Peds Heme/Onc tips

[SB100]

I just got a glimpse at what I believe may be my schedule and I'm starting intern year in heme/onc. Any good resident-level books or specific resources I should check out, especially with understanding chemo regimens and what to monitor and when?

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[deleted311769]

I just got a glimpse at what I believe may be my schedule and I'm starting intern year in heme/onc. Any good resident-level books or specific resources I should check out, especially with understanding chemo regimens and what to monitor and when?

No one expects you to know anything about chemo regimens. By the end of the rotation you should know what to look out for regarding particular chemo agents, but almost all pediatric cancer patients are on study protocols (or are treated off study on similar protocols) and you really are unlike to be able to sort that out beyond what agents you are more often seeing in what kinds of patients. And unfortunately, because everyone is on a different protocol, you can't even master what should be simple things (like at what blood level methotrexate is considered cleared, or how long you pre-hydrate for... all these things are different depending on their protocol). No to mention that residents will NEVER put in chemotherapy orders. So all that said, I honestly wouldn't worry about the chemo part before you start.

For what to monitor, you all will learn a lot of that on the job. It's normally pretty straight forward, an almost always part of their chemo protocol/on their roadmap. And things like that all kids on cyclophosphamide/ifosfamide get UAs to check for blood, and that you have to watch out for anaphylaxis in patients getting L-aspiriginase for the first time, will be covered.

The things to possibly read up on, and you can do this in a general text or uptodate or whatever, would be:
- Tumor lysis syndrome
- Fever and neutropenia
- Common tumors/cancer's in kids
- Sickle cell disease

No one is expecting you to be an oncologist. At least at my program heme/onc is one of the hardest first year rotations. It's when you learn to tell if a patient is sick or not, because these kids can get really sick really fast. So try to get out of it as much as you can, but it's a steep learning curve, and don't worry about the minutia just yet. There are lots of other people there to handle that part.

 

[Rutgers06]

I agree with pediperson. For onc, it's all about learning sick vs not sick, the chemo protocols are set by the attendings or fellows. Other general topics to look over for heme/onc are:

- common side effects of the chemo meds (ie cyclophosphamide causing hemorrhagic cystitis or methotrexate causing mucositis...you can remember chemoman
- Blood transfusion reactions
- ITP
- Clotting disorders
- HLH (these are some of the sickest kids I've ever had to manage during intern year)

Good luck with the start of intern year!

 

[SB100]

Thanks for your input guys!

 

[BigRedBeta]

I just got a glimpse at what I believe may be my schedule and I'm starting intern year in heme/onc. Any good resident-level books or specific resources I should check out, especially with understanding chemo regimens and what to monitor and when?

Just to further emphasize the point on chemo...other than common side effects with individual agents chemo does NOT show up on Peds boards.

If your really starting out as an intern on heme/onc, in all actuality focus on becoming a good intern. You can always go back and learn the specifics later, but your life will be easier now and forever if you pay more attention on how to get your work done than on heme/onc topics. Sick vs not sick, asking for help, prioritizing your day, understanding the structure of your new hospital and how to get things done, these are the things that are going to consume your days far more than doing medicine, which is true of any intern...you just have to manage that transition in a higher stress environment...

 

[Stitch]

For what to monitor, you all will learn a lot of that on the job. It's normally pretty straight forward, an almost always part of their chemo protocol/on their roadmap. And things like that all kids on cyclophosphamide/ifosfamide get UAs to check for blood, and that you have to watch out for anaphylaxis in patients getting L-aspiriginase for the first time, will be covered.

The things to possibly read up on, and you can do this in a general text or uptodate or whatever, would be:
- Tumor lysis syndrome
- Fever and neutropenia
- Common tumors/cancer's in kids
- Sickle cell disease

No one is expecting you to be an oncologist.

If your really starting out as an intern on heme/onc, in all actuality focus on becoming a good intern. You can always go back and learn the specifics later, but your life will be easier now and forever if you pay more attention on how to get your work done than on heme/onc topics. Sick vs not sick, asking for help, prioritizing your day, understanding the structure of your new hospital and how to get things done, these are the things that are going to consume your days far more than doing medicine, which is true of any intern...you just have to manage that transition in a higher stress environment...

Totally agree with these. The hardest part about starting any rotation is getting a grasp on what information is important day to day. What day of chemo are they on and where on their treatment 'map' are they? Is the kid neutropenic? What to do when that kid gets a fever.

Have good attention to detail and ask a lot of questions, even if you think you know the answer. It's better to ask and be right than not ask and be wrong. And I'd keep in mind that peds heme/onc nurses tend to be pretty good. If they're telling you something, I'd listen.