What special considerations are required to minimise risk when providing cancer therapy to paediatric patients?

From Cancer Guidelines Wiki

Introduction

A number of sub-populations receiving cancer therapy may be at higher risk of errors due to factors such as age, place of residence, treatment location, cultural background, ethnic origin, psychosocial and other social factors.

This section highlights recommendations for paediatrics. This section is not exhaustive and facilities should consider how medication safety can be optimised and errors reduced according to the population that is treated or who may present to the facility for management of treatment effects.

Individual sections on dose calculations, prescribing, dispensing and administration also provide information and recommendations on cancer therapy and roles of healthcare professionals in paediatric populations.


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Evidence Summary

Children often develop different types of cancers to adults, many of which can be categorized as rare tumors. For cancers which are common to children and adults, the treatments, response to treatment, tolerance of treatment and overall prognosis can differ significantly. Adolescents and Young Adults (AYAs) with cancer have been identified as a group of patients with unique needs.

Treatment protocols for paediatric cancers are usually more intensive, prolonged and complex compared with those for adults. Inclusion in a clinical trial is widely recognised as best standard of care for paediatric cancer patients. Treatment protocols for paediatric cancers take into account aspects of treatment which are unique to paediatric patients including the biology of paediatric tumours, the short and long term toxicities, the pharmacokinetics of cancer medicines and the complexity of dosing regimens as children grow and organ systems mature.

Dose calculations are dependent on age, weight, body surface area and maturation of organ systems.[1] This information is covered in more detail under Dosage calculations for paediatrics.

Some medications that may be of benefit to paediatric patients are not marketed for those indications due to limited numbers of patients with the particular type of cancer. This can mean that formulations are not suitable for paediatric patients and information related to appropriate dosing may not be readily available.

Children usually have a better tolerance to the short-term side effects of chemotherapy compared with adult patients, however can be at increased risk for some toxicities.[1] Children are more likely to develop late effects due to the intensity and types of therapies used, treatment occurring whilst their bodies are still developing and longer life expectancies post cancer treatment, relative to adults. As long-term survival of childhood cancer continues to improve, the development of late effects of cancer therapy is of significant importance to paediatric patients.


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Recommendations

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Children with cancer must be treated by a multidisciplinary team of staff trained and experienced in paediatric oncology to maximize optimal treatment outcomes and the safety of treatment with cancer medications and their associated toxicities.


Children with cancer should be offered the opportunity to participate in clinical trials when available. Continued clinical trials are vital to improving optimal treatment of children with cancer in the future.


Children with cancer should be treated with treatment protocols written specifically for paediatric patients by large cooperative groups wherever possible. For example: COG (National Cancer Institute - Children's Oncology Group) or the International BFM Study Group.


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Given the rarity of some paediatric tumour types, it is acknowledged that in some circumstances chemotherapy may need to be based on journal articles reporting on small clinical trials or case series or consensus-based specialist opinion.


Long term follow-up programs should be established to monitor for and manage the late toxicities of cancer therapies administered to children. These should address transition to adult services and the role of general practitioners.

(National Cancer Institute - Children's Oncology Group, 2016)[2] ;(International BFM Study Group, 2016)[3] ;(Australian Government and Cancer Australia, 2016)[4]


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References

  1. 1.0 1.1 Ceja ME, Christensen AM and Yang SP. Dosing Considerations in Pediatric Oncology. US Pharmacist 2013;38, 8-11.
  2. National Cancer Institute and Children's Oncology Group. Children's Oncology Group (COG). [homepage on the internet]; 2017 Nov 18 [cited 2016 Sep]. Available from: https://www.childrensoncologygroup.org/.
  3. International BFM Study Group. International BFM Study Group (I-BFM). [homepage on the internet]; 2017 Nov 18 [cited 2016 Sep]. Available from: http://www.bfm-international.org/index.php.
  4. Australian Government and Cancer Australia. Children's Cancer for health professionals and researchers. [homepage on the internet]; 2015 Aug 23 [cited 2016 Sep]. Available from: https://childrenscancer.canceraustralia.gov.au/health-professionals-and-researchers.

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