Pediatric oncology and hematology

ALSO KNOWN AS: Pediatric cancer treatment

DEFINITION: Pediatric oncology and hematology is the medical specialty for diagnosing and treating childhood and adolescent cancerous diseases and blood disorders. Most pediatric oncology and hematology programs treat children and young adults through age twenty.

Pediatric oncology and hematology practices are available in university medical centers, large community hospitals, specialized children’s hospitals, comprehensive cancer centers, and specialty pediatric cancer centers.

Certain medical centers are designated as comprehensive cancer centers by the National Cancer Institute because they meet specific research and patient treatment criteria, including having a multidisciplinary team of professionals with expertise and training in pediatric and adolescent hematologic and malignant disorders, clinical services connected to research, clinical trials and basic laboratory research, cancer information services, and psychosocial support services. Research has shown that children and adolescents treated in a center with specialized cancer services and specialists have better outcomes.

A child’s pediatrician or family doctor can provide a referral to a pediatric cancer program.

Subspecialties: Pediatric hematology, pediatric radiation oncology, neuro-oncology, ortho-oncology

Cancers treated: Many childhood and adolescent cancers, particularly leukemia, lymphoma, osteogenic sarcoma, rhabdomyosarcoma, Ewing sarcoma, neuroblastoma, non-Hodgkin lymphoma, brain tumors, bone tumors, musculoskeletal and soft-tissue tumors, solid tumors of the kidney and liver, tumors of the eye, Langerhans cell histiocytosis, and Wilms’ tumor (nephroblastoma)

Training and certification: In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Pediatrics, pediatric hematologists-oncologists have completed three years of postgraduate residency training in general pediatrics and at least three years of fellowship training in pediatric hematology and oncology.

After completing a minimum of three years of successful training, pediatric hematologist-oncologist fellows are eligible to take a certification examination offered by the Subboard of Hematology/Oncology of the American Board of Pediatrics. Once certified, pediatric hematologists-oncologists may further their training by participating in one or more years of clinical or laboratory research.

Pediatric hematologists-oncologists are trained in the basic science and clinical expression of cancer and blood diseases in children and adolescents. They are involved in patient care, medical teaching, and research. They study the etiology of cancer and its evaluation, diagnosis, and management in ambulatory and hospitalized patients. Specific areas of study include chemotherapy, oncology, hemostasis-thrombosis, hematology, sickle cell treatment, neuro-oncology, stem cell transplantation, hematopathology, clinical pathology, blood banking, and radiation oncology. Hematologist-oncologists often focus on treating patients with either cancer or blood disorders, although they receive training in diagnosing and treating both conditions.

Pediatric hematology and oncology clinical practice guidelines, quality standards, and quality assurance measures have been established by these organizations:

• Children’s Oncology Group (COG): A network of research groups sponsored by the National Cancer Institute with over two hundred international member institutions that conduct pediatric and adolescent clinical trials to identify cancer causes and introduce new treatments that address long-term childhood cancer survival.
• American Society of Pediatric Hematology/Oncology (ASPHO): A professional association for pediatric hematologist-oncologists. ASPHO established standard requirements for pediatric hematology and oncology programs.
• American Academy of Pediatrics (AAP): A professional organization of more than sixty-five thousand pediatricians and pediatric subspecialists that creates clinical practice guidelines.

Services and procedures performed: A pediatric hematologist-oncologist plans and coordinates the diagnosis and treatment of newly diagnosed or recurring malignancies and blood disorders in children and adolescents. The pediatric hematologist-oncologist is part of a multidisciplinary team of pediatric cancer providers whose goals are to provide early detection; accurately diagnose the condition; offer prompt, appropriate treatment to reduce morbidity and improve quality of life and survival; reduce long-term effects of chemotherapy and radiation therapy; and provide long-term follow-up. Pediatric hematologist-oncologists are trained and skilled in chemotherapy drug indications and toxicities to administer these therapies while minimizing side effects.

Related specialties and subspecialties: Pediatric hematologist-oncologists work with a multidisciplinary team that includes the primary care pediatrician and also may consist of pediatric surgical specialists, such as urologic surgeons, orthopedic surgeons, and neurosurgeons; diagnostic radiologists; radiation oncologists; infectious disease specialists; pediatric pathologists; pediatric oncology nurses; consulting pediatric specialists; physical therapists; pediatric oncology social workers and other allied healthcare professionals, such as child-life specialists, educational specialists, registered dietitians, and pharmacologists. Communication between the pediatric hematologist-oncologist and the patient’s primary care pediatrician is essential to ensure the continuum of care.

Laparoscopy and thoracoscopy are among the surgical techniques pediatric surgeons use to diagnose and treat cancers in children and adolescents. Pediatric surgeons first obtain a four-year medical degree from an accredited program and board certification from the American Board of Surgery. Then, they complete five years of residency training in an accredited general surgery program and at least two years of fellowship training in pediatric surgery. Pediatric oncology surgeons receive additional training in the surgical diagnosis and treatment of pediatric cancers.

Diagnostic radiologists capture and interpret medical images to diagnose patients. They must have a four-year medical degree from an accredited program, board certification from the American Board of Radiology or the American Osteopathic Board of Radiology, pass a licensing examination, and complete at least four years of residency training in an accredited radiology program.

Radiation oncologists use radiation to treat cancers. In the United States, most of them have completed residency training in their field in a program approved by the American Council of Graduate Medical Education or the American Board of Radiology.

Infectious disease specialists are pediatricians who are experts in diagnosing and treating infectious diseases. In addition to having a four-year medical degree from an accredited program and board certification from the American Board of Pediatrics, infectious disease specialists have completed three or more years of residency training and two to three years of additional training in infectious diseases.

Pediatric pathologists are physicians who are experts in the pathology of hematologic malignancies and solid tumors in children and adolescents. They assess malignancies using immunochemistry and molecular techniques. Pediatric pathologists obtain a four-year medical degree from an accredited program and board certification from the American Board of Pediatrics. They then complete three or more years of residency training and one to two years of additional training in pathology.

The Association of Pediatric Hematology/Oncology Nurses provides a certification program for pediatric oncology nurses. The organization also facilitates the professional development of pediatric oncology nurses. Pediatric oncology nurses provide medical care, educate patients and their families, and administer medications. Pediatric oncology clinical nurse specialists are registered nurses with a master’s degree in oncology nursing. They have experience in managing complications of cancer treatment, understand pediatric protocols, and prepare and administer medications, including chemotherapy. Pediatric oncology nurse practitioners are registered nurses with a master’s or doctoral degree. 

Bibliography

Fish, Jonathan D., et al. Lanzkowsky’s Manual of Pediatric Hematology and Oncology. 7th ed., Academic Press, 2022.

Fabozzi, Francesco, et al. "Management of nutritional needs in pediatric oncology: a consensus statement." Cancers, vol. 14, no. 14, 2022, p. 3378. doi.org/10.3390/cancers14143378.

Hastings, Caroline A., et al. Handbook of Pediatric Hematology and Oncology: Children's Hospital and Research Center Oakland. John Wiley & Sons, 2021.

Hoffman, Ronald, et al. Hematology E-Book: Basic Principles and Practice. Elsevier Health Sciences, 2022.

Husain, Aliya N. Stocker and Dehner’s Pediatric Pathology. 5th ed., Wolters Kluwer, 2021.

Liang, Xiayuan, et al. Pediatric Pathology of Hematopoietic and Histiocytic Disorders. Cambridge University Press, 2024. 

Pizzo, P. A., and D. G. Poplack. Principles and Practice of Pediatric Oncology. 7th ed., Lippincott, 2016.

Nathan, David G., et al. Nathan and Oski's Hematology of Infancy and Childhood. 8th ed., Saunders, 2015.

Savelli, Stephanie, and Jayson Stoffman​. "What is a Pediatric Hematologist/Oncologist?" Healthy Children, www.healthychildren.org/English/family-life/health-management/pediatric-specialists/Pages/What-is-a-Pediatric-Hematologist-Oncologist.aspx. Accessed 20 July 2024.

Shah, Aashaka C., et al. "Telemedicine in Malignant and Nonmalignant Hematology: Systematic Review of Pediatric and Adult Studies." JMIR mHealth and uHealth, vol. 9, no. 7, 2021. doi:10.2196/29619.