Curriculum standards

Knowledge guide

LG12: Foundations of oncology

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able tdescribe the underlying rationale, the indications for using one test or method over another, and the calculations required tgenerate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able tinterpret the reported results of each investigation or procedure.

Advanced Trainees will know how texplain the investigation or procedure tpatients, families, and carers, and be able texplain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

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Anatomy

Knowledge of anatomy, with an emphasis on tumour sites and common anatomical routes of metastases
Relevant anatomy related to type of cancer and potential for metastases

Epidemiology

Context within childhood illness
Incidence of childhood cancers:
- adolescent and young adult
- childhood
- ethnic and geographic variability
- infant
Risk factors
Survival and outcomes

Pathophysiology of childhood cancer (including but not limited to)

Cellular factors:
- cell cycle control:
  - cell cycle control in cancer
  - process of cell division and apoptosis
- gene expression and signal transduction pathways
- tumour microenvironment, such as:
  - angiogenesis
  - components of the microenvironment
  - immune system and tumour immunology
  - mechanisms of tumour cell invasion and metastasis
Genetic and molecular factors:
- germline / somatic:
  - chromosomal abnormalities
  - epigenetic changes
  - gene deletions / duplications / fusions / rearrangements / translocations
Growth, developmental, and environmental factors

Pharmacology

Nutrition and fluid management:
- alternative types of nutrition and administration techniques:
  - gastrostomy / nasogastric / nasojejunal tubes
  - parenteral nutrition
- fluid and caloric requirements by age and weight
- fluid requirements for treatment of various presentations and chemotherapies
Pharmacodynamics, pharmacogenomics, and pharmacokinetics, such as:
- compassionate access to therapeutic agents through direct interaction with sponsors and pharmaceutical companies
- differences between countries with respect to new drug development and approval mechanisms, equity, and availability of clinical trials
- drug approval and marketing processes in Australia / Aotearoa New Zealand, including off-label use of chemotherapy medications for paediatric patients
- indications, pharmacodynamics, pharmacogenomics, pharmacokinetics, potential interactions, and side effects of:
  - chemotherapy agents
  - chemotherapy combinations, interactions, and contra-indications
  - emerging novel therapies, including biologics and immune therapy
  - supportive care medications
- issues surrounding cancer drug approval, prescribing, and availability
- local policies for intrathecal cytotoxic therapy
- protective agents against toxicity, such as dexrazone with anthracyclines
- relevant regulatory requirements, such as opioid prescribing
- specificities of paediatric dosing, such as:
  - age
  - body surface area
  - size
  - weight

General

Informed consent / assent process
Interpretation of results
Local and international guidelines for investigations and procedures
Quality of life and patient-reported symptom measures
Safety guidelines for patients, families, whānau, and staff in relation to body fluids and radiation
Techniques, benefits, and potential complications of investigations and procedures

Imaging

Anatomical
Functional imaging, such as PET scans and other radionucleotide imaging
Image guided procedures

Pathology

Biopsy approaches, such as:
- excisional
- fine needle
- image guided
- open
- under general / local anaesthetic
Genetic and molecular testing
Samples required for accurate and complete diagnostics

Procedures

Access and collection of blood from central lines
Anaesthetic, analgesia, and sedation as per local and international guidelines
Bone marrow:
- aspiration and trephines
- harvests
Capillary blood sampling
ECG
Lumbar puncture and intrathecal chemotherapy administration
Nasogastric tube insertion
Non-invasive blood pressure measurement
Pleural aspiration
Skin biopsies
Urinary collection and testing
Venesection

Clinical trials and research

Analysis, interpretation, and application of results
Design, conduct, analysis, and reporting
Enrolment on and removal from a trial
Ethical issues
Role of collaborative study groups, such as:
- Australian and Aotearoa New Zealand Children’s Haematology and Oncology Group (ANZCHOG)
- Children’s Oncology Group (COG)
- International Society for Paediatric Oncology (SIOP)
Role of registries

Policy and provision of cancer care

Advocacy for patients
Contribution to implementation of national and local health policies, health service targets, and development of service
Duty of professionals working with children with respect to safety and child protection concerns
Government:
- policies on cancer notification
- programs and policies that affect the health of cancer patients
Legal and ethical guidelines relating to:
- competence
- confidentiality
- informed consent for treatment
- parents or carers as surrogate decision makers
- privacy
- the right to refuse treatment
Legal and practical issues related to:
- assisted dying legislation
- initiation of therapy
- postmortem and coroner referrals
- withdrawal of care
Local and major international agencies and organisations with a role in cancer control, research, and/or treatment
Role of government and legal aspects in the provision of health care

General management considerations

Adherence to treatments
Advance care planning and referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease, and known poorer outcomes
Communication appropriate to patients’ developmental stage and psychosocial circumstances
Complicating premorbid conditions or conditions related to treatment, such as:
- cognitive impairment
- fatigue
- mood changes
- neurological impairments
- vision and hearing loss
Consideration of patient demographics when managing and following up patients (travel from rural to metropolitan areas), such as geographic location, socioeconomic status, ethnicity, and cultural background
Consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
Educational and vocational considerations, such as supporting continued education through treatment, and assisting with facilitating special requirements
Family-centred and multidisciplinary models of care
Fertility preservation considerations
Genetic testing and implications
Goals of therapy
Individual patient clinical indications to determine patients’ needs and the most appropriate approaches to investigations and care
Late effects of cancer and therapies, and the importance of long-term follow-up
Monitoring and managing side effects during treatment
Principles of multi-modal therapy
Shared care with local practitioners for patients not living close to main treatment centres
Supportive care during cancer diagnosis and treatment (medical as well as psychosocial)
Unique and critical needs of children and young people with cancer