cardiologist.OH (CCO) monograph
Erwinia AsparaginaseIV/IMPlatelet count must be >20,000 for IM administration. Be aware of increased risk of allergic reaction. Requires post-administration observation. See Sub-Section 3.7.4 Erwinia Asparaginase for module. Per-vial reimbursement via NDFP.OH (CCO) monograph
EtoposideIV/POClose monitoring required for infusional reactions.OH (CCO) monograph
IrinotecanIV/POManagement plan for irinotecan-induced diarrhea should be initially explained by the referring specialized childhood cancer program and reinforced by POGO Satellite Clinic teams. See Sub-Section 3.7.2 Provider Guide: Prevention and Management of Irinotecan-Induced Diarrhea for irinotecan-induced diarrhea management.OH (CCO) monograph
MethotrexateIV/IMMay be given as fixed dose or escalated as per protocol. See Sub-Section 3.7.3 Capizzi Methotrexate for algorithm.OH (CCO) monograph
NelarabineIVPOGO Satellite Clinics and specialized childhood cancer programs should review risk of potential neurotoxicity. POGO Satellite Clinic administration dependent upon drug reimbursement strategy.OH (CCO) monograph
TopotecanIV OH (CCO) monograph
VinblastineIV1Ensure constipation is managed prior to administration.OH (CCO) monograph
VincristineIV1Ensure constipation is managed prior to administration.OH (CCO) monograph
VinorelbineIV1Ensure constipation is managed prior to administration. Protocol for post-infusion line flushing should be discussed prior with referring specialized childhood cancer program.OH (CCO) monograph

*Check individual patient’s protocol road map for special considerations and monitoring requirements. Developed November 1994. Revised: April 1998, May 2001, October 2001, May 2002, December 2006, March 2015, February 2022, March 2024.

1Vesicant; ensure procedures and resources for extravasation are available (refer to Sub-Section 3.3. Extravasation Management).
2Administration of cyclophosphamide may require an 8-hour day. If the POGO Satellite Clinic is not able to provide 8-hour monitoring, cyclophosphamide should not be delivered. The ordering physician should also be available to respond to calls as appropriate.

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
23/8/2024Revised version posted.
2.2.2 Children Eligible for the Management of Complications in a POGO Satellite Clinic
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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
    • 2.1.1 POGO Satellite Care Decision Flowchart
  • 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
    • 3.7.5 Crisantaspase (Rylaze) Asparaginase
    • 3.7.6 Nelarabine
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Sample Fever Cards
    • 4.1.3 Outpatient Fever and Neutropenia in POGO Satellites
  • 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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