Pediatric Hematology/Oncology: Pediatric Oncology Service

The fellowship training program includes two one-month inpatient rotations, and two outpatient months with the pediatric oncology team at Memorial Sloan-Kettering Cancer Center (MSKCC) during the first year of training.

During these rotations, the goals and objectives of the fellows' training include the understanding of the following components:

1. Knowledge of state-of-the-art management (chemotherapy, radiation therapy, surgery, biological therapies) of malignancies seen in children and young adults, including:
2. • acute lymphoblastic leukemia;
   • acute myelogenous leukemia;
   • Hodgkin's disease;
   • non-Hodgkin's lymphoma;
   • brain tumors;
   • neuroblastoma;
   • osteosarcoma;
   • Ewing sarcoma;
   • rhabdomyosarcoma;
   • retinoblastoma;
   • germ cell tumors;
   • Wilms' tumors;
   • other rare tumors.

2. Knowledge of state-of-the-art management of complications related to cancer care, including:
3. • fever and neutropenia;
   • infectious complications, including bacterial, fungal, viral, and parasitic infections;
   • cardiovascular emergencies, such as septic shock and respiratory insufficiency;
   • blood product transfusions;
   • electrolyte abnormalities;
   • pain management;
   • organ toxicity, including renal insufficiency, hepatic insufficiency, seizures, ototoxicity, and cardiac complications, such as anthracycline-induced cardiomyopathy;
   • perioperative management.

3. Knowledge of the current understanding of the biological mechanisms underlying these malignancies and their treatment, including:
4. • molecular genetics of childhood malignancies;
   • genetic and molecular systems contributing to metastasis;
   • clinical, pathological, genetic, and molecular features of disease;
   • pharmacology of antineoplastic agents, immunotherapies, and biologicals;
   • pharmacodynamic and pharmacogenomic bases of drug metabolism.

The Pediatric Oncology Service

Approximately 700 new pediatric patients are seen by the Pediatric Oncology Service annually on an outpatient basis, and the MSKCC pediatric inpatient unit has over 1,400 admissions/discharges each year. The Pediatric Oncology Service is comprised of 36 attendings, whose specialties include the treatment of childhood cancers (leukemias, lymphomas, sarcomas, neuroblastoma, Wilms' tumors, germ cell tumors, retinoblastomas, and brain tumors); surgical management of pediatric cancers; and the long-term follow up of patients successfully treated for pediatric malignancies. Integral to the program are attendings who specialize in the treatment of the cardiac, endocrinologic, neurologic, developmental, neuropsychiatric, and psychosocial sequelae and comorbidities of cancer and its treatment.

The Pediatric Oncology Service at MSKCC is organized into disease-specific teams comprised of attendings, nurse practitioners, and social workers. The teams include:

Sarcoma
Neuroblastoma
Neuro-oncology
Leukemia
Lymphoma
Retinoblastoma
Late-effects
Bone Marrow Transplantation

Inpatient Rotation (General Oncology)

During the inpatient rotations the fellows take active care of the pediatric oncology patients, and under the close guidance of the attending physicians, fellows supervise the clinical team. The inpatient pediatric oncology team includes the fellow on service, one attending pediatric oncologist, three to four rotating pediatric residents, one pediatric nurse practitioner, and one pediatric nurse clinician.

During these rotations, the fellows learn both the basic principles of pediatric oncology mentioned above and advanced techniques for the diagnosis, treatment, and monitoring of cancer in pediatric oncology patients. They take active part of the inpatient care, including:

1. daily review of problems;
2. daily physical examinations;
3. review of medications;
4. review of laboratory results;
5. review of radiological studies with the attending pediatric radiologist; and
6. formulation of a daily treatment plan.

Fellows play an active role in the implementation of research protocols. They not only learn treatment protocols and the rationales for their use but are also responsible for protocol implementation and application to the patients enrolled.

Depending on the various pathologies seen during their rotation, specific literature pertinent to these pathologies is reviewed with the fellows.

As fellows mature clinically during their first year, they are progressively afforded more autonomy.