Establishing the Skeletal Health in Childhood Cancer (SHICC) Team to Improve Care

Describe development and function of a novel clinical team focused on skeletal health in childhood cancer. Children with cancer have increased risk of developing skeletal complications. Improved overall survival rate of children with cancer seen in recent decades has yielded development of comorbidities impacting bone during & after treatment, including avascular necrosis (AVN) and low bone mineral density (BMD). Clinical practice guidelines/official positions about mitigation of bone health risks & monitoring of bone health for children undergoing cancer treatment exist but practices vary across institutions. We formed a multidisciplinary team to address bone concerns in childhood cancer at our children's hospital. We describe this team, approach to developing care guidelines, and the team's efforts. A team comprising pediatric specialists was formed: oncology, oncology nurse practitioners, radiology, endocrinology, physiatry, physical therapy, researchers, orthopedics, clinical nutrition, medical librarian, & family representative. A charter defining membership, meeting frequency, and goals was developed. The group meets monthly; subgroups meet more frequently for project work. Goals were established: 1) develop protocols for imaging and lab monitoring for children undergoing cancer therapy & create a care pathway; 2) provide education to patients/families/medical staff regarding skeletal health in childhood cancer; 3) provide medical staff education on new care protocols/pathway; 4) develop research protocols on skeletal health in childhood cancer & outcomes of pathway; 5) monitor effectiveness. A list of search terms was developed; literature search was performed. The Skeletal Health in Childhood Cancer Team (SHICC) launched January 2021. Since, the group: 1) met monthly to create a charter and review/discuss literature to develop protocols/pathway; 2) agreed on laboratory monitoring components & schedule; 3) developed imaging modality & scan protocols (DXA for BMD & MRI for AVN); 4) created educational materials for patients/families; 5) developed educational talks for medical professionals on the skeletal health program. Two research protocols were submitted for funding in November 2022; decisions are pending. December 2022, educational talks were developed and initiated for medical professionals; skeletal health report card for patients was implemented. Laboratory & imaging protocols were implemented January 2023. Using a multifaceted approach, the multidisciplinary SHICC team is addressing care for children undergoing cancer treatment. The team has maintained a regular meeting schedule for over a year to discuss and evaluate the skeletal problem & concerns of children with cancer and created/delivered educational materials to patients/families/healthcare providers about pediatric cancer bone concerns. Protocols and a care pathway for skeletal health monitoring was developed. Clinical outcomes will be assessed 6 & 12 months post pathway implementation, & annually thereafter. The group will monitor evidence continuously to inform best practices. Group members are engaged in research on skeletal health and outcomes to expand the literature. This approach could be used for many medical conditions affecting children and adults where bone health is a concern.