4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program

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It is anticipated that some pediatric oncology patients under care in POGO Satellite Clinics will experience treatment complications and/or deterioration in health status which will be an indication to transfer to the appropriate specialized childhood cancer program. The list below is an attempt to highlight conditions which, when present or suspected, should prompt consultation with and possible transfer to the patient’s specialized childhood cancer program.

All patients may be seen for initial antibiotic therapy/stabilization before transfer to the appropriate specialized childhood cancer program. Also, blood product administration, if needed, should not be delayed while arranging transfer.

1. Complex fever and neutropenia
   1. Patients with high-risk diseases or on high-intensity protocols (such as AML, post-stem cell transplant or induction phase of treatment).
   2. Patients presenting with sepsis syndrome.
   3. Patients with persistent fever beyond 5 days or return of fever after period of defervescence.
   4. Patients with presumed surgical focus (such as recent surgery, appendicitis and typhlitis).
   5. Evidence of significant local infection (such as tunnel infection, peri-rectal abscess or cellulitis).
2. Potential interstitial pneumonitis/pneumocystis pneumonia or pleural effusion
3. Pericardial effusion, heart failure or superior vena cava syndrome
4. Intracranial bleed or suspected increased intracranial pressure
5. Seizures or unexplained or new neurological symptoms
6. Spinal cord compression
7. Bowel obstruction
8. Uncontrolled bleeding
9. Concern of relapse or progression of tumour
10. Acute renal dysfunction
11. Acute hepatic dysfunction

Note: Bone marrow aspirates, tumour biopsies and diagnostics such as bronchoscopy are not to be performed in the POGO Satellite Clinic as the procedure will be repeated by the specialized childhood cancer program.

This guidance was updated by Dr. Paul Gibson, Children’s Hospital, London Health Sciences Centre, 2015. POGO gratefully acknowledges the following members of the 2021 Scope of POGO Satellite Program Clinical Panel for their review and input regarding Sub-Section 4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program: Dr. Uzma Ahmed, Trillium Health Partners, Credit Valley Hospital; Dr. Sarah Alexander, The Hospital for Sick Children; Dr. Sarah Barker, Orillia Soldiers’ Memorial Hospital; Dr. Carolyn Hutzal, Grand River Hospital; Dr. Mohammad Jarrar, Windsor Regional Hospital; Dr. Donna Johnston, CHEO; Dr. Arif Manji, Southlake Regional Health Centre; Cristina McCauley, POGO and The Hospital for Sick Children; Kirsty Morelli, Scarborough Health Network, Centenary Hospital; Dr. Sean Murray, Northeast Cancer Centre, Health Sciences North; and Dr. Alexandra Zorzi, Children’s Hospital, London Health Sciences Centre.

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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 Number	Date of Effect	Summary of Revisions
1	12/12/2022	Original version posted.