State-of-the-art therapy for childhood cancer requires access to highly coordinated delivery of care and a multidisciplinary approach of specialized pediatric cancer programs. The experience of specialists at cancer centers and their access to therapeutic protocols enables state- of-the-art treatments to be tailored to the needs of pediatric patients, and such treatment has been shown to improve patient results. Prior studies have indicated that when pediatric patients are treated outside of this specialized care setting, there are qualitative differences in their care and outcome. Data from the State of Florida indicate that 19% of children with cancer are never seen at a cancer center, despite the efforts of the three university-based pediatric cancer programs (and two affiliated programs) and the Florida Pediatric CCOP, which extend state- of-the-art therapies to seven community hospitals in Florida. To reduce morbidity and mortality due to pediatric cancer, further interventions based on cancer control research studies in community oncology must be designed and utilized to impact this population and enhance the utilization of existing cancer expertise.
The specific aim of the proposed study is to identify the factors that affect the decision by the community physician and patient/parent of where to seek care for a child with cancer, whether at a pediatric cancer center (PCC) or a non-cancer center (NCC), and to design interventions to impact on this decision. Children will be classified by whether they were treated at a PCC (control) or not (case). These data will be analyzed as a nested case-control study to allow formulation of hypotheses that might directly lead to community oncology interventions and to improving such as the application of patient management and continuing care research advances into community settings, which is the long range goal of this research. This study has particular strength in that the proposed Study Center has extensive experience in conducting multi-institutional studies, and maintains close affiliations with both of the Florida cancer registries. Through access to the registries, the Study Center tracks approximately 400 patients newly diagnosed each year with pediatric cancers and monitors transfers and referrals from non-pediatric cancer programs so that children with cancer can be characterized as receiving care at a pediatric cancer center (PCC) or not (NCC). By conducting this study, appropriate interventions can be targeted directly to treating physicians and patients/parents so that state-of-the-art cancer care can be made available to all children with cancer in Florida.