Implementation science in pediatric oncology: A narrative review and future directions

Abstract

Implementation science (IS) has garnered attention within oncology, and most prior IS work has focused on adult, not pediatric, oncology. This narrative review broadly characterizes IS for pediatric oncology. It includes studies through 2020 using the following search terms in PubMed, Ovid Medline, and Cochrane: “implementation science,” “pediatric,” “childhood,” “cancer,” and “oncology.” Systematic review was not performed due to the limited number of heterogeneous studies. Of 216 articles initially reviewed, nine were selected as specific to IS and pediatric oncology. All nine examined oncologic supportive care, cancer prevention, or cancer control. The supportive care focus is potentially due to the presence of cooperative study groups such as the Children's Oncology Group, which efficiently drive cancer‐directed therapy changes through clinical trials. Future IS within pediatric oncology should embrace this ecosystem and focus on cancer control interventions that benefit patients across multiple cancer types and patients treated outside cooperative group studies.

Clinical practice guideline‐inconsistent management of fever and neutropenia in pediatric oncology: A Children's Oncology Group study

“…We assessed strong CPG recommendations, meaning that they could be expected to be implemented as policy with little need for institution-based or patient-based adaptation. They also were 9 the same may not be the case for supportive care CPGs. Low uptake of CPG recommendations into practice is common.…”

“…The pediatric FN CPG was first published in September 2012, and endorsed by the COG in February 2014. Although COG‐member institutions have been quick to adopt new evidence into cancer treatment protocols, 9 the same may not be the case for supportive care CPGs. Low uptake of CPG recommendations into practice is common 14–16 .…”

“…Patients were considered for study inclusion if they had a cancer diagnosis associated with high risk of poor FN outcomes (i.e., newly diagnosed acute lymphoblastic leukemia [ALL] during induction, relapsed ALL, acute myelogenous leukemia [AML], advanced stage Burkitt [outside of maintenance phase] or mature B‐cell non‐Hodgkin lymphoma [outside of maintenance phase], or myeloablative autologous hematopoietic cell transplant [HCT] or allogeneic HCT), 9 were previously enrolled to a COG study (therapeutic or nontherapeutic) at a participating site from January 1, 2014 through December 31, 2015, and were less than 21 years of age at enrollment to that study. COG created a list of patients meeting these criteria and then randomly selected patients for local chart review to identify episodes of FN.…”

Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors—Opportunity to Address Gaps in Cancer Prevention and Survivorship

“…Most providers in our survey study [41] identified cancer prevention education on HPV vaccines as both an opportunity and responsibility of providers treating PYAC survivors, although providerlevel HPV vaccine knowledge was also identified as a barrier. Unfortunately, there are few implementation science studies targeting cancer prevention strategies targeting PYAC survivors [82]. HPV, human papillomavirus; PYAC, pediatric, adolescent, and young adult cancer.…”