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FACING STAGE 4 CANCER AT JUST TWO MONTHS OLD

Posted on July 23, 2025 by Nehal Singla

By Ruveena Mariathas

When Mallika was born, we thought she was just a fussy baby. She cried every night, and we took turns holding her upright while sleeping on the couch. Several visits to walk-in clinics indicated she had colic. But when she stopped having wet diapers and bowel movements, we knew it was something
more serious.

At just two months old Mallika was diagnosed with stage 4 rhabdomyosarcoma. Her treatment began almost immediately—aggressive chemotherapy that had us constantly travelling to downtown Toronto, me with no income and bills piling up.

Our POGO Interlink Nurse connected us to POGO’s Financial Assistance Program and handled the paperwork during a time when everything felt overwhelming. On her regular visits to our home, she always took time to check in on our older daughter, Ashwana, to make sure she was coping with her sister being sick and her parents being away so often at the hospital.

Eventually, we were able to move part of Mallika’s care to the POGO Satellite Clinic at Scarborough Health Network. Being close to home meant we could sleep in our own beds, spend more time with Ashwana, and bring Mallika in for her daily chemotherapy without the added pressure of a long commute. The Satellite Clinic is a warm and welcoming environment, and the nurses became like family—they knew her well, noticed small changes and helped us through some scary moments, including a serious episode of dehydration.

Mallika has had surgery to remove her bladder and now needs daily catheterization, which means we have to use a tube to keep her wounds from closing. When she turns five, doctors plan to create a neobladder—a surgically constructed bladder to help restore some normal function. Despite all she’s faced, she’s full of energy and steadily catching up on her milestones.

Mallika rang the bell at the clinic to mark the end of treatment. Our POGO nurse cried. We cried. After everything we’d been through, it felt like we could finally breathe.



Posted in Misc | Tagged chemotherapy, financial assistance, nursing, satellite clinic

Marking National Indigenous History Month with a Special Video for Parents and Caregivers of Children with Cancer

Posted on June 2, 2025 by Kirsten Efremov

Introductory Note from POGO

The POGO Indigenous Children with Cancer Initiative, established in 2019, is dedicated to enhancing equality and cultural safety in the care of Indigenous children with cancer and their families. This initiative brings together individuals with lived experience, healthcare providers from across the Ontario, Indigenous Navigators from hospitals, and members of the Indigenous Cancer Care Unit of Ontario Health.

In honour of National Indigenous History Month this June, we are proud to share a heartfelt video designed to increase understanding of a childhood cancer diagnosis. Recognizing the diverse caregiving roles within Indigenous communities, this video is intended for anyone in the child’s support circle, including parents, community elders, extended family, and Indigenous healers.

Jennifer Keis, Nurse Practitioner at SickKids and a valued member of our initiative, shares her reflections below on the creation of this video and its impact on her practice.

Walking alongside Indigenous Patients and their Communities

In nursing, we are taught to provide culturally-safe, patient/family-centered, and holistic care. My experience with the POGO Indigenous Children with Cancer Committee has reinforced that achieving this requires an open mind and a willingness to listen and learn from others.

I am grateful for the wisdom, stories, and expertise shared by Indigenous healthcare providers, community members, and families who are part of the committee. Their strength in sharing the challenges and trauma of navigating the healthcare system with such honesty and integrity has had a profound impact on me.  I recognize that I must continue to engage in learning, listening, and adapting to ensure I am providing meaningful and thoughtful care to Indigenous families.

I had the privilege of getting to know the patient featured in the video, Makenzy, and his mom, Wendy, during a long stay at SickKids, so you can imagine the emotional impact the video has had on me.  In the video, Wendy, who, in her spare time, enjoys art as a hobby, shares with viewers a painting, which beautifully illustrates the family’s hope to remain connected to their Indigenous culture and practices while Makenzy was receiving treatment for leukemia.  Wendy’s powerful symbol of resilience and connection is not unlike the hope of other Indigenous families who will need pediatric oncology care in the future.

Indigenous families deeply value preserving cultural identity, even as they navigate the challenges of western healthcare. This shared experience resonates with many and underscores the importance of walking alongside Indigenous patients and their communities—recognizing, respecting, and integrating their traditional practices and medicines into our care approach.

Supporting Families through Childhood Cancer Diagnoses

As nurses, we understand how overwhelming it can be for families to receive a childhood cancer diagnosis. Suddenly, families are thrown into an unfamiliar world filled with medical jargon, blood tests, diagnostic procedures, and various healthcare providers.  While trying to comprehend the gravity of the diagnosis, families are faced with making significant treatment related decisions that may feel overwhelming, all while grappling with the emotional shock of the news.

Now, imagine how much more difficult this experience is for families coming from a place of historical and medical trauma, racism and discrimination, loss of cultural identity, and health disparities.  The intricate nature of these challenges can magnify the emotional toll, making it even harder for families to navigate this already overwhelming experience.

Creating a Culturally-Sensitive Support Tool for Indigenous Families

Our vision in creating the video is to provide an avenue to open communication, build rapport, and share information in a way that is culturally sensitive and less overwhelming for Indigenous families facing a new childhood cancer diagnosis.  Acknowledging the significant value of connection within Indigenous communities and with their elders, we also understood the importance of providing an educational tool that families can share with others.

Thank you for reading my reflections on the privilege of participating in the POGO Indigenous Children with Cancer Committee and helping to create the video, Childhood Cancer: A Guide for First Nations Communities. If you haven’t watched it yet, I encourage you to do so.

Watch Childhood Cancer: A Guide for First Nations Communities

I hope it becomes a valuable resource for sharing with colleagues, but most especially, with Indigenous pediatric oncology families you support. As nurses, we have the privilege of spending meaningful time at the bedside, listening to families share their stories, building trust, and advocating when their voices need to be heard.  My hope is that the video, along with other POGO Indigenous resources, will support you in fostering these important relationships with cultural humility, an openness to listen and learn, and compassion in the care we provide.


Jennifer Keis is a pediatric nurse practitioner at The Hospital for Sick Children, working with families facing leukemia or lymphoma.

At the time of writing, this video is pending translation to Ojibwe Nbisiing Dialect.

Posted in Nursing Newsletter | Tagged Indigenous, Indigenous Video, Nurses, nursing, nursing newsletter

A New Era in the Treatment of Pediatric B-ALL

Posted on June 2, 2025 by Kirsten Efremov

Expert Recommendations for Administration of Blinatumomab and Looking to the Future

For those working in pediatric oncology, there’s been no shortage of conversation this past year about a new era in treating pediatric B-ALL. The Children’s Oncology Group (COG) Nursing Steering Committee hosted a webinar earlier this year, providing insights into the widely discussed AALL1731 study and sharing practical strategies for managing blinatumomab infusions. This webinar was presented by the Children’s Oncology Group (COG) Nursing Steering Committee on February 12, 2025.

The intended audience for this webinar is primarily nurses, although allied health professionals will also find it beneficial. Attendees will gain insights into the AALL1731 study results and learn how nurses have effectively addressed challenges related to blinatumomab infusions in their institutions.

The webinar objectives are:

  • Review AALL1731 study results
  • Highlight nursing contributions to success of blinatumomab on COG clinical trials
  • Brief review of qualitative results – perspective of caregivers
  • Framework for improving healthcare experiences
    • Perceived risks (to patient/family outcomes) with care delivery
  • Consideration of hypogammaglobulinemia
  • Sharing examples of delivery practices
    • Rural populations
    • 7-day bags
    • Equipment challenges
    • Prior authorization

If you missed the live webinar, you can still watch it here – COG Nursing Webinar Blinatumomab

If you collect Continuing Education Units, you can earn 1.5 hours by watching this presentation and using the QR code to access the evaluation.


Articles of Interest

  1. Bernhardt MB, Militano O, Honeyford L, Zupanec S. Blinatumomab use in pediatric ALL: Taking a BiTE out of preparation, administration and toxicity challenges. J Oncol Pharm Pract. 2021 Mar;27(2):376-388. doi: 10.1177/1078155220979047. Epub 2020 Dec 18. PMID: 33334253.
  2. Montgomery KE, Zupanec S, Yun C, Okada M, Kubaney H, Feehily E, Withycombe JS. A Quality Approach to Blinatumomab Delivery in Pediatric Oncology: A Children’s Oncology Group Study, 2024, J Pediatr Hematol Oncol Nurs (Epub 9 Sept 2024).
  3. Withycombe JS, Kubaney HR, Okada M, Yun CS, Gupta S, Bloom C, Parker V, Rau RE, Zupanec S. Delivery of Care for Pediatric Patients Receiving Blinatumomab: A Children’s Oncology Group Study. Cancer Nurs. 2024 Nov-Dec 01;47(6):451-459. doi: 10.1097/NCC.0000000000001309. Epub 2023 Nov 22. PMID: 38016041; PMCID: PMC11128477.
Posted in Nursing Newsletter | Tagged Blinatumomab, Nurses, nursing, nursing newsletter

Cancer-Related Fatigue and What Pediatric Oncology Nurses Need to Know

Posted on June 2, 2025 by Kirsten Efremov

Cancer-related fatigue is a major but often under-recognized aspect of childhood cancer care. As treatments become more effective and survival rates improve, attention is shifting to the overall well-being of young patients during therapy. Fatigue stands out as a common experience that can affect every part of a child’s life, from play to school to home. Understanding fatigue is an essential step in providing truly comprehensive pediatric oncology care.

What does the evidence say about fatigue in pediatric oncology?

We know that fatigue is one of the most prevalent, severe and distressing symptoms and it can persist long-term into survivorship. Fatigue is associated with a decreased quality of life and can co-occur with other symptoms such as depression and sleep disturbance.

So, what can we do about it?

POGO’s Guidelines Program provides healthcare professionals in Ontario and worldwide with the best options for managing the adverse effects of cancer and its treatment with the goal of improving the health and quality of life of children with cancer.

Read more about the program here.

Recently, this POGO program released a fatigue clinical practice guideline (CPG) to get you moving in the right direction. The purpose of the fatigue CPG is to guide healthcare providers in the management of fatigue in children and adolescents with cancer and pediatric recipients of hematopoietic stem cell transplants (HCT).

The fatigue CPG ultimately highlights four recommendations and one good practice statement (see table below). Nurses at the bedside and in clinics are uniquely positioned to implement these evidence-based recommendations.

Adapted from Table 1. Patel et al, 2023    

I’ve reviewed the fatigue CPG, now what?

Start with the good practice statement. You can ask your patients about fevers, nausea and vomiting, pain and more, so now is the time to start asking about fatigue. There are many tools to help you assess fatigue; see if your institution is using any of them. Some examples include: Peds-PRO-CTCAE, PROMIS and SSPedi: Symptom Screening in Pediatrics Tool.

Next, try recommendation 1, the use of physical activity. There is no perfect intervention for physical activity, but you can assess what brings your patient joy and start small and scale up. Maybe it is a dance party that the unit holds for 10 minutes a day or maybe your unit has organized scavenger hunts that have the patients up and moving around the unit and hospital. Encourage families to get involved and plan activities such as walks, bike rides or yoga.

Guided by the POGO fatigue CPG, the Children’s Oncology Group (COG) New Diagnosis Guide now incorporates information about fatigue, including describing fatigue as a symptom of cancer and cancer therapy and offering suggestions to families on how to manage fatigue. This guide can help you start the conversation.  

Find the New Diagnosis Guide and other COG family resources here. https://childrensoncologygroup.org/cog-family-handbook

Review POGO’s clinical practice guidelines on fatigue, and other topics, here. 

AboutKidsHealth has also developed some great resources about fatigue which you can read more about here: Cancer-related fatigue

Denise Mills, MN, RN(EC), NP Pediatrics
POGO Provincial Clinical Lead, Pediatric Oncology Nursing


References

  1. Hooke, M.C., & Linder, L.A. (2019). Symptoms in children receiving treatment for cancer-part 1: fatigue, sleep disturbance, and nausea/vomiting. Journal of Pediatric Oncology Nursing, 36(4), 244-261.
  2. Patel, P., et al. (2023). Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. www.thelancet.com Vol 63 September, 2023.
Posted in Nursing Newsletter | Tagged Cancer-related Fatigue, Clinical Practice Guidelines, Nurses, nursing, nursing newsletter

Meet Renee Smith, Compassionate and Experienced Pediatric Oncology Nurse at Windsor Regional Hospital

Posted on June 2, 2025 by Kirsten Efremov

As a nurse at the POGO Satellite Clinic at Windsor Regional Hospital (WRH), Renee Smith plays a pivotal role in ensuring that pediatric oncology patients in the Windsor-Essex County area receive the care they need, closer to home. Her work is a testament to the power of empathy, teamwork, and dedication that makes a lasting impact on the families she serves. Here, Renee shares her experiences, insights, and the reasons why pediatric oncology nursing is so close to her heart.

Helping Children Receive Optimal Care

Renee’s role is focused on coordinating care for childhood cancer patients residing in the community. A key part of her mission is to help these children and families avoid long travel on the highway to reach a larger hospital with a specialized childhood cancer program.

“I work as the RN in the clinic, organizing appointments and working closely with our pediatrician and pharmacists to administer chemotherapy,” Renee explains. “Patients come to me for lab work, port access, blood transfusions, and supportive care as needed. If a child is feeling unwell, they can come to our POGO Satellite Clinic and be assessed on-site.”

The POGO Satellite Clinic at WRH also coordinates imaging and communicates with their partner hospital, Children’s Hospital, London Health Sciences Centre, to ensure patients receive optimal care. The highlight for Renee is the deep relationships she forms with the POGO families, helping them through one of the most difficult times in their lives.

“I love meeting the POGO families and working with them throughout their journey. It’s rewarding to be part of their lives, especially knowing that our work can help make a terrible time a little more bearable. I also love how the role allows me to continuously learn new information and grow as a nurse.”

A Journey in Nursing

Renee’s career journey is one of passion, dedication, and a deep love for pediatric care. She worked in pediatrics for 19 years before she began covering shifts in the POGO Satellite Clinic at WRH. She then spent three years in the chemotherapy suite of the Adult Cancer Centre, with a primary oncologist, managing patients with solid tumours, melanoma, and hematology.

However, Renee’s heart always remained with pediatric patients, and when the opportunity to return to the POGO Satellite Clinic became available, she jumped at the chance to be back with children and their families.

“I’ve always felt deeply connected to the pediatric population, and being part of the POGO team has been a dream come true,” says Renee.

Advice for Aspiring Nurses

For those interested in pursuing a career in pediatric oncology nursing, Renee offers some valuable advice:

“Be patient, listen actively, and develop strong communication skills. Children and families need to feel heard and supported. It’s also important to find healthy coping strategies through hobbies or exercise to maintain a balanced life and avoid burnout.”

She also emphasizes the importance of ongoing education. POGO offers several educational opportunities, including Satellite Education Day, AfterCare Education Day and virtual education.   

“Pediatric oncology is constantly evolving, so staying up to date with new treatments and technologies is key. Work as part of a strong team, advocate for your patients, and always take the time to celebrate the small wins along the way.”

The Emotional Toll of Pediatric Oncology Nursing

Renee highlights one of the most pressing challenges in pediatric oncology nursing: the emotional toll. Nurses in this field witness the pain and suffering of children and their families, which can be incredibly difficult to cope with.

Above all, Renee reminds aspiring nurses not to neglect their own well-being.

“Taking care of yourself is just as important as taking care of your patients. It’s important to acknowledge the emotional strain that comes with the job. Nurses are there to support both the patients and their families, but sometimes we forget to take care of our own emotional needs. It’s crucial to recognize when burnout is a concern and to take steps to manage it.”

A Family Legacy of Nursing Begins

One recent achievement that Renee is particularly proud of is seeing her son, Owen, enter the nursing program at Western University.

“When I asked him why he chose nursing, he said it was because he remembers me always speaking so highly of the profession and its impact on helping people. He told me he wanted to follow in my footsteps and become the best nurse he could be. It was such an emotional and proud moment for me.”

Inspiring the Next Generation of Nurses

Renee’s story is one of inspiration, dedication, and unwavering commitment to the families she serves. Her work in pediatric oncology nursing touches the lives of children and families, making a profound impact during some of their most difficult times. Through her work, she exemplifies what it means to provide compassionate, high-quality care with a heart full of empathy.

We thank Renee for sharing her journey and insights. Her dedication continues to inspire not only the patients and families she cares for, but also the next generation of nurses, including her own son.

Posted in Nursing Newsletter | Tagged Nurses, nursing, nursing newsletter, POGO Satellite Clinic, POGO Satellite Nurse

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