Editorial: Critical complications in pediatric oncology and hematopoietic cell transplant – how far we have come and how much further we must go

Abstract

Editorial on the Research TopicCritical complications in pediatric oncology and hematopoietic cell transplant History of pediatric onco-critical careThe evolving experience and expertise in caring for critically ill pediatric oncology, hematopoietic cell transplant (HCT), and cellular therapies (CT) patients is a very recent effort. This topic, however, carries behind it tremendous energy and enthusiasm as evidenced by the numerous quality submissions to this Research Topic, "Critical Complications in Pediatric Oncology and Hematopoietic Cell Transplantation".Pediatric HCT was first successfully performed by the Robert A. Good team in 1968 to treat a non-malignant disorder (X-linked severe combined immune deficiency) (1) followed by expanded indications to bone marrow malignancies and failure (2-4). In this era, pediatric critical care was also early in its infancy but was available to patients with sepsis/septic shock, hemorrhage, and respiratory insufficiency/failure. Pediatric renal replacement therapies were limited, tunneled central venous access was in development, and non-invasive positive pressure was still decades away. Initial hematopoietic growth factors, anti-viral agents, and infection prophylaxis were undergoing study in clinical trials.Mortality in this early era in both adult and pediatric oncology and HCT patients with septic shock and/or acute respiratory failure was dismal, with mortality rates exceeding 80% (5-9). Indeed, one published series from this early period stated: "Intensive respiratory care is effective for patients with readily reversible causes of respiratory failure, but is generally futile for patients with progressive interstitial pneumonia" and "We also recommend providing bone-marrow transplant patients with realistic prognostic estimates … before transfer to the intensive care unit … This approach may reduce the amount of futile care" (10).

Assessment of the quality of interdisciplinary communication (CritCom): evaluation and refinement of a center summary report

“…Outcomes for critically ill patients improve when clinicians work together and communicate effectively as a team (1)(2)(3). Communication between clinicians is particularly important in the care of children with cancer, who are at higher risk of deterioration and subsequent mortality (2,3). High-quality interdisciplinary communication has been linked to earlier recognition of adverse events and decreased mortality (4).…”

“…Outcomes for critically ill patients improve when clinicians work together and communicate effectively as a team ( 1 – 3 ). Communication between clinicians is particularly important in the care of children with cancer, who are at higher risk of deterioration and subsequent mortality ( 2 , 3 ). High-quality interdisciplinary communication has been linked to earlier recognition of adverse events and decreased mortality ( 4 ).…”

Improving quality of pediatric onco‐critical care: A 2‐year experience using PROACTIVE at a cancer center in Jordan

“…1,2 Children with cancer are at high risk of critical illness, particularly in resource-limited settings, which face multiple challenges delivering high-quality pediatric onco-critical care (POCC). [3][4][5] Despite resource limitations, modifiable practices can improve outcomes for critically ill children with cancer, 6 making quality improvement (QI) around POCC imperative to improve This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors.…”

“…Most children with cancer live in low‐ and middle‐income countries, where survival can be as low as 8.1% 1,2 . Children with cancer are at high risk of critical illness, particularly in resource‐limited settings, which face multiple challenges delivering high‐quality pediatric onco‐critical care (POCC) 3–5 . Despite resource limitations, modifiable practices can improve outcomes for critically ill children with cancer, 6 making quality improvement (QI) around POCC imperative to improve global survival.…”