King Fahad National Centre for Childrens Cancer
Services
Leukemia/Lymphoma:
The Section of Leukemia/Lymphoma strives to standardize the care of children with acute and chronic leukemias, myelodysplastic and myeloproliferative syndromes Hodgkin’s disease, Non-Hodgkin’s Lymphoma and other lymphoproliferative disorders. Leukemia’s are the most common cancer seen in childhood and constitutes 30-35% of all malignancies seen in children. Together Leukemia/Lymphoma account for approximately 50% of patients in PHO.
Solid Tumors:
The Section of Solid Tumors has three approved programs; Solid Tumors, Neuro-Oncology and Histiocytosis. The Section coordinates the multidisciplinary team care and treatment of all varieties of pediatric solid tumors as needed for optimal care. Solid tumors constitute more than 50% of all malignancies seen in PHO.
Stem Cell Transplant:
The Section of Pediatric Stem Cell Transplant (SCT) provides care for children in need of Stem Cell Transplantation. The program performs more than 140 Stem Cell Transplants per year, for patients with various malignancies and non-malignant haematological disorders as well as for immune deficiency and metabolic diseases. It is the largest SCT program in the region.
Hematology:
The Section of Hematology has two approved programs; Hemophilia and Hemoglobinopathy. It handles a multitude of unique Blood Disorders and cares for a large population of patients with Bone Marrow Failure Syndrome. It is a major source for the Stem Cell Transplant program and provides Consultative Service to the entire institution.
Pediatric Palliative Care:
Children diagnosed with cancer or other serious blood diseases often have complex care needs. Along the disease trajectory, family members regularly go through an array of strong emotions and have to take multiple complex and difficult decisions regarding care. The Pediatric Palliative Team specializes in addressing these challenging, complex, and emotionally-charged situations of care.
Pediatric Palliative CareA A A
Pediatric Palliative Care Program
Children with complex, life-limiting or life-threatening conditions represent a heterogeneous population characterized by a variety of disease trajectories. These children often have complex care needs. Along the way, family members regularly go through an array of strong emotions and have to take multiple complex and difficult decisions regarding care. Pediatric palliative care is a field that specializes in addressing these challenging, complex, and emotionally-charged situations of care.
Types of conditions for which a pediatric palliative care approach can be of benefit:
Conditions where curative treatments are possible but may fail (e.g. cancer, congenital heart disease, children awaiting organ transplant);
Condition where intensive long-term treatment can provide a quality of life for a chronic, potentially progressive condition (e.g. cystic fibrosis, severe immunodeficiency, severe, progressive neuromuscular diseases);
Non-progressive, irreversible conditions with vulnerability to various health complications (e.g. children with severe developmental disabilities such as severe cerebral palsy, hypoxic brain injury, or brain malformations);
Progressive conditions without a curative option from diagnosis (e.g. trisomy)
Goals of Palliative Care Services:
Pain and symptom management
Psychological support for children
Communication with family about end of life goal-setting and expectations
Family support and assistance with dealing with transitions
End-of-life care
The involvement of a Pediatric Palliative Care team also aims to reduce avoidable clinic and emergency department visits while addressing children and families' need with flexible outpatient options (e.g. phone clinic, virtual clinic, home visits).
Modalities of Service:
Inpatient consultations (Main Hospital and King Fahd Children Cancer Center)
Outpatient clinics
Consultation and Support in Home Health Care
Days and Hours of Operation:
The team usually operates according to the Hospital usual working hours:
Sunday to Wednesday (0730-17:00H)
Thursday (0730-16:00H)
Team Members:
The team is composed of specialized nurses and a physician. It works in close collaboration with a play therapist, psychiatrist, social worker, and patient relation representative. Charity organizations and volunteers from the hospital are also a source of support to some of the team activities.
Areas of Research and Publications:
Publications
Khan S, Sadler K, Sidiqui K, AlYami H, AlGarni M, Al-Kofide A, Podda A (2023). Physicians’ knowledge, attitudes, andperception toward pediatric palliative care in Saudi Arabia: A National Exploratory Survey, Palliative Medicine Reports 4:1, 185–192, doi:10.1089/pmr.2023.0010.
Sadler, K., Nancarrow, L., Alyami, H., & Abudari, G. Implementing a Nurse-Led Pediatric Palliative Care Service in a Tertiary Hospital: Steps and Recommendations Through a One-Year Retrospective Analysis. (Accepted for publication in 2021). Intl J Palliat Nursing.
Sadler, K., Abudari, G., Snelling, D., & Aljawi, D. (2020). Deaths in the Emergency Department: An Assessment of Patients’ End-of-Life Trajectory and Quality of Care, Indian J Palliat Care, 26(3), 352-357.
Sadler K, Khan S, AlGhamdi K, Alyami HH, Nancarrow L. Addressing 10 Myths About Pediatric Palliative Care. American Journal of Hospice and Palliative Medicine®. 2023;0(0). doi:10.1177/10499091231174202
Ongoing researches
Sadler, K., Alyami, H,. Khan, S.J., AlGhamdi, K., Discordance between the child's self-report, parent and nurse-proxy-report symptom assessment scores on the Arabic Symptom Screening in Pediatrics Tool (SSPedi).
Alyami, H., Sadler K., Khan, S,J., Alayed, D., Alsaif, S., Abdulla, L., Alfuaim, M., Alghamdi, W. Translating the Symptom Screening in Pediatrics Tool (SSPedi) into Saudi Arabic for Saudi children and adolescents receiving cancer treatments : evaluating understandability and cultural relevance in a multiple-phase descriptive study.
Sadler, K., AlKhattabi, F., Alyami, H., Albedah, N., Alturaiki, N., Healy, M. Examining the effect of the Buzzy® Device in Reducing the Pain and Fear in Young Children During Vaccination.
Sadler, K., AlKhattabi, F., Alyami, H., Albedah, N., Alturaiki, N., Healy, M. Examining the effect of Sucrose 24% oral in Reducing the Pain and Fear in Infants During Vaccination.
Staff Education Opportunities:
The Pediatric Palliative Care team members are official trainers for the recognized course “Pediatrics Education in Palliative and End-of-Life Care” (EPEC-Peds).
Medical, nursing, or allied health care provider trainees can request a stage with the team going through their respective academic department.
Resources
Pediatric Hematology/Oncology Services cover both King Faisal Specialist Hospital (KFSH&RC) and King Fahad National Centre for Childrens' Cancer (KFNCCC) – Riyadh. The pediatric malignancies are cared for by the Department of Pediatric Hematology/ Oncology and admitted at KFNCCC with total allocation of 46 beds. The Pediatric Stem Cell Transplant patients for transplants and post transplants are admitted at KFSH&RC with total allocation of 24 beds.
Pediatric Hematology/Oncology Services cover both King Faisal Specialist Hospital (KFSH&RC) and King Fahad National Centre for Childrens' Cancer (KFNCCC) – Riyadh. The pediatric malignancies are cared for by the Department of Pediatric Hematology/ Oncology and admitted at KFNCCC with total allocation of 46 beds. The Pediatric Stem Cell Transplant patients for transplants and post transplants are admitted at KFSH&RC with total allocation of 24 beds.
Types and Ages of Patients Served:
The Department of Pediatric Hematology/Oncology provides comprehensive care in children and adolescent with Leukemia, Brain Tumors, Lymphoma, Bone and other Solid Tumors, in addition to patients with malignancies, non-malignant hematological and bleeding disorders. Patient age range from Zero to 14 years, after which if their treatment is not completed they are referred to the Adult Service at KFSH&RC.
Scope and Complexity of Patient Care Needs:
The Department of Pediatric Hematology/Oncology requires multi-disciplinary team care involving but not limited to Pediatric Hematologist/Oncologist, Pediatric Surgeons; General Surgery, Thoracic Surgery, Neurosurgery, Cardiac Surgery, Urology, Vascular Surgery and all-inclusive Pediatric Subspecialties, PICU, Pediatric Radiology, Pediatric Radiation Oncology, Chemotherapy Certified Nurses, Nutrition Support, Physical Therapy, OBGyne, Occupational Therapy, Audiology, Speech Therapy and Social Services, Radiology, Laboratory & Pathology.
Strategies to Assess and Meet Patient Care Needs:
Comprehensive therapeutic protocols and treatment programs.
Evidence based supportive care guidelines
Annual review of patients` outcomes
Psychosocial multidisciplinary team responsive to patient and family needs
A team of staff nurses, management and support staff provide nursing care to this patient population across both inpatient and outpatient settings.
The nursing units and their bed capacities/clinic activities are as follows:
Inpatient Care Ward A1: 10 bed unit that provides acute care to pediatric hematology and oncology patients aged from birth to 14 years of age
Inpatient Care Ward A2: 10 bed unit that proviREdes care to pre and post stem cell transplant patients
Inpatient Care Ward B: (20) bed unit that provides acute care to pediatric hematology and oncology patients aged from birth to 14 years of age
Inpatient Care Ward C: 6 bed unit that provides acute care to pediatric hematology and oncology patients aged from birth to 14 years of age
In patient Care Ward D: 4 bed that houses the isolation beds of acute care to pediatric hematology and oncology patients aged from birth to 14 years of age
Intensive Care Unit: (4) projected bed unit that potentially may provide acute care to pediatric hematology and oncology patients aged from birth to 14 years of age.
Outpatient Treatment Area: procedure and treatment area for pediatric hematology and oncology patients aged from birth to 14 years of age
Drop in Clinic: provides acute care to pediatric hematology and oncology patients from birth to 14 years of age
Walk-In Treatment Area –KFNCCC
Consultative services – KFSH&RC
B3-1 pediatric hematology oncology – KFSH&RC
B3-2 Stem Cell Transplant – KFSH&RC
PICU – KFSH&RC
Emergency Room – KFSH&RC
WALK IN CLINIC (WIC)
Scope of Service
The aim of the Walk-in Clinic is to provide treatment and supportive nursing care for pediatric Hematology/Oncology patients. Patients are assessed and sorted according to medical acuity, not in order of arrival.
Type of service:
Include but not limited to:
Acute Febrile illness
Dehydration
Vomiting and diarrhea
Allergic Reaction
Frequent Procedures/Services/Functions
The Health Care Team incorporates various diagnostic and treatment modalities when planning patient care. These may include:
Ongoing assessment, planning, intervention and evaluation by nursing and medical staff
Pharmacological support
Medication delivery including chemotherapy administration and management
Pain management
Blood product administration
Central and peripheral intravenous line management
Patient/family education
Oxygen therapy and pulse oximetry
Psychosocial support
Hours of Operation:
The Department of Pediatric Hematology/Oncology operates according to the Hospital working hours Sundays to Wednesdays (0730-17:00H) and Thursdays (0730-1600H). Clinics are closed during Eid Holidays
The most commonly treated cancer and blood disorders include:
Acute Lymphoblastic Leukemia
Acute Myelogenous Leukemia
Non-Hodgkin’s Lymphoma
Hodgkin’s Lymphoma
Burkitt’s Lymphoma
Brain Tumors
Osteosarcomas
Ewing’s Sarcoma/PNET
Neuroblastoma/CNS tumors
Germ Cell Tumor
Wilm’s Tumor
Rhabdomyosarcoma
Retinoblastoma
Aplastic Anemia
Sickle Cell Anemia
Langerhan’s Cell Histiocytosis
Frequent Procedures/Services/Functions
Medication delivery including chemotherapy administration and management
Blood product administration
Central and peripheral intravenous line management
Pain management
Bone marrow biopsy and aspiration
Lumbar puncture
Patient assessment and evaluation
Patient/family education
Hemodynamic monitoring
Oxygen therapy and pulse oximetry
Moderate sedation
Isolation
Nutritional support (TPN, NGT, weight assessment, dietary instruction)
Psychosocial support
BMT work-up
Diagnostic and Treatment evaluation
Radiation therapy
Achievements
Awards & Recognitions 2015
Quality Day 2015 awarded the department of PHO “Hematology Consultation Tracking System”
Medical Administration Award for Best Patient Story 2015
10th patient and public hemophilia awareness day recognition April 2015
Accreditation
The department of pediatric hematology oncology obtained and maintained its accreditation by the Joint Accreditation Committee ISCT-EBMT, Children’s Oncology Group (COG), European Society for Blood and Marrow Transplantation (EBMT), National Marrow Donor Program (NMDP), and Center for International Blood and Marrow Transplant Research (CIBMTR).
Performance Improvement Projects
The medical team including the medical staff and nursing are continuously looking at ways to deliver up to date patient care and measures to improve patient satisfaction. The most recent performance improvement project addressed the process of the walk-in guidelines for the patients, their families and staff alike. The project has aimed at empowering and educating the families in the ways to maximize the appropriate utilization of the walk-in area.
Research
Research is a fundamental component of pediatric hematology oncology. From 2010- 2015 over 100 research projects were performed including abstracts and publications in prestigious journals with high impact factor and presentations at national & international conferences worldwide. Several projects were funded by SANAD & KCAST. In 2015 alone there were 10 research papers published in peer reviewed journals and presented 9 our experience in 9 national/international conferences. Six (6) new research projects were initiated in 2015 making a total of more than 40 active research studies. Operation of a newly established Tissue Bank and FISH Laboratory in the KFNCCC Research Facility
Hematology Initiative
The hematology Pre-BMT patient tracking and clearance system was created in order to enhance and facilitate the stem cell transplant process. Innovative Consultative service – for improved care, capturing data unique to the PHO service and Research support is currently in place.
Education
The members of the department of PHO at KFNCCC&R and KFSH&RC are dedicated to the teaching, mentoring and counselling of medical students, interns, residents, nurses and fellows continuously providing the educational needs and requirements for advancement and optimizing their medical careers.
The pediatric hematology oncology fellowship Program is accredited by the Saudi Commission for Health Specialties (SCHS) since 03 November 2010 and fellows graduating from the program are serving children with cancer and blood disorders throughout the Kingdom.