The 2016 AfterCare Education Day examined selected clinical and psychosocial issues impacting childhood cancer survivors and will provide delegates with theoretical knowledge and practical strategies to manage these issues in order to improve care provided to survivors of pediatric cancers. Over 90 pediatric oncologists, nurses, social workers, and other provincial interdisciplinary AfterCare staff working with childhood cancer survivors will enhance their knowledge of late effects associated with childhood cancer and be exposed to new strategies to manage this unique patient population.
NOTE: The content of each presentation below captures the unedited information and opinions presented by the speakers. Please note that the information contained in the presentations was current at the time it was presented – there may be further information in subsequent literature. Listed speaker credentials were current at the time of presentation.
Presentation Description: After original cancer relapse and second cancers, cardiovascular disease is now the most common cause of premature morbidity and mortality among long-term childhood cancer survivors. This presentation will review the epidemiologic risk factors for early cardiovascular disease in this high-risk population, new prediction tools being developed to more accurately identify those at risk, and conclude with a survey of potential intervention strategies whereby cardiovascular risk may be ameliorated.
Speaker: Eric Chow, MD, MPH Medical Director, Cancer Survivor Program
Seattle Children’s Hospital
Assistant Professor of Pediatrics, University of Washington, Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center
Dr. Chow earned his MPH from the University of California, Berkeley, and completed his medical degree at the University of California, San Francisco. He is a pediatric oncologist and epidemiologist, and his clinical and research focus is on pediatric cancer survivorship. Dr. Chow serves as the Medical Director of the Cancer Survivor Program at Seattle Children’s Hospital, and holds leadership roles within both the Childhood Cancer Survivor Study (CCSS) and the Children’s Oncology Group’s Survivorship and Outcomes committees. Dr. Chow’s clinical and research goals are to improve the care of all people who have had cancer through well-designed and detailed follow-up studies, with a particular focus on cardiovascular health following treatment for childhood cancer and after hematopoietic cell transplantation.
Presentation Description: Improved rates of survival for children with cancer have resulted in a dramatic escalation of young adult survivors entering POGO’s Provincial Pediatric Oncology AfterCare Program. The current model of care, whereby the vast majority of young adult survivors are cared for in the oncology centers, is therefore rapidly becoming unsustainable. This session will therefore explore a future model(s) of care that would move survivors from an oncology centre-focused model to one that involves other care providers (e.g., family health teams).
Speakers: Paul Nathan, MD, MSc Director, AfterCare Program
Division of Hematology/Oncology
Hospital for Sick Children
Dr. Nathan is Director of the AfterCare clinic in the Division of Pediatric Hematology/ Oncology at the Hospital for Sick Children (SickKids). He is a Senior Associate Scientist in the SickKids Research Institute and an Associate Professor of Pediatrics and Health Policy, Management and Evaluation at the University of Toronto. His research is focused on long-term outcomes in survivors of childhood cancer. He studies specific “late effects” of cancer therapy, including cardiac disease and second malignant neoplasms. Much of his research focuses on health care utilization and its relationship with long-term outcomes in adult survivors of childhood cancer. He is a member of several North American research and clinical committees focused on research, clinical care, and policy creation for long-term survivors of childhood cancer, including the Children’s Oncology Group Survivorship and Outcomes Committee, and the Childhood Cancer Survivor Study (CCSS).
Eva Grunfeld, MD, DPhil, CCFP, FCFP Director, Knowledge Translation Research, Health Services Research Program
Ontario Institute for Cancer Research
Dr. Grunfeld is a physician-scientist and Director of the Knowledge Translation Research Network, Health Services Research Program, at the Ontario Institute for Cancer Research. At the University of Toronto, Dr. Grunfeld holds the post of Giblon Professor and Vice-Chair (Research) at the Department of Family and Community Medicine.
Dr. Grunfeld is a leader in cancer health services and outcomes research. Her research focuses on evaluation and knowledge translation of cancer health services, covering the entire spectrum of cancer control activities. She is internationally recognized for research on integration of care and on cancer outcomes.
Dr. Grunfeld uses a mixed-methods approach including randomized controlled trials (RCTs), qualitative research and outcomes research. Knowledge translation is an integral part of all her research activities. She has conducted several multi-centre RCTs on cancer survivorship which have influenced clinical practice guidelines and policies internationally.
Dr. Grunfeld holds many peer-review grants as Principal Investigator and has served on many committees to further the goals of cancer control in Canada and internationally. From 2004 to 2008 she founded and directed the Cancer Outcomes Research Program at Cancer Care Nova Scotia and Dalhousie University. She obtained her medical degree from McMaster University and doctoral degree from Oxford University.
Jonathan Sussman, MD, CCFP, FRCPC, MSc Radiation Oncologist
Director, Supportive Care Research Unit
Juravinski Cancer Centre
Dr. Sussman is a Radiation Oncologist at the Jurvanksi Cancer Centre who specializes in the treatment of breast cancer and hematological malignancies. He received his initial training as a family physician. His research interests include trials in the treatment of breast cancer and lymphoma and health services research in models of care with a special focus on improving integration between providers in caring for cancer survivors. He is an Ontario Association of Radiation Oncologists Clinician Scientist and is the Chair of Advisory Committee in the Survivorship Program at Cancer Care Ontario.
*POGO was not granted permission to share Eva Grunfeld’s and Jonathan Sussman’s slide.
Presentation Description: Treatment for childhood cancer has evolved over the past five decades such that over 80% of children diagnosed with cancer will survive at least five years. Unfortunately, cure is not without consequences, leaving survivors at risk for the early development of chronic health problems typically associated with ageing. Among young adults treated for malignancy in childhood, an ageing phenotype, frailty, has been identified in nearly 8% of survivors. This phenotype is associated with new onset of chronic disease and with mortality in this population. This presentation will describe the prevalence and predictors of frail health in childhood cancer survivors, referencing who is at greatest risk for this outcome and who is not at risk for this outcome. It will also discuss the implications of frailty and describe potential interventions to prevent or remediate frail health in children during treatment for cancer and among cancer survivors.
Speaker: Kirsten K. Ness, PT, PhD, FAPTA Present Full Member; Department of Epidemiology and Cancer Control
St. Jude Children’s Research Hospital
Dr. Ness is a physical therapist and clinical epidemiologist and Member of the faculty at St. Jude Children’s Research Hospital. She has a BA in Physical Therapy, an MA in Leadership and an MPH and PHD in Epidemiology. She is a Catherine Worthingham Fellow of the American Physical Therapy Association and has been in Physical Therapy practice for over 30 years. Her research focuses on the observation and remediation of functional loss among persons who were treated for cancer during childhood. She has funding from the American Cancer Society, the Gabrielle’s Angel’s Foundation, the National Cancer Institute, and the National Institute of Child Health and Human Development. She has over 160 peer reviewed publications and serves on the Steering Committees for the Childhood Cancer Survivor Study and the Children’s Oncology Group Survivorship and Outcomes Committee. She is a member of the Survivorship Committee for the American Society for Clinical Oncology, an active member of the Oncology Section of the American Physical Therapy Association, and on the Editorial Boards of Pediatric Physical Therapy, Rehabilitation Oncology, and the Journal of Clinical Oncology.
Presentation Description:
Routine screening for emotional distress has been identified as a standard of care for all cancer patients. However, identifying appropriate screening measures that have both clinical and research utility is not a simple undertaking. What information to collect, how to collect it, and how to use the information to improve clinical care are all questions to be taken into consideration. Dr. Madeline Li is the creator of the Distress Assessment and Response Tool (DART) that has been used since 2010 at the Princess Margaret Cancer Center. She will provide a brief overview of the development and implementation of DART. Adolescents and young adults with cancer (age 15-39, AYA) are recognized to have unique psychosocial issues and distress screening must be tailored to assess their specific concerns. Dr. D’Agostino will present the adaptation of DART for AYA and she will give a brief overview of work being done internationally to develop an AYA-specific distress screening tool.
Speakers: Madeline Li, MD, PhD Psychiatrist, Department of Supportive Care
Princess Margaret Cancer Centre
Dr. Li is an assistant professor in the Department of Psychiatry, University Health Network, University of Toronto and a psychiatrist in Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre. In addition to clinical practice in cancer psychiatry, she conducts collaborative research in the areas of psychoneuroimmunology and psychosocial cancer research. She has authored several publications, guidelines and interprofessional education resources on the topic of management for anxiety and depression in cancer patients. She has served as a Psychosocial Oncology Clinical Lead in Toronto for Cancer Care Ontario, and is the developer and physician lead of the Distress Assessment and Response Tool (DART) program at Princess Margaret.
Norma D’Agostino, Ph.D., C.Psych. Clinical Health Psychologist, University Health Network
Lecturer, Department of Psychiatry, University of Toronto
Dr. D’Agostino is a Staff Psychologist at the Princess Margaret Cancer Centre. She is a registered psychologist with the College of Psychologists in Ontario and holds an appointment as Lecturer in the Department of Psychiatry, University of Toronto.
Dr. D’Agostino has over 10 years of professional experience in pediatric and adult psychosocial oncology. Her clinical work and research focuses on young adults with cancer, including long-term survivors of childhood cancer. The goals of her work are to create developmentally appropriate psycho-social resources for adolescent and young adults with cancer, optimizing the transition process of emerging adulthood, and exploring how the illness experience in early life influences psychosocial adjustment and development across the life-span.
