Effects of cancer on growth and development
- Cancer effects on young patients and their families, whānau, and/or carers regarding development, education, and functioning
- Developmental assessments during and after treatment
- Educational, employment, financial, and vocational impacts of cancer diagnosis and treatment
- Effects of cancer, recurrence, and chronic illness on growth and emotional, physical, psychosocial, and sexual development
- Impact of diagnosis and treatment on later development, such as brain radiation to learning
- Impact on fertility, and the evidence, role and timing for fertility preservation
- Importance of advocacy for patients and families
- Physiological changes in growth and development as they relate to cancer and non-malignant haematological disorders, such as:
- maturation of organs and tissues
- normal laboratory values
- Psychosocial impacts of cancer and possible interventions, such as:
- coping mechanisms of patients and their families / whānau within the context of the cancer diagnosis
- impacts on siblings of children with cancer
Indications for and basic principles of the major therapies used in cancer
- Chemotherapy:
- chemotherapy concepts, interactions, and protocols
- classes of chemotherapy
- dosing and delivery
- monitoring compliance and side effects
- pharmacogenomics, side effects, and toxicity
- principles of chemotherapy
- Immunotherapy:
- classes of immunotherapy
- other cellular therapies, such as:
- cytotoxic T cells
- donor lymphocyte infusions
- principles of immunotherapy
- side effects and monitoring of immune effects
- Principles of transplants:
- allogeneic donor selection and source
- autologous transplant
- complications
- complications post-transplant
- conditioning, principles and toxicity
- indications and principles of stem cell transplant, autologous and allogeneic, across malignant and non-malignant conditions, such as:
- benign haematology
- inborn errors of immunity and metabolism
- principles of autologous transplant
- Radiation:
- basic scientific principles
- benefits, indications, and risks
- role of chemotherapy as radiosensitiser
- timing and dosing of radiation
- types, including:
- brachy
- photon
- proton
- radionuclide
- Surgery:
- impact of surgery on growth and development
- principles of surgical control
- timing
- Targeted therapies:
Overriding principles of treatment
- Biological, genetic, and molecular factors in diagnostics, prognosis, and treatment
- Features and clinical presentations of childhood malignancy, and how to stage different cancers
- How to manage patients from diagnosis to long-term follow-up or palliative care, taking into account age, cultural, environmental, and family circumstances, and pre-existing situation
- Principles of biopsy, definitive surgery, and optimal handling of tissue for bio-banking, biological studies, and diagnosis
- Principles of curative intent for most diagnoses with systemic treatment and local control, with aim of long-term survival and use of least toxic therapy for cure or best amelioration of symptoms
- Role of multidisciplinary care required in oncology management, including oncologists, radiation oncologists, surgeons, and other subspecialty teams
Prevention and early detection
- Application of cancer screening
- Early detection principles and methods
- Education of primary health care and the general population about recognition of potential cancer diagnoses
- Immunisations and prevention of cancer, such as:
- human papillomavirus vaccination
- sun protection for skin
- Promotion of healthy lifestyle in transition to adulthood
- Risk of potential second malignancies in childhood cancer survivors
- Role of genetics and cancer predisposition syndromes, and applicable screening surveillance
Principles and conduct of oncology clinical trials and research
- Appropriate diagnosis, such as subtypes and risk / staging assignment to guide treatment
- Biomarker development
- Case reports
- Community / Policy prevention measures
- Concept of study types, and ability to explain these to patients and parents
- Considerations / Difficulties around informed consent / assent, such as gaining consent for a randomised clinical treatment trial with a family who have recently been given a potentially life-threatening diagnosis
- Ethical principles guiding research
- Evolution of current clinical trials and treatment outcomes
- Good clinical practice in line with international directives for all aspects of the conduct of clinical trials
- Issues around collaborative working, both nationally and internationally, in the development of clinical trials for childhood malignancy, such as knowledge of large study bodies
- Levels of evidence and classes of recommendations
- National clinical guidelines and how they guide practice
- Population risk determination of disease:
- randomised control trials
- registry analyses
- Principles of cancer drug development and the rapidly evolving landscape of clinical trials in cancer
- Role and importance of clinical trials in patient care and outcomes
- Systematic reviews and meta-analysis
Principles of supportive care
- Antiemetics for nausea and vomiting
- Appropriate referral and involvement of other specialities
- Cardiac protection
- Fertility preservation considerations prior to commencement of therapy
- Haematological, such as:
- anaemia
- coagulation issues
- neutropenia
- thrombocytopaenia
- Infection:
- febrile neutropenia
- fungal and viral infections
- immunisation
- immunity and infection
- prophylaxis
- Management of side effects, such as the use of aperients and anxiolytics
- Managing, monitoring, and recording toxicities
- Nutrition:
- assessment of nutritional requirements
- cachexia and malnutrition
- fluid management
- management of nutrition
- Pain and symptom control
- Principles of survivorship and late effects, such as:
- assessment of chronic / late drug toxicities
- management of the fear of cancer recurrence
- Psychosocial and allied health care
- Diagnosis, stage of cancer, and goals of care
- Impacts of cultural, ethnic, geographical, psychological, and socioeconomic factors in the accessibility, compliance, and suitability of specific treatments for patients
- Indications for specific anticancer therapies (pharmacological and non-pharmacological) in the adjuvant, concomitant, definitive, neoadjuvant, and palliative settings
- Off-label use of treatments, such as increasing trials in younger age groups of new agents
- Potential effect of patients’ comorbid medical conditions on the toxicity and efficacy of treatments
- Special conditions that influence treatment, including age and developmental stage
- Conflicts in care decisions
- Delayed diagnoses
- Early palliative care involvement for high-risk cancers with poor prognosis, and role in symptom management for patients
- Impact of underlying conditions on treatment, such as genetic disorders and immunodeficiencies
- Indications and role of repeating biopsies, monitoring and predictive testing, such as repeating immunohistochemistry or molecular testing after progression to guide future therapy
- Interplay between medical and psychological comorbidities, socioeconomic and cultural factors in patient presentations, and therapy choices and care wishes
- Management of complex presentations
- Oncological emergencies
- Surgical techniques, such as limb sparing, and impacts on morbidity
- Adjustment to drug dosing:
- as per body surface area of patient, drug / therapy interactions, pharmacogenomics (if known), radiosensitisation, and toxicity
- for pre-existing conditions:
- Awareness of protocols and clinical guidelines for conditions
- Close monitoring of patients during treatment for acute or other side effects, and appropriate documentation
- How to measure quality of life and patient-reported outcomes
- How to recognise and manage oncological emergencies
- Informed consent for treatments
- Multidisciplinary team approach to treatment and management, such as:
- infectious diseases
- radiation oncologists
- surgeons
- other speciality teams as required, and re-present patients in multidisciplinary medical / psychosocial meetings to ensure optimal care
- Tailoring management to specific ages
- Monitor for and manage any side effects post-therapy, from diagnosis, different treatments used, and psychosocial impacts
- Post-transplant care, and management of complications
- Surveillance in cancer predisposition syndromes, and awareness of risk factors for second malignancies
- Transition to adult care, palliative care, and other specialists in a timely manner
Late effects of treatment / survivorship care
- Fertility and sexual health issues
- Genetic counselling
- Impacts on education, lifestyle, socialisation, and vocation
- Impacts on normal growth and development
- Mental health and neuropsychological effects
- Potential:
- long-term complications of cancer, chemotherapy, surgery, radiation, surgery, and other systemic treatments in childhood
- second malignancies
- Specific organ issues, such as:
- cardiac
- lung dysfunction
- neurological
- vascular
- Childhood cancer in context of family and environment, such as the need for appropriate and sensitive communication around diagnosis and treatment initiation
- Ethical issues within paediatric oncology
- Importance of quality of life during treatment, and the associated need for supportive care and allied health support
- Need to review and modify management plans, as required
- Need to tailor management to specific age and developmental stage
- Specific requirements and unique issues of adolescent and young adult patients
- Timing of referral to palliative and end-of-life care services
