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Cancer & Blood Disorders

We provide comprehensive care for children under 17 years of age who have cancer or complex blood disorders.
About

Cancer 

The care is provided by a team of experts knowledgeable in the specialized laboratory, radiological, surgical and medical evaluation of children. 

The team works in close collaboration with the BC Cancer Agency and its community centres and clinics, in providing treatment and follow-up for children with cancer. Adolescents over the age of 17 at diagnosis should be referred to the BC Cancer Agency. In special cases, older adolescents will be considered for treatment at BCCH.

The program is a member of the Children’s Oncology Group (COG), a worldwide cooperative research group. Children’s cancer specialists are in constant communication with centers all over the world and are able to decide the best possible treatment for any childhood cancer.

Please contact us if you require additional information about the program.

Blood disorders 

We provide consultative service and directive care for patients with complex hematological disorders such as bleeding, red cell disorders, thrombosis, cytopenias, and bone marrow failure syndromes. 

The hematology outpatient service is staffed by the same physicians who run the oncology service.  

 

‎This service receives consultations from different pediatric subspecialties in the hospital as well as from pediatricians and family physicians in the community on complex hematology patients.    It is a busy service, receiving over 200 new in-patient consultations, over 300 new out-patient consultations, and sees over 1,500 patients every year.

 

New consults are usually seen in the New Hematology Consult clinic on Wednesday afternoons.  Follow-up visits for children with chronic hematological problems are provided Monday-Friday.


The Hematology Nurse Clinician is Susan Lee 

Office: (604) 875-2345 ext 7060                                         

Email: SLee@cw.bc.ca

The Hemoglobinopathy comprehensive care team consists of hematologists, nurse, social workers and psychologists. Patients are followed at BC Children's Hospital until age 18 and then transitioned to St. Paul's Hospital for continuing care. 

 

Currently, the Hemoglobinopathy program has ~85 patients, and receives 5-10 new patients each year. This service provides comprehensive continuing care and support to children and their families across BC with inherited disorders of hemoglobin.  These include beta thalassemia major, hemoglobin H disease sickle cell disease, , and other hemoglobinopathies. 

 

This program also manages, supervises, and coordinates the chronic transfusion program and iron chelation therapy.  When suitable, patients may be offered the option of bone marrow transplantation.  

New patients are referred by community pediatricians and family physicians, and via Newborn Screening Program, Perinatal Services of BC.


The Hemoglobinopathy Nurse Clinician is Heather McCartney

Office: (604) 875-2345 ext 7103

Email: hmccartney@cw.bc.ca

 
 

We are the home for the British Columbia Inherited Bleeding and Red Cell Disorders Provincial Program, administered by the PHSA Provincial Blood Coordinating Office.

This service provides comprehensive care and support to children and their families with hemophilia, von Willebrand disease, platelet disorders, and other rare inherited coagulopathies.  It has the mandate to supervise and coordinate the distribution and usage of provincial blood coagulation products with tracking by Canadian Blood Services and the patient database.  

The team consists of hematologists, nurses, physiotherapist, and social worker.  Patients are followed at BC Children’s Hospital until age 18 and then transitioned to St. Paul’s Hospital for continuing care.  


The Bleeding Disorders Nurse Practitioners are Erica Crilly and Celina Woo

Office: 1-888-300-3088 ext 5335 
Email: hemophilia_clinic@cw.bc.ca

 

‎The Thrombosis program provides consultation and continuing care for children and young adults with thrombosis or at risk of developing thrombosis.  The service receives consultations from different pediatric subspecialties in the hospital as well as from pediatricians and family physicians in the community.  It is also an anticoagulation resource for families and health care professionals around the province.  

The INR Point of Care home INR monitoring was developed for patients who require frequent bloodwork because of unstable INR values.  Patients receive an 1 year loan of a POC monitor that can be used at home to check INR by finger poke.  Families call the Thrombosis service with the INR value and anticoagulation is adjusted over the telephone.

Patients are usually seen in the clinic on Tuesday afternoons. 


The Thrombosis Nurse Clinician is Jane Braun 

Office: (604) 875-2345 ext 7058
Email: jbraun@cw.bc.ca 

Prepare

Outpatient Visit

Check in with the appropriate receptionist, who will direct you where to go. The clinic has two areas: 

  • Short stay area (front)
  • Infusion area (back) 

If your child requires isolation (because of a cough, runny nose, rash, etc.) please advise the receptionist. Please ensure all other family members are well if visiting the clinic

You will be given an ID armband and blood requisition. Please put the armband on your child's wrist.

Short stay area (front)

Sign your name and time of arrival on the whiteboard.

The nurse will check your child's height, weight, temperature and blood pressure.

Bloodwork results take approximately 45-60 minutes to process.

Please advise the nurse if you will be leaving clinic during this wait time.

You can expect to see your physician or nurse approximately 1 hour after check-in.

Infusion area (back)

Find your child's name and write arrival time on board.

Proceed to the playroom and keep your blood requisition with you. 

 

You will be given a follow-up appointment, if needed. This should be handed in to the receptionist who will give you an appointment time

Certain appointment types (eg Vincristine only, VAD flushes, Pentamidine, bloodwork only) will only be scheduled outside of high volume clinic hours (usually in the afternoon).

The oncologists/hematologists have designated days on which they are available to see patients in the clinic. If it is not their specific clinic day when you come to the clinic, you will be seen by one of the other doctors. Some appointments may be with the nurse only.

Some appointments will go unexpectedly longer than originally scheduled. Please have a plan for family members at home if this should happen.

 

Appointment check-in time is not the same as procedure start time. The appointment check-in time is to allow enough preparation time before the start of the procedure. 

Procedure time is determined on the day of your appointment. Procedure times vary according to the availability of the anesthesiologists, number of procedures, how sick patients are, emergency patients or if your child is on isolation.

Plan to be in clinic for 2-5 hours.

Let your nurse know if your child has any cough, runny nose, or any other isolation reasons (eg. MRSA) as soon as possible. This may affect the time of the procedure.  Put EMLA cream on VAD, LP, bone marrow sites one hour prior to appointment check-in time. If unsure where to put EMLA, please ask your nurse.

Remember to strictly follow fasting instructions:

  • No solids (including milk, NG feed, formula) 6 hours before appointment check-in time
  • No breast milk 4 hours before appointment check-in time
  • No clear fluids (water, apple juice, kool-aid, clear tea) 2 hours before appointment check-in time
 

Inpatient Routine (3B/2B)

  • The 24-bed inpatient wards, which includes a 5-bed blood and marrow transplant unit, are located on the 2nd and 3rd floor of Children's Hospital main building. 
  • Routines on 3B/2B Inpatient Unit(PDF)
    • 3B phone 604-875-2345 ext 7614
    • 2B phone 604-875-2345 ext 2690

The Discharge Planning Nurse will meet with all new families before discharge:

  • to check that parents are learning the necessary knowledge and skills, 

  • to discuss what to expect when at home, and 

  • to check specific concerns parents have about their child and situation. 

At times there can be many different health care professionals involved in one child’s care. The Discharge Planning Nurse helps to make sure that all the involved people are aware of the discharge date so that everyone is ready when the day comes. Information is passed to the nurse clinicians in the outpatient clinic and/or the home community health care professionals so that the transfer of care from one setting to another goes smoothly. 

A discharge summary is provided to all parents at the time of discharge.

The Discharge Planning Nurse is Cecilia Lau


Follow-up

Long-Term Follow-Up Clinics

‎At the end of active treatment the patient and the family are informed that in approximately 6 months they will be transferred to the follow-up clinic. 

The patient’s VAD/CVC is removed; all oral chemo and septra are discontinued. Patients are followed at least until they have reached 21 years of age and have been off treatment for at least 5 years. 

Team members include 2 follow up nurse clinicians: Angela Pretula and Marion Nelson. The patient’s oncologist continues to see them in follow up clinic which happens on Tuesdays or Thursdays.

There are 2 community hosiptials which also provide

follow-up care to off treatment patients and their families: Surrey Memorial Hospital and Victoria General Hospital.

The oncology team has developed disease-specific long term follow-up guidelines. However the health risk issues are complex and dependent on the original disease and treatment. Knowledge regarding the incidence and severity of these risks is increasing as well as new facts are emerging with newer therapies.


Goals

  • Assess for disease recurrence
  • Surveillance for new problems related to original disease or its treatment
  • Screen, diagnose and treat long term effects, includes coordination with other specialists
  • Inform patients and their family about the specifics of their diagnosis and treatment
  • Educate patients,families and health care professionals about long term effects
  • Provide support related to survivorship issues and treatment consequences
  • Promote the health and well being of patients
  • Help survivors plan and coordinate their transition to adulthood and adult health care

Angela Pretula, RN, MSN, Nurse Clinician 

Office: 604-875-2345 ext 7126
Email: apretula@cw.bc.ca

Marion Nelson, RN, Nurse Clinician
Office: 604-875-2345 ext 4827
Email: mnelson@cw.bc.ca

 

It’s hard to say goodbye however it is important with assistance and guidance from the pediatric caregivers that survivors enter the adult health care world. It is important that the survivor’s health care needs are continued to be met in an age appropriate setting, by knowledgeable and supportive health care providers. 

Patients who have had a bone marrow or stem cell transplant or radiation as part of their initial treatment can be transitioned to adult oncology care. Depending on the patient’s needs for follow-up, care can also be transferred to their primary health care professionals. 

Patients will be given a written summary of their treatment; this includes information on their diagnosis, treatment, current health concerns, potential future health concerns and recommended follow-up tests and frequency of visits. Their adult health care provider will also be given a copy of this. Ultimately the young adult will be equipped with a comprehensive survivorship care plan that will enable them to make wise health care decisions and feel confident about the future.

 
 

There are at least 3,000 survivors of childhood cancer in BC. Many are not aware of some of the long-term risks associated with their previous treatment. The current situation in BC is that only a very small number of patients are followed as adults at the BC Cancer Agency, some are followed by their family doctor who has been given guidelines, and some are cared for by physicians who are not aware of long-term consequences of therapy.

An ongoing comprehensive follow-up clinic for adult survivors of childhood cancer has been developed. Efforts will be made to trace and contact long-term survivors of childhood cancer. 


Survivors who are interested in this program may contact Marion Nelson, Long Term Follow Up Nurse Clinician, at mnelson@cw.bc.ca


What survivors will receive through this clinic:

  • a review of their previous treatment
  • a written summary of their previous treatment
  • advice regarding possible late effects of treatment and how to prevent or treat them
  • help to organize any recommended tests if necessary
  • collaboration with their own doctor to maintain their health
  • participation in research studies of long-term outcomes if they are interested
BC Cancer Agency and BC Children’s Hospital have created the Adult Childhood Cancer Survivors Program for childhood cancer survivors. 
As part of this program, a new clinic called the Late Effects, Assessment and Follow-up (LEAF) Clinic is open to ensure that adult cancer survivors are getting the best care. 
For more information about the clinic, please visit the website

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