Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you initiate hormone replacement therapy in a young woman with treatment-induced primary ovarian insufficiency after childhood cancer?
Yes, absolutely. In patients who are at high risk for POI (i.e., received high doses of alkylators or undergone BMT), we follow estrogen, FSH, LH, and AMH levels yearly. These survivors are seen by a pediatric endocrinologist in a survivor clinic, and (depending on parental preference) may be referr...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
What are the main barriers you encounter in enrolling pediatric oncology patients on clinical trials?
Medical mistrust: We have a large Native American population at our institution, and they tend not to enroll in clinical trials. We also have a large population of anti-vaxx parents who tend not to want to enroll patients in clinical trials. Language barrier: 1/3 of our patients' parents are Spanis...
Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?
The short answer is "no". I do reimage many people near the end of the 3-6 months of treatment, but it doesn't really change my mind about duration of treatment in most instances. I use repeat imaging to help me understand how much of the clot resolved and thus, determine what their new baseline is....
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
Nivolumab can be used every 4 weeks rather than every 2 weeks. We have to be flexible and change our approach according to circumstances.
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Outpatient administration of cisplatin/doxorubicin (albeit at a slightly reduced cisplatin dosage of 100 mg/m²) protocol is documented in the BC Cancer out in Vancouver, British Columbia. We offer this at Roswell, with the addition of mannitol, but it is a long 8-hour day, and close follow-up is rec...
What is the best way to support a pediatric oncology survivor with fears about 2nd neoplasm or relapse?
Concerns regarding recurrence of the primary malignancy or the development of a second malignant neoplasm are common among pediatric cancer survivors and may be a significant source of ongoing anxiety. It is therefore important to routinely assess for these concerns, as well as to screen for anxiety...
How do you approach adjuvant therapy for resected Stage I Ewing sarcoma of the kidney?
Since the intent is cure, treat it with "adjuvant" systemic therapy like a standard Ewing sarcoma, until maximum tolerance.