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Fred Hutchinson Cancer Research Center
Seattle, Washington
206.667.5000
www.fhcrc.org

Seattle Cancer Care Alliance
Seattle, Washington
206.288.SCCA (7222)
www.seattlecca.org

Pediatric Oncology Services

Introduction

Through Seattle Cancer Care Alliance, pediatric patients have access to a broad range of oncology services offered by Fred Hutchinson Cancer Research Center, Seattle Children's, and UW Medicine.. These services include chemotherapy, radiation therapy, surgery, and bone marrow transplantation. The primary aims of the pediatric services are to provide optimal patient care for children with cancer and to engage in both clinical and basic research to develop and evaluate new approaches for the treatment of childhood neoplasia.

Multidisciplinary Teams

Multidisciplinary teams include physicians, nurses, and social workers who specialize in pediatric cancer care. The transplant team includes an attending physician who is on Hutchinson Center's staff and is very experienced in transplantation. In addition, the patient will have a primary health-care provider who will provide most of the patient's direct care. Other team members include nurses, a social worker, child life specialist, pediatric pharmacist, and an educational support team.

Special Expertise

Leukemias

Brain Cancers

Lymphomas

Bone Cancers

Immune deficiency diseases

Bone marrow failure diseases

Neutoblastomas

Wilms' Tumors

General information

Social Support

Child Life specialists provide recreation therapy services and age-appropriate educational supportive therapy at Seattle Children's.

A pediatric social worker interacts with the pediatric transplant patients and families throughout the transplant period (consult, transplant, long-term follow-up). The social worker provides an initial assessment, advocacy, limited counseling, and psychosocial referral coordination.

The Hutch School is an accredited school program that is recognized by the Seattle Public School System. It is sponsored by Hutchinson Center, serving patient and family members of Seattle Cancer Care Alliance (SCCA) and staffed by accredited teachers. The program is designed to meet the educational needs of school-aged patients and those of the school-aged relatives of patients. The school has several components:

The Elementary Family Member Program, with one class for kindergarten through third grade, and one for grades four through seven, meets four days a week. The class sizes are small and there are many volunteer tutors.

The High School Family Member Program attendees are seen on a one-to-one tutorial basis and are grouped for field trips and other social activities. Pediatric patients may be tutored individually 2-3 days per week.

For more information, call the Hutch School at 206.667.1400.

Home Health Care

Home health care is arranged for pediatric transplant patients.

Ages Treated

Children of all ages are treated.

Acceptance Criteria

The patient must meet the inclusion criteria of open protocols or standard treatment plans.

Cooperative Group Membership

Children's Oncology Group

Average Number of Pediatric Clinical Trials

84

Special Expertise

Bone Marrow and Stem Cell Transplant Program

Fred Hutchinson Cancer Research Center performs approximately 400 transplants a year, including 50-60 pediatric transplants. Transplantation is available for all types of hematologic malignancies and non-malignant hematologic disorders as well as a number of solid tumor, genetic disorders, and autoimmune diseases. Active protocols exist for transplantation with bone marrow, peripheral blood stem cells, and umbilical cord blood from related as well as unrelated donors. (UBC, normally discarded after the delivery of a newborn, is increasingly utilized as a stem cell source for transplantation. UCB has the advantageous quality of an immature immune system, which allows it to be used for transplant, even when not fully matched to the patient, without increased risk.
Therefore, even those patients who cannot identify a standard related or unrelated donor can still get a potentially life-saving transplant with UCB.)

Hutchinson Center performs all types of donor transplants: autologous-self donor, syngeneic-identical twin donor, allogeneic-related donor, allogeneic-unrelated donor, and allogeneic-"mismatched" donor. Also performed are myeloablative and non-myeloablative transplants. Children who require bone marrow transplantation receive their treatment at Seattle Children's.

Physicians from SCCA, Fred Hutchinson Cancer Research Center, and Seattle Children's take care of children with all types of leukemias, neuroblastoma, and lymphoma.

Continuing Care Chronic Graft vs. Host Disease (GVHD) Clinic

This special clinic is available to any pediatric patient at high risk to develop or who has developed clinical chronic GVHD. These pediatric patients are followed weekly at Hutchinson Center outpatient clinic and are treated according to Hutchinson Center chronic GVHD protocols or practice policies. This clinic is under the direction of Dr. Jean Sanders, who keeps in contact with the patient's primary care community physician regarding patient management issues.

Graft vs. Host Disease

Prevention of and treatment of acute and chronic GVHD continues to be a particular area of clinical and research interest of Hutchinson Center investigators. Pediatric patients are eligible for entry into all prevention and treatment trials with novel regimens and/or agents. All patients are evaluated at approximately day 80 post-transplant for presence of or risk of chronic GVHD.

Long-Term Follow-Up

Following patients long-term, determining the problems that they encounter, and carefully evaluating children with respect to the impact of the bone marrow or stem cell transplant process on their subsequent growth and development into productive adult citizens is a special area of interest and on-going clinical research. Dr. Jean Sanders directs the pediatric long-term follow-up program. Patients may return to Seattle for a comprehensive one-week evaluation annually or have the major portions of this evaluation performed at home. The goal is to discover specific abnormalities early in order to institute treatment.

Long-term follow up care is provided to cancer survivors through two programs. Seattle Children's ACCESS (After Cancer Care Ends Survivorship Starts) program is for hematology/oncology patients treated at Seattle Children's. All other transplant patients are seen through Fred Hutchinson Cancer Research Center's Long-Term Follow-up Program. Both programs are designed to meet the unique health-care needs of long-term survivors of cancer and their families. Both focus on health promotion and prevention. ACCESS addresses potential risks of developing complications secondary to childhood cancer and its treatments. A variety of long-term effects have been observed that may interfere with various organ systems, psychological well-being, and quality of life. For most survivors, these late effects are not serious, but are important to monitor. With education, intervention, and empowerment, survivors can take charge of their health and manage these problems.


 

Pediatric Surgeons

Pediatric surgeons from all major surgical specialties are on staff at Seattle Children's. Neurosurgery, transplant surgery, and limb-salvage orthopedic surgery represent a few of these specialties that are uniquely available at Seattle Children's. Pediatric General and Thoracic Surgeons use minimally invasive surgery whenever possible to diagnose and treat pediatric cancer. Pediatric experts in imaging, radiology, and surgery work with our pediatric pathologists to make accurate diagnoses from a minimum of tissue, reducing physical trauma and emotional distress.

Tumor resection by minimally invasive techniques such as thoracoscopy or laparoscopy is often made possible by neoadjuvant, or "up-front" chemotherapy, which can reduce tumor size. These approaches can decrease morbidity, shorten recovery, improve long-term survival, and improve the quality of life for survivors of childhood cancer.

Pediatric Bone and Soft-Tissue Sarcoma Program

The Pediatric Bone and Soft-Tissue Sarcoma Tumor Program brings high-quality care to children and adolescents with musculoskeletal tumors. Metabolic imaging methods, such as positron emission tomography (PET), have improved our ability to evaluate musculoskeletal malignancies, including their response to neoadjuvant chemotherapy. Our bone transplantation and skeletal reconstruction procedures leave patients with more function than older techniques did.

Pediatric Neuro-Oncology Program

The Pediatric Neuro-Oncology Program provides leading-edge technology to patients with brain or spinal cord tumors. A multidisciplinary pediatric cancer team provides a unified approach to cancer care in dedicated child-friendly inpatient and outpatient units. These physicians staff a weekly clinic for brain and spinal cord tumor patients. The pediatric team includes:

Neuro-oncologists

Pediatric neurosurgeons

Radiation oncologists

Pediatric anesthesiologists

Advanced practice nurses

Staff nurses with special training in the care of children with cancer

Nutritionists and diet technicians

Occupational, physical, and child life therapists

Oncology pharmacists

Social workers

Educators

Other disciplines as needed


 

Functional brain mapping and electrocorticography is used when a tumor is close to language or motor areas or is causing seizures. The program also uses state-of-the-art frameless stereotactic equipment as well as microscope and laser equipment.

Radiation Therapy

Radiation therapy is provided to our pediatric patients at University of Washington Medical Center, which offers state-of-the-art treatment technologies including: 3-D conformal treatment planning, Gamma knife stereotactic radiosurgery, and both permanent and temporary brachytherapy implants. A board-certified pediatric radiation oncologist participates in our Tumor Boards, providing continuity of care for our patients who receive radiation therapy here. I-131 radiolabeled antibody therapy is also available.

Statistics - Pediatrics

Percent of children treated in calendar year 2006

Age Range

0-4

5-9

10-14

15-19

20+

Number of Cases

80

70

109

230

0

Percent Treated

24%

34%

260%

20%

0%

Pediatric Oncology Program, Calendar Year 2006

No. of Inpatient Beds

No. of Admissions

Average Length of Stay (days)

No. of New Outpatients

Total Outpatient Visits

No. of Bone Marrow Transplants

No. of Oncologists

38

1,469

7.5

386

2,156

53

15