IntroductionChildren with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.MethodsWe describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.ResultsBetween January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.ConclusionsOur experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.

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Scoring on ASCO and ESMO frameworks for 102 advanced oncology drugs were taken from Cherny 2018. Corresponding final appraisal documents by NICE were reviewed. Data were extracted for indication, comparators, clinical benefit assessment, toxicity, quality of life, and cost-effectiveness. NICE committee's final decision was recorded: recommended or not, with restriction in indication or with a patient access scheme (PAS) or on the cancer drugs fund (CDF). The relationship between ASCO/ESMO scores and NICE recommendation was investigated. Results: 79% of the 102 drugs included in Cherny 2018 were assessed by NICE; 45% were recommended by NICE, 22% were with PAS and 12% on the CDF. Of the recommended treatments, 82% and 93% were associated with a moderate to high clinical benefit score on ASCO (.40) and ESMO (.3), respectively. Treatments with restricted recommendation based on indication and on CDF were associated with the highest mean ASCO (54) and ESMO (4) benefit score. Cost-effectiveness was less correlated with clinical scoring, potentially suggesting that pricing does not fully reflect clinical benefit. The cost-effectiveness analysis was limited by the confidential nature of the final agreed price. Conclusions: An association was found between NICE recommendations and clinical benefit assessments by ASCO and ESMO despite the difference in performance criteria, clinical evidence, comparator choice, disease burden, and cost-effectiveness, adopted by payers and clinical frameworks.