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POGO Satellite Manual

2.2 Eligible Patients

2.2.1 Children Eligible for Chemotherapy Administration in a Satellite Centre

Eligibility Criteria for Chemotherapy Administration in a Satellite Centre includes:

  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 satellite care have central venous 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 the satellite context. 
  3. For leukemia patients, eligibility for chemotherapy administration is contingent on evidence that bone marrow recovery from induction therapy
  4. Patients whose chemotherapy protocols are out-patient-based;
  5. Pediatric oncology patients requiring selected chemotherapy agents according to a specified route listed in Section 2.3 Scope of Satellite Practice.  The satellite centre must have adequate expertise to administer the agent and monitor for toxicity, and have the tertiary centre in agreement.
  6. Children receiving oral chemotherapy started in the their tertiary centre may have these agents continued in a satellite centre. Furthermore, satellite centres may renew and adjust doses of oral chemotherapies such as corticosteroids, mercaptopurine and methotrexate in consultation and agreement with the referring tertiary centre. 
  7. Children on high intensity protocols where the protocol specified therapy, at any time, falls within the individual agent guidelines, (e.g. Vincristine administration) or is deemed no more toxic than agents already specified as acceptable.
  8. As new chemotherapy agents become available and are used on protocol, their toxicities and their appropriateness for use in the satellite context will be evaluated. New agents may then be added to the Table of Antineoplastic Agents approved for administration in the satellite context and suitable knowledge transfer undertaken.

Table – Chemotherapy Agents that can currently be Administered in the Satellite Context 1 2

DRUG

ROUTE

PRECAUTIONS
(See section 3.5 Chemotherapy Administration)

MONITORING*

Vincristine

IV

Vesicant

Ensure a proper line is in place.

Dactinomycin

IV

Vesicant

Liver Function & platelet count 7-10 days after administration at satellite centre

Daunorubicin

IV via CVC

Vesicant

Echo at tertiary centre

Doxorubicin

IV via CVC

Vesicant

Echo at Tertiary centre

Vinblastine

IV

Vesicant

CBC

Vinorelbine

IV

Vesicant

CBC; Ensure a proper line is in place

Bleomycin

IV

Infuse in saline over
15 – 20 minutes

Pulmonary Function Test at Tertiary centre if necessary

Methotrexate
(<450 mg/m2/day without rescue)

IV push
IM

Mouth ulcers

 

Escalating Methotrexate

IV

 

See section 3.7.4 Capizzi Methotrexate for algorithm.

L-Asparaginase
E Coli or Erwinia

IM
IV

Platelet count must be > 20,000
Be aware of increased risk of allergic reaction

Observe for 1 hour
Availability of the drug is dependent upon availability of funding.
See section 3.7.5 Erwinia L-Asparaginase for module.

Carboplatin
(dose specified by tertiary centre)

IV

   

Cyclophosphamide3
(< 1.2 gm/m2)

IV

Satellite must be able to provide adequate hours of operation to ensure pre and post hydration.

Urine for blood while in clinic.

Topotecan +/- Cyclophosphamide

IV

First dose to be given in Tertiary centre ONLY.

** Consider administration in Advanced Satellite Practice setting only.

Irinotecan

IV

 

See section 3.7.2 (Provider Guide) & 3.7.3 (Parent handout) for Irinotecan Management.

Etoposide

IV

First dose to be given in Tertiary centre ONLY.
Administer doses early in the day to ensure that the ordering physician is available for monitoring.

 

Cytosine Arabinoside up to 100mg/ m2

IV
SQ

   

*Refer to patient’s protocol road map for additional monitoring requirements. Developed November 1994. Revised: April 1998, May 2001, October 2001, May 2002, December 2006, March 2015.

1First dose of all antineoplastic agents in chemo naive patients need to be administered in the Tertiary centre.
2Refer to Extravasation protocol for agents classified as vesicants.
3Administration of cyclophosphamide may require an 8 hr day; if the satellite centre is not able to provide 8 hr monitoring, it should not be delivered. The ordering physician should also be available to respond to calls as appropriate.

2.2.2 Children Not Eligible for Chemotherapy Administration in a Satellite Centre
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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 Satellite Care
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a Satellite Centre
    • 2.2.2 Children Not Eligible for Chemotherapy Administration in a Satellite Centre
    • 2.2.3 Children Eligible for the Management of Complications on a Satellite Centre
    • 2.2.4 Eligibility of Children Requiring Supportive Care
  • 2.3 Scope of Satellite Practice
    • 2.3.1 Implementation of Psychosocial Treatment Plan (Process for Communication)
    • 2.3.2 Limitations on Satellite Practice
  • 2.4 Advanced Satellite 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 Document
    • 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 When to consult the Tertiary Centre
  • 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 Satellite Readiness/ Preparedness Checklist
  • 9.2 Education Report for Tertiary Centres
  • 9.3 Vital Signs Report
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