REDiAL- Resuming Normalcy During Acute Leukemia
Leukemia maintenance therapy primarily involves oral chemotherapy at home, with less frequent hospital visits, and lower intensity symptoms that are expected to have less impact on daily activities. ALL (acute lymphoblastic leukemia) experts believe it is medically safe to resume developmentally appropriate activities during maintenance, and that promoting physical activity and social engagement may mitigate the severity of symptoms, late effects, and improve quality of life.
A significant gap and variability in the education provided at the start of maintenance therapy was identified by members of the leukemia team at SickKids. Building on the success of the new diagnosis education program, a structured education intervention called REDiAL (REsuming normalcy During Acute Leukemia treatment) was created by an expert interdisciplinary team, delivered by the leukemia clinic nurses, and evaluated.
The overall goal of the education sessions is to support families’ capacity to resume a sense of normalcy, and identify those who will need additional support to adjust to maintenance therapy.
Over the past year, the education sessions were delivered to over forty families of a child diagnosed with ALL, within one month of starting maintenance therapy. Sessions were delivered both in-person and virtually to meet the needs of the caregivers. The average length of the sessions was 35 minutes. 50% of sessions were attended by one caregiver, and the other 50% was a combination of 2 caregivers, 2 caregivers and their child, or 1 caregiver and 1 child. Most (60%) sessions were delivered virtually based on caregiver preference. Notable topics included transitioning back to school in person, extracurricular activities, sleeping independently, travel, review of medications, and healthy nutrition.
The team reviewed caregiver feedback collected with a survey for ongoing tailoring of the content, length of session, and delivery. 100% of caregivers responded ‘Yes’ to ‘Did you learn something new during this education session?’, and ‘Would you recommend this session to another family?’ Caregivers also provided valuable qualitative feedback, including:
“Learning about the social aspects (school, work), dietary, and positive transitions we are being suggested to make was reassuring and comforting.”
Another caregiver noted the session helped with feeling prepared for meeting with the team on day one of Maintenance. Another caregiver asked for:
“More focus on mental health and dealing with the longevity of treatment.”
The contact nurses provided valuable field notes with each session, with unanimous reports of feeling the sessions strengthened their therapeutic relationships with their patients and respective families.
As of October 2025, REDiAL education sessions have been adopted into the standard of care for leukemia patients receiving treatment at SickKids. Evaluations of the content, delivery, and follow up remain ongoing. The team is excited to share their insight to inspire other institutions to adopt similar initiatives, and expand caregiver education to other time points in leukemia therapy.
This story was written for the spring 2026 issue of The RePORTer, POGO’s Nursing Newsletter by Tanya Pryshlak, Clinical Program Coordinator, RN, BScN, The Hospital for Sick Children. Tanya has over eight years of inpatient and outpatient experience in pediatric oncology nursing. She brings a passion for empowering patients and their families through education, and has played a crucial role in the development and roll out of the education sessions.
It’s a Privilege to Care for a Child with Cancer
My introduction to POGO started 20+ years ago when I attended my first POGO Symposium. Back then, I craved learning more about pediatric oncology, and there were many POGO educational opportunities from which I could choose.
So, one day (and I am not sure of the exact details of how this happened), I found myself in a car with Dr. Mark Greenberg, a founding member of POGO, Corin Greenberg, POGO’s Executive Director at the time, and another staff nurse. We were on our way to the CBC to participate in an interview about childhood cancer awareness. They wanted a novice nurse’s side of the story along with Mark’s expert thoughts.
I was so nervous. Then came THE question.
“How can you work in pediatric oncology when it is such hard work?”
All of us who work in pediatric oncology either dread or welcome this question. It can be a conversation stopper or it can lead to an opportunity to educate the public about this important cause.
“It is a privilege to care for a child with cancer,” I remember saying.
At the time, I actually thought that I understood what it meant to do this work and I probably did to an extent.
I continued along in my nursing career gaining more knowledge and expertise. I felt good about my practice; I understood my purpose.
Fast forward to six years ago, nearly 15 years after that CBC interview. I found myself caring for my mom in a hospice. I spent hours there watching the healthcare providers at work, wondering, how do they do this?
One day, I was talking with a nurse.
“What kind of nursing do you do?” she asked.
“Pediatric oncology nursing,” I said.
She then shared with me that 15 years before, her daughter had neuroblastoma and had died. We talked for a little bit and on her next night shift, she brought in a photo album, sat with me, and shared stories about her daughter. After, she thanked me for listening and for asking her questions about her daughter. Most people were too uncomfortable to talk with her about her daughter or acknowledge that she had a deceased child. She said that it was always the staff at McMaster Children’s Hospital and SickKids, where her daughter was treated, who understood what she was going through the most and were the easiest to talk to.
That interaction helped me fully understand how the care we provide has an impact on families. And so, to do the best in my work I believe I need the best ongoing education.
The annual POGO symposium is a high-quality conference and—along with POGO’s one-day education events—has played a significant role in my professional education. POGO’s reputation for excellence in education attracts a broad spectrum of healthcare providers to present and learn about topics related to survivor care, standards of care at POGO Satellite Clinics and research.
And through my work with POGO I can be a champion of childhood cancer care with the general public and educate healthcare providers across the province.
To this day, I still say that it is a privilege to care for a child with cancer and their family. After all, where else can you go to work and get hugs and high fives (from the kids) all day long?
Denise Mills, MN, NP Pediatrics, works at The Hospital for Sick Children in the Solid Tumour, New Agents and Innovative Therapy, MIBG Program. She is co-chair of the POGO Nursing Committee and a past member of the POGO Board of Directors. She was a member of the planning committee for the 2018 POGO Multi-Disciplinary Symposium on Childhood Cancer and the Pre-Symposium Nursing Seminar. Denise is also a recipient of a POGO Seed Grant to fund her study “Improving Quality and Consistency in Family Education Prior to First Discharge Following a Pediatric Cancer Diagnosis.”
