Inpatient oncology care at Boston Children’s is divided into three disease-specific teams: hematologic malignancy, solid tumor, and neuro-oncology.
There are two hematologic malignancy teams. One is staffed by an attending, a fellow and two PL-2 residents. Typically, they take all new diagnoses, relapses, most ICU transfers, complications of treatment (e.g. pancreatitis, infections, etc). The other heme malignancy team has an attending, two nurse practitioners and no residents. Typically, they take the long-term patients (AML, in the hospital for 4-6 months), and routine chemotherapy admissions.
There are also two solid tumor teams: one inpatient and one outpatient. The inpatient service is staffed by an attending, a fellow, two PL-2 residents and two nurse practitioners (NP). The NPs and the residents split the patients, with NPs taking most routine chemo admissions and residents taking new diagnoses, relapses, ICU transfers, and complications of treatment. Everyone rounds together but the work-flow after rounds is mainly divided into NP and resident groups. The outpatient solid tumor team is staffed by an attending, a fellow and a nurse practitioner with no residents. They do outpatient consults, work-ups, and new diagnoses.
The neuro-oncology team consists of an attending, fellow and two nurse practitioners. They cover the inpatients, the ICU patients, and consults. Residents spend a day on the team during their Oncology block.
Goals of the rotation include: understanding common presentations of childhood cancer, management of oncologic emergencies, effective communication with families, management of febrile neutropenia, and identification and management of common complications of chemotherapy. The rotation also allows residents to gain an understanding of issues related to end-of-life care in a pediatric population. This rotation is augmented by daily didactic teaching sessions by oncology fellows and attendings, tumor boards and an outpatient experience in the Jimmy Fund Oncology Clinic at the Dana Farber Cancer Institute.