Cancer-Related Fatigue and What Pediatric Oncology Nurses Need to Know
Cancer-related fatigue is a major but often under-recognized aspect of childhood cancer care. As treatments become more effective and survival rates improve, attention is shifting to the overall well-being of young patients during therapy. Fatigue stands out as a common experience that can affect every part of a child’s life, from play to school to home. Understanding fatigue is an essential step in providing truly comprehensive pediatric oncology care.
What does the evidence say about fatigue in pediatric oncology?
We know that fatigue is one of the most prevalent, severe and distressing symptoms and it can persist long-term into survivorship. Fatigue is associated with a decreased quality of life and can co-occur with other symptoms such as depression and sleep disturbance.
So, what can we do about it?
POGO’s Guidelines Program provides healthcare professionals in Ontario and worldwide with the best options for managing the adverse effects of cancer and its treatment with the goal of improving the health and quality of life of children with cancer.
Read more about the program here.
Recently, this POGO program released a fatigue clinical practice guideline (CPG) to get you moving in the right direction. The purpose of the fatigue CPG is to guide healthcare providers in the management of fatigue in children and adolescents with cancer and pediatric recipients of hematopoietic stem cell transplants (HCT).
The fatigue CPG ultimately highlights four recommendations and one good practice statement (see table below). Nurses at the bedside and in clinics are uniquely positioned to implement these evidence-based recommendations.
I’ve reviewed the fatigue CPG, now what?
Start with the good practice statement. You can ask your patients about fevers, nausea and vomiting, pain and more, so now is the time to start asking about fatigue. There are many tools to help you assess fatigue; see if your institution is using any of them. Some examples include: Peds-PRO-CTCAE, PROMIS and SSPedi: Symptom Screening in Pediatrics Tool.
Next, try recommendation 1, the use of physical activity. There is no perfect intervention for physical activity, but you can assess what brings your patient joy and start small and scale up. Maybe it is a dance party that the unit holds for 10 minutes a day or maybe your unit has organized scavenger hunts that have the patients up and moving around the unit and hospital. Encourage families to get involved and plan activities such as walks, bike rides or yoga.
Guided by the POGO fatigue CPG, the Children’s Oncology Group (COG) New Diagnosis Guide now incorporates information about fatigue, including describing fatigue as a symptom of cancer and cancer therapy and offering suggestions to families on how to manage fatigue. This guide can help you start the conversation.
Find the New Diagnosis Guide and other COG family resources here. https://childrensoncologygroup.org/cog-family-handbook
Review POGO’s clinical practice guidelines on fatigue, and other topics, here.
AboutKidsHealth has also developed some great resources about fatigue which you can read more about here: Cancer-related fatigue
Denise Mills, MN, RN(EC), NP Pediatrics
POGO Provincial Clinical Lead, Pediatric Oncology Nursing
References
- Hooke, M.C., & Linder, L.A. (2019). Symptoms in children receiving treatment for cancer-part 1: fatigue, sleep disturbance, and nausea/vomiting. Journal of Pediatric Oncology Nursing, 36(4), 244-261.
- Patel, P., et al. (2023). Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. www.thelancet.com Vol 63 September, 2023.
Meet Renee Smith, Compassionate and Experienced Pediatric Oncology Nurse at Windsor Regional Hospital
As a nurse at the POGO Satellite Clinic at Windsor Regional Hospital (WRH), Renee Smith plays a pivotal role in ensuring that pediatric oncology patients in the Windsor-Essex County area receive the care they need, closer to home. Her work is a testament to the power of empathy, teamwork, and dedication that makes a lasting impact on the families she serves. Here, Renee shares her experiences, insights, and the reasons why pediatric oncology nursing is so close to her heart.
Helping Children Receive Optimal Care
Renee’s role is focused on coordinating care for childhood cancer patients residing in the community. A key part of her mission is to help these children and families avoid long travel on the highway to reach a larger hospital with a specialized childhood cancer program.
“I work as the RN in the clinic, organizing appointments and working closely with our pediatrician and pharmacists to administer chemotherapy,” Renee explains. “Patients come to me for lab work, port access, blood transfusions, and supportive care as needed. If a child is feeling unwell, they can come to our POGO Satellite Clinic and be assessed on-site.”
The POGO Satellite Clinic at WRH also coordinates imaging and communicates with their partner hospital, Children’s Hospital, London Health Sciences Centre, to ensure patients receive optimal care. The highlight for Renee is the deep relationships she forms with the POGO families, helping them through one of the most difficult times in their lives.
“I love meeting the POGO families and working with them throughout their journey. It’s rewarding to be part of their lives, especially knowing that our work can help make a terrible time a little more bearable. I also love how the role allows me to continuously learn new information and grow as a nurse.”
A Journey in Nursing
Renee’s career journey is one of passion, dedication, and a deep love for pediatric care. She worked in pediatrics for 19 years before she began covering shifts in the POGO Satellite Clinic at WRH. She then spent three years in the chemotherapy suite of the Adult Cancer Centre, with a primary oncologist, managing patients with solid tumours, melanoma, and hematology.
However, Renee’s heart always remained with pediatric patients, and when the opportunity to return to the POGO Satellite Clinic became available, she jumped at the chance to be back with children and their families.
“I’ve always felt deeply connected to the pediatric population, and being part of the POGO team has been a dream come true,” says Renee.
Advice for Aspiring Nurses
For those interested in pursuing a career in pediatric oncology nursing, Renee offers some valuable advice:
“Be patient, listen actively, and develop strong communication skills. Children and families need to feel heard and supported. It’s also important to find healthy coping strategies through hobbies or exercise to maintain a balanced life and avoid burnout.”
She also emphasizes the importance of ongoing education. POGO offers several educational opportunities, including Satellite Education Day, AfterCare Education Day and virtual education.
“Pediatric oncology is constantly evolving, so staying up to date with new treatments and technologies is key. Work as part of a strong team, advocate for your patients, and always take the time to celebrate the small wins along the way.”
The Emotional Toll of Pediatric Oncology Nursing
Renee highlights one of the most pressing challenges in pediatric oncology nursing: the emotional toll. Nurses in this field witness the pain and suffering of children and their families, which can be incredibly difficult to cope with.
Above all, Renee reminds aspiring nurses not to neglect their own well-being.
“Taking care of yourself is just as important as taking care of your patients. It’s important to acknowledge the emotional strain that comes with the job. Nurses are there to support both the patients and their families, but sometimes we forget to take care of our own emotional needs. It’s crucial to recognize when burnout is a concern and to take steps to manage it.”
A Family Legacy of Nursing Begins
One recent achievement that Renee is particularly proud of is seeing her son, Owen, enter the nursing program at Western University.
“When I asked him why he chose nursing, he said it was because he remembers me always speaking so highly of the profession and its impact on helping people. He told me he wanted to follow in my footsteps and become the best nurse he could be. It was such an emotional and proud moment for me.”
Inspiring the Next Generation of Nurses
Renee’s story is one of inspiration, dedication, and unwavering commitment to the families she serves. Her work in pediatric oncology nursing touches the lives of children and families, making a profound impact during some of their most difficult times. Through her work, she exemplifies what it means to provide compassionate, high-quality care with a heart full of empathy.
We thank Renee for sharing her journey and insights. Her dedication continues to inspire not only the patients and families she cares for, but also the next generation of nurses, including her own son.
Reflections of a Bedside Nurse
Reflective practice is a cornerstone of pediatric hematology/oncology nursing—strengthening team collaboration, elevating standards of care, and supporting the emotional well-being of nurses. Its benefits are far-reaching, touching not only the nurses themselves but also the young patients and families they care for. Reflective Practice Corner is a standing section in The RePORTer—POGO’s Nursing Newsletter—featuring reflections from nurses across the province and offering insights into their experiences. It also invites readers to pause and consider the questions posed.
Clare Holton has been a registered nurse for five years and found her passion for pediatric oncology two years ago when she joined the pediatric oncology team at McMaster Children’s Hospital, Hamilton Health Sciences.
What lessons have you learned from your patients?
It is a privilege to care for children and their families as they navigate the challenges and milestones of the cancer journey. Every day offers something meaningful, especially through the invaluable lessons I have learned from my patients, which cause me to pause and reflect.
I remember caring for a five-year-old patient with neuroblastoma. His love for the small things in life and his ability to live for the moment were truly inspiring. His perspective was untainted by fear or doubt. This was truly a breath of fresh air and a resounding lesson in resilience. There was something profoundly inspiring in this patient’s unshakeable hope and pure-hearted view on life. He had a strong fighting spirit and a bright outlook that resonated with everyone around him. I remember walking into his room after he had several grueling days of chemotherapy. I heard Elton John’s “I’m Still Standing” playing and there he was playing with his race cars quietly singing along. That moment stuck with me, reminding me that even on our hardest days we can still stand on our own two feet and keep moving forward, even if it’s small steps. This has become one of the most powerful lessons I have learned working in pediatric oncology: to be hopeful, keep going, and never underestimate the strength found in resilience. Every time I hear that song, I think of this patient and his unwavering spirit, brightness, and strength in the highs and the lows. I carry this memory, especially on my own tough days, as a reminder of the incredible courage and resilience of the patients we care for.
How do you prioritize self-care?
While caring for my patients is my priority, on my days off I like to spend time in nature, reading, and at my family cabin with my family and with my dog. Working in an acute, fast-paced, and unpredictable environment is challenging at times especially during 12-hour shifts. I encounter both ups and downs, and I frequently experience emotionally difficult situations. On my days off, I really take advantage of doing the things I enjoy. I also engage in mindfulness and reflective practices to support a healthy work-life balance. This is important to me so that I can continue to provide family-centered compassionate care. I try to incorporate the same mindfulness into the workplace by embracing the ability to “take things as they come” while balancing it with the planning and the structure my job requires.
How do you stay motivated and inspired on tough days?
Caring for a child with cancer means supporting the entire family unit. One of the most difficult parts of this role is to navigate the delicate balance of offering hope with the reality of their diagnosis. I aim to be honest while maintaining compassion, giving the families space to process. It is a balance of holding hope while also preparing for the worst possible outcomes, and I try to walk that line with humility and grace.
Clare Holton, RN, has been a registered nurse for five years. She found her passion for pediatric oncology when she joined the pediatric oncology team at McMaster Children’s Hospital, Hamilton Health Sciences.
Related content: Reflective Practice IS Nursing Practice
Highlights from the 2024 POGO Symposium: Through a Nurse’s Lens
By Denise Mills
This year, the POGO Multidisciplinary Symposium on Childhood Cancer took an exciting road trip to Niagara-on-the-Lake, where Ontario’s pediatric oncology community gathered to connect, collaborate, and learn. POGO partner hospitals were well represented, including the five centres with specialized childhood cancer programs and eight POGO Satellite Clinic locations. Over 60 nurses participated in this impactful event! While we can’t relive the Symposium, here are a few key takeaways from the sessions.
Lee Dupuis: The Power of the Patient's Voice in Symptom Management
Lee Dupuis delivered a powerful closing presentation on the critical role of the patient’s voice in improving symptom management. She explained how we define the "patient's voice," how to elicit it from pediatric patients, and why it’s essential to listen and respond effectively to improve care. Lee shared compelling results from a recent trial conducted in the US and Canada, which randomized symptom screening against usual care.
The findings were clear and will be shared in an upcoming publication. For more insights into symptom assessment tools, explore SSPedi and Spark here: Symptom Assessment Tools.
Lee also emphasized the importance of implementing clinical practice guidelines (CPGs) in our clinical practices, such as the Spark Clinical Care Pathways. For more information on CPGs, visit the POGO Clinical Practice Guidelines.
Nicole Culos-Reed: Exercise and Fatigue Management in Pediatric Oncology
Nicole Culos-Reed's session highlighted POGO’s updated CPG recommending physical activity as an effective intervention for fatigue in children and adolescents with cancer. Nicole explored the benefits of exercise during treatment, such as protecting muscle strength, improving immune function, and managing common side effects. She also discussed the long-term importance of physical activity after treatment, including its impact on cognitive function, cardiac health, bone mineral density, and the risk of metabolic syndromes.
To learn more about her POEM program (Pediatric Oncology Exercise Manual) and the IMPACT intervention for physical activity during treatment, visit POEM & IMPACT.
Agnes Wong: The Art and Science of Compassion
Agnes Wong led an inspiring session that guided us through the components of compassion, emphasizing the importance of mental and emotional training for healthcare providers. Agnes also underscored the need for self-compassion as a prerequisite for effectively caring for others. She challenged us to consider how compassion training should be integrated at a systems level, in institutions, and in professional training programs.
For those interested in further developing their compassionate practices, Agnes shared a valuable resource: the Mindfulness & Compassion Training Program at the Sarana Institute.
We hope you find these highlights inspiring and insightful. Thank you to all who attended and contributed to the success of the 2024 POGO Symposium!
Improving the Experience: Innovating the Standard Blinatumomab Medical Backpack at SickKids
By: Alia Petropoulosand Lisa Honeyford
Blinatumomab is an immunotherapy primarily used to treat certain types of blood cancers. Its administration necessitates a continuous 28-day infusion delivered on an outpatient basis that families typically can manage at home. Although a standard medical-grade bag is provided to families to hold the device, our clinical team at SickKids identified several design flaws, including poor fit and function for children, along with a distinctly “medical” appearance that can be stigmatizing.
To address these challenges, a grant proposal was submitted to the Garron Family Cancer Centre (GFCC) to improve the experience for families caring for children receiving blinatumomab. Our goal was to understand the challenges families faced going home with a 28-day blinatumomab infusion. We knew that the right carrying bag design could make a significant difference in the daily lives of these patients and maximize the activities they are able to participate in while receiving the medication
Once the project was successfully funded, a dedicated team was assembled, comprising of nurses, an oncologist, a child life specialist, and an industrial designer. Our approach included comprehensive desktop research, product testing, and personal interviews with families to understand their experiences with the current medical bag. The insights gathered after interviewing patients, families, and healthcare providers, led to the creation of a list of criteria for the ideal medical bag. The team then collaborated with an industrial designer to develop a blueprint for a prototype and secured a vendor to produce it for testing.
The new prototype bag was created as a backpack and tested with 10 pediatric patients receiving blinatumomab. Half of the participants began with the standard bag while the other half started with the prototype backpack. The team gathered feedback from frontline nurses and families who completed surveys assessing comfort, function, acceptability, and preference. Remarkably, 9 out of 10 participants preferred the prototype backpack, citing improved fit, comfort, and functionality.
“It really helped my child feel more independent during daily activities,” shared one parent, highlighting the emotional benefits of a well-designed product.
This valuable input guided the industrial designer in creating a second-generation prototype, enhancing the fit, security, and accessibility of the medication and pump, as well as improving how families could set up and wear the bag.
Looking ahead, the project team* is working to secure funding and create a process that will allow the backpack to be accessible to any Canadian child receiving blinatumomab. Canadian sites will be contacted when this step is complete, and backpacks are available for distribution. Future efforts will focus on expanding the availability of the backpack internationally.
[Watch the video The Blina Backpack: Changing how we deliver paediatric immunotherapy treatments]
*Project Team includes Alia Petropoulos, Chantal Campbell, Registered Nurse (RN), Lisa Honeyford and Sue Zupanec, Nurse Practitioner (NP).
About the Authors
Alia Petropoulos and Lisa Honeyford are Interprofessional Education Specialists at SickKids.
Editorial Team Note
Congratulations to the project team who were recently recognized for their innovative intervention, the Blinatumomab Backpack, by way of a SickKids President's Award. The President's Award was introduced in 2011 to recognize staff, teams, students and/or volunteers who demonstrate superior leadership and collaboration resulting in major contributions to the organization.
Evaluating Healthcare Simulation Escape Rooms as an Educational Tool in Nursing Continuing Education: A Fellowship Journey
By: Brennah Holley
Fellowship Overview
Brennah Holley, Clinical Nurse Educator at CHEO in Ottawa (and former Co-Chair of the POGO Nursing Committee), recently completed an Advanced Clinical Practice Fellowship (ACPF) through the Registered Nurses Association of Ontario and is now conducting an exciting research project (directly related to her fellowship) to explore the potential of Healthcare Simulation Escape Rooms (HSER) as an innovative educational tool in nursing. With the nursing profession facing pressing challenges such as staffing shortages and varied learning needs, her research aims to assess whether HSERs can enhance knowledge acquisition among nursing staff.
“HSERs merge gamification with traditional learning, creating engaging team-based experiences,” Brennah explains. As defined by Anderson et al. (2020), HSERs infuse healthcare themes into interactive escape room settings, offering a fresh platform for education and assessment.
Research Objective and Methodology
At the heart of Brennah’s research is the objective to evaluate HSERs' effectiveness in nursing education. The study, which began in early 2024, will investigate whether engaging in an HSER focused on anaphylaxis leads to better knowledge retention and application compared to traditional lecture formats.
In a randomized controlled trial, nurses at CHEO will be divided into two groups: Group A will receive a lecture, while Group B will experience both the lecture and the HSER. “This approach allows us to gather vital data on the impact of immersive learning,” she notes.
Learning Experience and Skill Development
Brennah’s journey through the fellowship has been rich with learning. She acquired essential skills in research design, ethics submissions, and statistical analysis. Working alongside the Clinical Research Unit (CRU) at CHEO, she navigated the complexities of ethics applications, completing necessary training and developing vital documentation like consent forms.
Addressing knowledge gaps in statistical analysis was a significant focus for Brennah. By collaborating with a co-investigator from CHEO’s CRU, she enhanced her research capacity. “This partnership has been instrumental in refining my project,” she emphasizes.
Brennah also developed her skills in survey design and literature reviews, both critical for creating effective educational tools.
Outcomes and Future Directions
Data collection for her research will extend until early 2025, with plans to draft a manuscript by fall 2025. The implications of Brennah’s research could be profound, providing evidence to support the integration of HSERs into nursing curricula and continuing education programs. “Ultimately, we want to enhance patient care through improved educational strategies,” she states.
Reflections
Reflecting on her ACPF experience, Brennah describes it as transformative, filled with opportunities for professional growth. Presenting at international conferences and collaborating with nurse educators worldwide have enriched her journey. As she begins her master’s in Nursing, she is eager to further explore innovative educational methodologies, with HSERs leading her efforts to improve nursing practice.
In summary, Brennah Holley’s fellowship at CHEO highlights the promise of innovative educational approaches in nursing, paving the way for advancements in continuing education and enhanced patient care.
“We are on the brink of a new era in nursing education,” she concludes, optimistic about the future.
To learn more about Brennah’s fellowship experience or research endeavours, feel free to reach out to her.
Reflective Practice IS Nursing Practice
By: Arvinder Aulakh, Jessica Brooks
“Let us never consider ourselves finished nurses…we must be learning all of our lives.”
Clearly, Florence Nightingale had early insights into the importance of continual professional growth and development. Reflective practice is foundational within pediatric hematology/oncology nursing, enhancing team collaboration, improving care standards, and supporting nurses’ emotional well-being. This offers multifaceted benefits for nurses, their young patients, and the families they care for.
Pediatric hematology/oncology nursing is a profession that embraces collaboration through reflecting on shared experiences and challenges. Reflective practice allows nurses to contribute to the collective knowledge base by critically evaluating their current practices to drive evidence-based practices. Engaging with nurses with different experiences allows for dialogue that contributes to holistic patient care, team learning, and improved communication.
Patient care outcomes are improved through reflective practice. Personal values and beliefs can indirectly and unknowingly affect patient care. Reflective practice provides insights into nurses’ strengths and challenges contributing to better clinical acumen, empathetic communication, and emotional resiliency. Through this, professional growth and development are achieved, allowing for higher standards of patient care.
It is well understood through literature and lived experience that caring for seriously ill children can lead to burnout and compassion fatigue. Reflective practice empowers nurses by enhancing their self-awareness through professional reflection, facilitating peer support through group discussion, and promoting empathy and compassion by providing a safe and non-judgmental environment. Supporting nurses’ well-being through group self-reflection promotes enhanced job satisfaction.
There are many guidelines and frameworks that can be used when doing a reflective practice. When engaging in reflection, nurses should consider these key aspects:
- Description of experience: Recall the important events and features by giving a clear, non-judgmental and comprehensive account of the experience. Experiences may include describing a challenging patient interaction, a successful teamwork experience, or any other significant event.
- Evaluation: Take a “look back” and think about the importance of that experience. What went well? What were the challenges? How did these moments impact patient care, team dynamics, or your personal feelings about work?
- Analysis: An opportunity to critically think about the experience using theory and research. This could include analyzing communication strategies, ethical dilemmas, or case studies that highlight successes and challenges.
- Future action: The experience is summarized to help gain personal insights and determine any next steps. What will you continue to do? What will you change? Setting specific and measurable goals can guide your growth.
Consider incorporating reflective practice into staff meetings, evaluations, and group discussions. Through this, professional development is enhanced because reflective practice IS nursing practice!
About the Authors
Arvinder Aulakh and Jessica Brooks are POGO Interlink Nurses working at SickKids. Learn more about the POGO Interlink Nursing Program.
Spotlight on Tanya Hobson: A Dedicated Advocate for Pediatric Oncology Families in Northern Ontario
Introducing Tanya
For Tanya Hobson, a POGO nurse based at Health Sciences North in Sudbury, caring for young patients with cancer goes far beyond clinical responsibilities. As both a pediatric oncology Satellite Clinic nurse and AfterCare Clinic case manager, Tanya provides essential support for families navigating the challenges of childhood cancer treatment and survivorship in Northern Ontario.
Behind the Care: Tanya’s Daily Impact
In her dual role, Tanya fills her days with clinical duties like, chemotherapy administration and assessments, as well as emotional support that carries into AfterCare. "During treatment, our focus is on helping children manage side effects and supporting families through the process," she says. Post-treatment, her work shifts to help survivors address the long-term effects of cancer treatment, with a special emphasis on maintaining health and well-being for years to come. Reflecting on her work, Tanya shares, “We make a real difference to these families—our work is so valued."
A Unique Path to Pediatric Oncology
Tanya’s path to this role reflects her passion and deep commitment. Initially pursuing medical school, she shifted to nursing to seek a more hands-on, patient-focused career. She gained valuable experience in the Neonatal Intensive Care Unit (NICU) and Intensive Care Unit (ICU) at The Hospital for Sick Children (SickKids) in Toronto for over a decade before moving to Sudbury and discovering her true passion in pediatric oncology. Since then, she has built lasting connections with patients and families in her community, something that she finds deeply rewarding.
Overcoming Challenges in Northern Ontario
Northern Ontario’s vast geography presents unique challenges for healthcare access. Some of Tanya’s patients live up to seven hours away, making trips to the clinic daunting. This distance, coupled with sometimes unpredictable weather and limited access to immediate healthcare resources, requires tailored care that Tanya and her team strive to deliver with dedication.
Addressing Mental Health in Pediatric Oncology
One pressing issue in pediatric oncology, Tanya notes, is the growing need for mental health support. As childhood cancer survival rates improve, families and survivors grapple with the psychological impact of a cancer journey, often extending beyond the treatment phase. Tanya believes integrating mental health support into standard of care is crucial, starting at diagnosis and continuing through survivorship.
Proud Achievements and a Lasting Impact
Reflecting on recent meaningful experiences, Tanya is proud of her recent Canadian Nurses Association (CNA) Certification in Oncology and completion of the Association of Pediatric Hematology/Oncology Nurses (APHON) Chemotherapy/Biotherapy Provider Course. Both credentials affirm her commitment to best practices and a high standard of care for her patients. But her greatest achievement, she shares, came when a former patient recently told her he was pursuing nursing because of the care he received from her. “It was lovely to hear the impact we make,” Tanya says, smiling.
Closing Reflections
In her 10 years in Sudbury, Tanya remains inspired by the resilience of her patients and families. Each day, she brings a compassionate approach to a field she feels called to, embodying POGO’s mission to ensure children with cancer and their families receive the best possible support—no matter where they live.
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.”
POGO Celebrates Pediatric Oncology Nursing Excellence with Bruna DiMonte
"Excellence in oncology nursing is about demonstrating a high level of compassion, empathy and pediatric oncology specialty expertise in caring for kids with cancer and their families. Nurses incorporate evidence-based literature and research in our clinical practice, and we are excellent resources to allied health teams and the field of pediatric oncology. We advocate for resources to meet the challenging needs of kids with cancer, families, pediatric oncology nursing and the childhood cancer care system."
Data Drives Practice
These days, my work at SickKids overlaps with my data management role at POGO. In both organizations, I lead teams responsible for capturing data in our POGONIS database. This data—clinical information that includes specifics about children’s diagnosis, treatment, complications and long-term outcomes—is used by POGO and our system partners for cancer surveillance, research, decision-making, system and program planning and evaluation, and policy advice.
Her Passion for Her Patients and Work as a Pediatric Oncology Nurse
My early career was devoted to working on the frontlines and in doing so, I always strived to provide compassionate care to kids with cancer. While it’s hard to choose, I would say that one of the most rewarding things was finding time in my day to play with a child and distract them from the complex cancer treatment I still had to provide. Every day brought a new set of challenges and however a child’s story played out, my only hope was that I had made a positive difference in their life and their family’s.
POGO Values Pediatric Oncology Nurses
I have had the pleasure of helping POGO support pediatric oncology nurses in making valuable contributions to the pediatric oncology community. I am the staff representative on the POGO Nursing Committee and have worked with Committee members on such special projects as POGO guidance documents about telephone practices (telepractice) and the safe handling of antineoplastic agents. The Committee has also had the opportunity to contribute to publications, abstracts, presentations at conferences of health organizations like the Association of Pediatric Hematology/Oncology Nurses (APHON), The International Society of Pediatric Oncology (SIOP), and POGO education events like AfterCare Education Day, the Annual Multidisciplinary Symposium on Childhood Cancer and Nursing Pre-Symposia education events. Through POGO, pediatric oncology nurses also have the opportunity to advocate on a policy level, and in the past actively supported POGO’s recommendation of the nurse coordinator position and acquisition of the Interlink Nursing program. POGO also proactively seeks preceptorships with nursing student placements at the POGO office and with the POGO Interlink Nurses at their hospitals.
Other Career Achievements of which Bruna is Most Proud
This is another difficult question as I have had many wonderful opportunities to support novice pediatric oncology nurses, as well as data managers and researchers. I hope I have helped empower others to provide excellent clinical care. And, in collaborating with researchers using POGONIS data for epidemiological research and data analysis, I hope I have adequately supported their policy planning and program development goals for pediatric oncology, and inspired them to collect accurate provincial population data for these needs.
Bruna DiMonte, RN, BScN, has been a pediatric nurse for 36 years and has spent 28 of those working double duty at The Hospital for Sick Children (SickKids) in Toronto and with POGO as the Senior Database Administrator and Privacy Officer
