Curriculum standards

Knowledge guide

LG13: Acute and emergency paediatric oncology care

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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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 to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain 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 and management and integrate these into care.

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Presentations (including but not limited to)

Cardiovascular:
- hypertension
- tachycardia
Gastrointestinal and nutrition:
- abdominal distension or pain
- abdominal mass
- altered bowel habit
- anorexia and reduced intake
- hepatosplenomegaly
- mouth ulceration
- nausea and vomiting
Genitourinary:
- haematuria
Haematological:
- anaemia
- bleeding, bruising, and petechiae
- lymphocytosis, lymphopenia, and neutropenia
- pallor
- thrombocytopenia and thrombocytosis
Lymphatic system:
- lymphadenopathy
Musculoskeletal:
- bony mass
- pain
- soft tissue mass
Neurological:
- headache
- impaired conscious state
- seizures
- visual loss
Ophthalmologic:
- loss of red reflex
- proptosis
Respiratory:
- chest pain
- cough
- dyspnoea
Skin:
- rash
Systemic / General:
- acutely unwell
- allergy symptoms and anaphylaxis
- fever
- pain
- weakness and fatigue

Conditions (including but not limited to)

Cardiovascular:
- cardiac tamponade
- cardiotoxicity from anthracyclines
- superior vena cava syndrome
Gastrointestinal and nutrition:
- constipation
- malnutrition
- mucositis
Genitourinary:
- haemorrhagic cystitis
Haematological:
- anaemia
- bleeding due to thrombocytopaenia
- coagulopathy
- hyperleucocytosis
Immunologic:
- cytokine release syndrome
- immune-related complications of cellular / immunotherapy, and grading of these
Infectious:
- febrile neutropenia
- sepsis
- pneumonia:
  - atypical
  - bacterial
  - fungal
  - pneumocystis jirovecii
  - viral
Metabolic:
- adrenal insufficiency
- tumour lysis syndrome
Neurological:
- posterior reversible encephalopathy syndrome (PRES)
- raised intracranial pressure from intracranial lesion or drug toxicity
- spinal cord compression
Respiratory:
- anterior mediastinal mass / airway compression from upper airway mass
Systemic / General:
- anaphylaxis
- dehydration

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Conditions

Adrenal insufficiency and acute adrenal crisis
Coagulopathy related to acute promyelocytic leukaemia
Disseminated intravascular coagulation
Horner syndrome
Immune effector cell-associated neurotoxicity syndrome (ICANS)
Opsoclonus myoclonus ataxia syndrome
Paraneoplastic syndromes

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Acute toxicities and complications of treatment on different organs and systems
Anatomical compression from masses on:
- airway
- bowel, such as Burkitt lymphoma
- spinal cord
- vascular systems
Haematological complications
Immunosuppression and infectious complications
New oncology diagnoses presentations

Assessment

Full examination and history, such as height and weight
Grading of toxicities, such as by Common Terminology Criteria for Adverse Events (CTCAE)
Mucositis score
Pain score
- chest x-ray
- CT scan
- others as clinically indicated
Immediate IV access, with aim of central venous access
Inflammatory markers as appropriate
Referral to other speacialist teams as appropriate

Investigations

As indicated by presentation and suspected diagnosis
Basic observations
Blood cultures (as per local guidelines) and other microbiological investigations as indicated
Blood work as indicated:
- biochemistry
- coagulation studies
- full blood examination (FBE)
Imaging:
- chest x-ray
- CT scan
- others as clinically indicated
Immediate IV access, with aim of central venous access
Inflammatory markers as appropriate
Referral to other specialist teams as appropriate

Procedures

Cardiorespiratory resuscitation
Central line / IV access
Conscious sedation
Indwelling urinary catheter
Insertion of intraosseous needle
Intradermal, intramuscular, intravenous, and subcutaneous injections
Nasogastric tube insertion
Needle thoracocentesis for pleural effusion

General management considerations

Consider goals of therapy
Consider patients’ demographics, including geographic location, socioeconomic status, ethnicity, and cultural background when managing and following up patients, such as travel from rural to metropolitan areas
Consider timing of decisions and risks for individual patients:
- advance care planning and referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease and known poorer outcomes
- compliance with treatments
- complicating premorbid conditions or those related to treatment, such as:
  - cognitive impairment
  - fatigue
  - mood changes
  - neurological impairments
  - vision and hearing loss
- 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
Impact of comorbidities on diagnosis and management
Multidisciplinary care in management and treatment
Tailor communication according to patients’ age, developmental stage, and psychosocial circumstances
Unique requirements of adolescents and young adults (appropriate language and setting)

Specific management considerations

Emergencies require prompt assessment and management, including escalation of care as required
Goals of care
Monitoring and managing side effects during treatment