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Viewpoint: How we’re keeping children’s cancer trials going

by Tracey Crowe | Research Feature

29 September 2020

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Lead nurse Tracey Crowe and her team at the Royal Marsden Hospital continued to care for children with cancer in clinical trials during the COVID-19 pandemic. Tracey highlights the importance of effective communication across health teams and restarting patient recruitment as she looks to the future of paediatric cancer research. 

Taking a moment to reflect has made me appreciate the enormity of what we had to deal with in the early days of the lockdown. Around that time, hospitals had to temporarily halt recruitment to all clinical trials for both adults and children. I understand why this decision had to be made. In the weeks that followed lockdown, the NHS needed to quickly adjust to increased levels of staff absence and reduce the risk of transmission of this then unknown virus among our patients and their families. 

These were challenging times for our patient group, who often travel a long distance to the Royal Marsden’s Centre for Children and Young People for treatment. Fear of the unknown was infectious, but regular contact and constant reassurance of the continuation of our service, albeit with slight changes, ensured that the families continued to receive the best care possible. We found different ways of working to reduce footfall into the hospital where appropriate and helped our trial patients to continue their treatment safely and in line with the trial protocol by supporting them closer to their homes.

In paediatric research, having strong links between referring tertiary clinicians and the patient’s local shared care hospital in real time is key to safe, effective patient care. The pandemic further highlighted the importance of good communication across the whole team caring for a child with cancer – from their local GP, to their shared care centre, to their primary treatment centre.  

The pandemic further highlighted the importance of good communication across the whole team caring for a child with cancer.

During the peak of the pandemic we took pragmatic steps to minimise disruption to our trial patient group still receiving treatment, converting some scheduled Royal Marsden Hospital visits to a local hospital review that included a telephone consultation with our team. With clear instructions aided by our trial-specific worksheet and good communication with the local team, child, and family, this model of collaboration could improve recruitment if incorporated into future trial designs. 

Fortunately, the halt to recruitment to clinical trials at our hospital was reversed fairly quickly and our team at the Oak Paediatric and Adolescent Drug Development Unit worked tirelessly to ensure we got back on track safely. A key focus for the team was to ensure we restarted the collection of valuable tissue samples for research, including for the Stratified Medicine Paediatric (SMPaeds) programme. SMPaeds enables a panel of experts to allocate children with cancer to early phase trials based on molecular targets alongside their knowledge of the disease.

Improving referrals for early phase trials is a key objective for the coming months. Its success will rely on our ability to show referring consultants and trial sponsors how effectively we cared for our patients during the peak of the pandemic.

Improving referrals for early phase trials is a key objective for the coming months.

I am acutely aware of the uncertainty surrounding the impact of a second wave of COVID-19 in the coming months, but I also know we have learnt so much and developed effective strategies to keep our patients safe whilst visiting our hospital. Recruitment to clinical trials – particularly in paediatric oncology – should continue. However, the research team should take into account the nature of the product under investigation, the ability to conduct appropriate safety monitoring and the nature of the disease under study before making recruitment decisions.

 

 
Correction 13 October 2020: The initial version of the article incorrectly stated that the National Institute for Health Research was responsible for the decision to temporarily halt recruitment to all clinical trials. The article has been corrected to indicate that these decisions were made at a hospital level.
 
About the author: Tracey Crowe


Tracey Crowe is lead nurse for paediatric oncology research at the Oak Paediatric and Adolescent Drug Development Unit at the Royal Marsden Hospital and a member of the steering committee of the Experimental Cancer Medicine Centres (ECMC) research nurse network. The ECMC paediatric network brings together clinicians and translational scientists to run early phase clinical trials in children and young people with cancer across 11 centres in the UK. This year, Tracey celebrates 25 years in nursing and 15 years of work in drug development at the Royal Marsden Hospital.