Children's Oncology Group Educational Track

APHON is pleased to partner with the Children's Oncology Group (COG) again this year to present a special educational track of sessions that focuses on the care of children enrolled on COG clinical trials.

Concurrent Sessions

Acute Lymphoblastic Leukemia: Current COG Trials for T Cell, Ph+, and Ph-Like ALL (C205)

Although the current overall 5-year survival rate for acute lymphoblastic leukemia (ALL) is more than 85%, patients with some subsets of ALL continue to have poorer event free survival (EFS). T Cell ALL, Philadelphia chromosome positive (Ph+) and Ph-like ALL subtypes have suboptimal EFS rates and are the focus of new treatment approaches within the Children’s Oncology Group. For newly diagnosed T Cell ALL who remain in first remission, the EFS rate is similar to high risk B lineage ALL, but outcomes for patients with relapsed T Cell ALL are dismal, with a 3-year EFS rate of < 15%, due to chemotherapy resistance and lack of responsiveness to salvage/relapsed treatment. Therefore, the current COG study, AALL1231, is investigating the utility of bortezomib, a protease inhibitor, in preventing relapse by overcoming chemotherapy resistance and sensitizing T ALL cells to steroid therapy.

For Ph+ ALL, the overall induction remission rate is 89%, but the 7-year overall survival rate, prior to the addition of continuous tyrosine kinase inhibitor (TKI) therapy, was only 45%.3 The COG study AALL0031, which added continuous TKI therapy for patients with Ph+ ALL, aims to significantly improve EFS, but the data are not yet mature for publication. Ph-like ALL is a recently identified ALL subtype, which expresses gene mutations within the tyrosine kinase, CRLF2 and/or JAK/STAT pathways. The overall 5-year EFS for the Ph-like ALL subtype, identified from biology samples on the previous high risk (HR) B ALL trial (AALL0232) was 62.6 %.4 The current HR B ALL COG trial (AALL1131) includes a plan to transition patients with an identified TKI-sensitive Ph-like mutation to receive added dasatinib therapy, and to offer patients with an identified CRLF2 and/or JAK pathway mutation the option of enrolling on AALL1521 to receive ruxolitinib. During this session, current therapy, innovative approaches to care, and future directions for the treatment of patients with T Cell, Ph+, and Ph-like ALL subtypes will be discussed, providing learners with new knowledge that can be used in daily practice.

 

Acute Promyelocytic Leukemia:  Current COG treatment for a unique AML subtype (C211)

Acute promyelocytic leukemia (APL), a sub-classification of acute myeloid leukemia (AML), is characterized by the t(15,17) gene mutation. While survival rates for pediatric patients with newly diagnosed AML generally remain suboptimal, changes in treatment for the APL subtype, including the addition of Arsenic Trioxide (ATO), have improved survival rates to over 90%.1 Although its mechanism of action is not fully understood, ATO has demonstrated improved efficacy when used in combination with all-trans retinoic acid (ATRA).2 Treatment regimens for APL have historically included ATRA and anthracyclines as the backbone for all risk groups.

In the Children’s Oncology Group protocol AAML0631, the total anthracycline dose was significantly decreased with the addition of ATO1,2 with the aim of minimizing cardiac toxicity. The current COG AAML1331 study aims to determine if eliminating or reducing the amount of conventional chemotherapy (including anthracyclines) used in APL treatment, through the use of ATRA and ATO-based therapy, will reduce toxicity while maintaining excellent survival outcomes. This session will review the COG AAML1331 protocol, including discussion of ATRA and ATO administration, and will highlight nursing care of patients enrolled on this clinical trial. During this session, innovative approaches to care and future directions for the treatment of patients with APL will be discussed, providing learners with new knowledge that can be applied in daily practice.

 

Patient/Family Education in Pediatric Oncology: The Children’s Oncology Group Experience (C217)

The majority of children newly diagnosed with cancer in North America are treated on Children’s Oncology Group clinical trials. Parents of these newly diagnosed pediatric oncology patients need specialized education in order to provide safe care for their child at home. The quality of the education provided to parents of newly diagnosed patients has the potential to significantly influence clinical trial outcomes; for example, in regard to proper administration of oral chemotherapy and other home medications, recognition of when to bring the child to the hospital for emergent treatment, and knowledge regarding how to access appropriate care in a timely fashion. Recognizing that there was little evidence available to support current patient/family educational practices, the Children’s Oncology Group (COG) Nursing Discipline has focused its efforts on understanding the effective delivery of patient/family education.

This session will describe the outcomes of recent work done by the COG Nursing Discipline to identify current evidence surrounding patient/family education practices, and to bring together experts to develop consensus recommendations to standardize essential content and facilitate the effective provision of patient/family education for parents of newly diagnosed pediatric oncology patients.  Five guiding principles for providing patient/family education to newly diagnosed families will be presented, essential content for inclusion in initial education will be identified, and exemplars of best teaching practices will be reviewed.  This session will enhance nursing practice by helping nurses to identify the essential educational content necessary for safe home care of newly diagnosed patients, determine the most promising and innovative techniques for providing education to parents of these children, and understand how the initial educational process fits within the continuum of pediatric oncology care.

 

 Nurse-Led Models for Enhancing the Conduct of Children’s Oncology Group Cancer Control Trials (C223)

Improvements in survival in pediatric cancer has led to a broadened focus of research that includes symptom prevention and management, patient- and caregiver-reported outcomes, and disease prevention and control. The Children’s Oncology Group (COG) Cancer Control (CCL) Domain conducts independent and embedded clinical trials to identify preventive measures and evaluate interventions to improve patient- and caregiver-reported outcomes and reduce the morbidity of cancer therapy.

Due to prioritization of treatment trials, shortage of clinical research resources, and other factors, it has been historically challenging to accrue to CCL trials. Nurses are at the frontlines of pediatric cancer treatment, and many have an inherent interest in cancer control, which has led some COG sites to create nurse-led models to support CCL trials. These models vary in structure and operation; however, all models include dedicated nurses and/or advanced-practice nurses who champion CCL trials by facilitating eligibility screening, patient enrollment, trial conduct, and communication between COG and the local COG sites in order to successfully carry out the trials.

This session will provide the learner with knowledge regarding current trends and innovative processes that have been used by nurses within the COG to enhance the conduct of CCL trials; learners can apply this knowledge in their own practices in order to enhance the conduct of clinical trials at their local institutions.

Putting Evidence into Practice: Results from Two COG EBP Teams (C229)

This session will feature evidence-based systematic reviews conducted by two Evidence-Based Practice (EBP) teams from the Children’s Oncology Group (COG) Nursing Discipline. The evidence-based recommendation process includes a rigorous examination of the literature to assist health care providers in the care of children, adolescents, and young adults before, during, and after cancer treatment.1 Evidence to guide nursing practice in regard to PEG-asparaginase administration, including monitoring for hypersensitivity reactions, management of reactions, and recommendations for patient/family education will be presented.2 Additionally, evidence related to fertility preservation options for pediatric, adolescent, and young adult patients undergoing cancer treatment, and related recommendations for nursing practice, will be discussed.3 Findings from these projects will demonstrate the importance of incorporating evidence and evaluating patient outcomes in nursing practice, and will provide learners with new knowledge and skills to enhance the care that they provide for pediatric oncology patients and their families.

The Landscape of neuroblastoma in COG: yesterday, today and tomorrow’s therapies (C234)

Many advances in the therapy of children with neuroblastoma have been made in the past decade by the Children’s Oncology Group (COG).  New trials build upon those successes in an attempt to reduce therapy for lower risk (LR) and intensify therapy for high risk (HR) disease patients.  Current therapies and the nursing care management of LR, HR and relapsed disease will be discussed.

 

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