Cancer Care

Childhood cancers are rare tumors: the current organization and the projects are therefore not specific to the University Hospital Group (GHU) sites but are integrated into regional (RIFHOP, CANPEDIF…), national (SFCE and its specific working groups: GCPOT committee, leukemia committee, lymphoma committee, RELYE, Childhood Lymphoma Network, HSCT committee, etc) and international dynamics (EICNHL, ITCC, SIOP, IBFM, EBMT…). The GHU AP-HP Nord is involved at each level of organization.

Our whole University Hospital is dedicated to pediatrics, in a 5 million inhabitant territory, composed of a large hemato-cancerology department with bone marrow transplantation, pediatric intensive care, surgery and radiology departments as well as other pediatric medicine departments, along with a dedicated pediatric clinical research unit.

 

The care of children and adolescents with cancer and hematological malignancies within the GHU Nord is organized over three departments across two sites that have close and permanent interactions:

• Pediatric Hematology and Immunology (Robert Debré Hospital): 42 beds + 12 day hospital places per day + consultations
• Onco-Pediatric Surgery (Robert Debré Hospital): 12 beds + 8 day hospital places per day + 5 intensive care beds + consultations
• Pediatrics (Louis Mourier Hospital): 16 beds + 6 day hospital places per day + 4 intensive care beds + consultations

 

For leukemia/lymphoma patients, the whole clinical care pathway takes place in the regional Great Paris Pediatric cancer network “RIFHOP”, integrating the expertise and skills from three university hospitals (Robert Debré, Armand Trousseau and Saint Louis Hospitals; all belonging to the AP-HP consortium), Gustave Roussy Cancer Center and Curie Cancer Center. Such integration allows the young patient to follow its chemotherapy in both Robert Debré Hospital and the closest local hospital affiliated to the RIFHOP network, depending on the type of chemotherapy. Moreover, the RIFHOP nurse coordinator may organize home visits. When the child and his family live in the territory covered by the Home Hospitalization (HH) of the AP-HP organization (Hospitalisation à Domicile), part of the care is delegated to the HH, which is a stakeholder of the RIFHOP. When the child is from overseas, the care is continued in one of the RIFHOP’s follow-up care and rehabilitation centers (SSR), Pediatric Red-Cross Hospital of Margency Children’s Hospital, Bullion Center, FSEF Center. The various stages of the treatment’s efficacy assessment are systematically carried out within the hematology and immunology department of Robert Debré Hospital. Decisions to initiate, continue or change the protocol are taken after discussion at the local and/or regional multidisciplinary tumor board (MTB) meetings.

 

For patients with solid tumors, only the surgery treatments are delivered in Robert Debré Hospital. Patients are referred by other centers depending on the location, through the surgical emergency unit or consultations. The Pediatric Oncology Department of the Curie Cancer Institute can also directly entrust Robert Debré Hospital’s teams to perform specialized surgical treatments before or after neoadjuvant medical treatments administered at Curie, which monitors the coordination of the patients’ pathway with Robert Debré surgical teams.

The interregional pediatric organization for pediatric hematology-oncology referrals of the Great Paris area, named CANPEDIF and labeled by INCa, has been progressively implemented since September 2011. CANPEDIF allows for the exhaustive identification of new cancer patients under 18 years old, the identification of management channels, the contribution to clinical research and also the participation in training.

Due to the large number of patients of CANPEDIF area (2,200 cases presented annually), 7 pediatric MTB meetings have been created:

– Brain tumors: weekly

– Lymphoma: monthly

– Musculoskeletal system: monthly

– Leukemia/allograft: bi-monthly

– Thorax/abdomen: bi-monthly

– Head and neck: monthly

– New drugs: bi-monthly

 

Cases are presented systematically at diagnosis and then further discussed if questions arise during treatment or at relapse. These meetings are most often held remotely thanks to the use of common secure computerized tools for the management of MTB (ARKDos), the transmission of images (ETIAM) and web conferencing (Zoom) of audio and web conferences.