Clinical Exposure

Our fellowship program offers the kind of clinical exposure that very few others in pediatrics will ever receive. Through a vision to enrich the clinical and medical research innovation for our patients, Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center and the University of Washington Medical Center have partnered to form the Seattle Cancer Care Alliance (SCCA). The combination of vast clinical exposure at Seattle Children’s Hospital, which is consistently ranked among the best children’s hospitals in the country, with the expertise and innovation driven by our collaborative Seattle medical community is unbeatable.

Seattle Children’s Hospital offers multiple specialty services, including a bone tumor clinic, bone marrow transplant services, hematologic and sickle cell disease clinics, a multidisciplinary solid tumor oncology clinic, a brain tumor clinic, surgical oncology care, palliative care and survivorship clinic.  Our comprehensive, multidisciplinary team of pediatric cancer experts treats 250 children newly diagnosed with cancer every year — more than any other institution in the region — and provides follow-up care to more than 3,000 children and adolescents.

Fred Hutchinson Cancer Research Center, through the SCCA, has one of the largest hematopoietic cell transplant centers in the world. Dr. E. Donnall Thomas pioneered bone marrow transplant there and received a Nobel Prize for his groundbreaking work. The Hutchinson Center is also one of only 40 comprehensive cancer centers in the United States, as designated by the National Cancer Institute. As a result of our doctors’ expertise as pioneers in the field:

  • Patient survival rates after hematopoietic cell transplant at the Hutchinson Center/SCCA are outstanding  (the best one-year outcomes in the US)
  • Hematopoietic cell transplants are performed in patients with malignant (including high risk disease) and non-malignant diseases.
  • Novel hematopoietic cell transplant therapies are investigated to improve outcome of our patients
  • SCCA has a unique long-term follow-up program to evaluate issues related to graft versus host disease and long term complications of hematopoietic cell transplant.

UW Medicine owns or operates Harborview Medical Center, University of Washington Medical Center, Northwest Hospital & Medical Center, a network of seven UW Medicine Neighborhood Clinics that provide primary care, the UW School of Medicine, the physician practice UW Physicians and Airlift Northwest. In addition, UW Medicine shares in the ownership and governance of Children’s University Medical Group and Seattle Cancer Care Alliance, a partnership among UW Medicine, Fred Hutchinson Cancer Research Center and Seattle Children’s.  The University of Washington Medical Center is the site of our world-class pediatric radiation oncology center, delivering total body irradiation, external beam radiation and gamma knife therapy to our pediatric oncology patients. A proton beam therapy facility is planned to open within the next year–one of only of handful of such facilities in the country.

The first year is devoted to 12 months of clinical training in pediatric hematology and oncology with exposure to pediatric hematology/oncology, clinical hematopoietic cell transplantation (HCT) and to general clinical research. A combination of patient types and treatment modalities is offered to provide fellows with a solid foundation in pediatric hematology and oncology care.

Core rotations are divided among three sites of practice, as follows:

  1. Seattle Children’s (four months inpatient general hematology/oncology; two months inpatient hematopoietic stem cell transplant; four months ambulatory care general hematology/oncology)
  2. Seattle Cancer Care Alliance (one month ambulatory acute  and long term care of hematopoietic stem cell transplant patients)
  3. University of Washington Medical Center/Seattle Children’s (one month elective with exposure to radiation oncology and laboratory medicine)

The general Hematology/ Oncology Inpatient Service is headed by Dr. Todd Cooper. The Hematopoietic Cell Transplantation service is headed by Dr. Scott Baker.  The general hematology/oncology outpatient service is headed by Dr. Navin Pinto.

General Hematology/Oncology Inpatient Service (four month-long rotations)

This month-long inpatient rotation provides training in the care for pediatric benign hematology and oncology patients, including initial evaluation, treatment, management of disease and/or treatment-related complications and disposition. This inpatient service is located at Seattle Children’s Hospital. The team consists of one attending, one fellow, and three pediatric R-1 or R-2 residents.  In conjunction with the attending, the fellow will plan the evaluation and treatment of patients including protocol enrollment, diagnostic procedures, chemotherapy orders, supportive care and appropriate follow-up at discharge. The daily patient census for each team averages from 18-20 patients. The oncology patients are hospitalized on a multidisciplinary 60-bed oncology ward. The fellow and attending make work rounds every morning with a multi-disciplinary team including pediatric residents, lead oncology pharmacist, oncology nutritionist, RNs and social work. Fellows are trained to be able to discuss diagnosis, complications and prognosis from cancer with our patients and families. The majority of our patients are enrolled onto either consortia-based or investigator initiated clinical trials.  Fellows are trained to understand and discuss these clinical trials with patients and their families. A service consisting of one attending  and one Advanced Practice Nurse runs parallel to the inpatient service, designed to oversee uncomplicated patients admitted to receive chemotherapy only.

Children’s HCT Inpatient Service (three month-long rotations during Year 1 and one month during Year 3)

This month-long inpatient rotation at Seattle Children’s Hospital allows fellows to develop the skills and knowledge required in Hematopoietic Stem Cell transplantation (HCT), including delivery of preparative regimens, management of acute and chronic complications of HCT, diagnosis and treatment of graft-versus host disease and procedure of bone marrow harvest. Primary care for the HCT patients is provided by the pediatric oncology fellows, advanced practice providers (APP), and occasionally visitors from many centers throughout the world who wish to gain clinical training in the area of HCT. The fellow makes patient-centered rounds every morning with the attending physician and APPs. The fellow is intimately involved in the conduct of ongoing clinical research trials dedicated to HCT regimens and associated supportive care. Third year fellows take on a larger role in team leadership, patient management and family communications in preparation for their future faculty-level clinical duties.

Outpatient Hematology/Oncology Service (four month-long rotations)

Two month-long rotations in the ambulatory care facility at Seattle Children’s Hospital provide training in ambulatory care for pediatric benign hematology and oncology patients, including initial evaluation, treatment, management of disease and/or treatment-related complications and disposition. The fellow’s days are structured to allow participation in our general oncology clinic, sub-specialty clinics and consultation service. Throughout the month, the fellow works directly with an attending physician providing care to newly diagnosed children, ongoing chemotherapy and supportive care for patients undergoing therapy for cancer or hematologic disorders. Two months provide focused clinical exposure to hematology and solid/central nervous system tumors, respectively. The fellows participate in multidisciplinary patient management, dedicated educational time, and opportunity to observe and interact with related subspecialists.

A half-day per week (Monday morning) is devoted to formal training in performance of lumbar puncture and bone marrow aspirate and biopsy procedures. The fellow attends weekly sub-specialty multi-disciplinary clinics in bone tumor (Tuesday afternoon), brain tumor (Wednesday afternoon), hematology (Thursday morning and afternoon) and Sickle Cell clinic (Thursday afternoon once monthly). Together with the attending physician, the fellow is responsible for consultation requests from community physicians and in-hospital physicians and reviews these consultations, the majority of these consults are focused on benign hematology and thromboembolic disorders.

SCCA Hematopoietic Stem Cell Transplant Outpatient Service (one month-long rotation)

The ambulatory care facilities for Hematopoietic Stem Cell Transplant (HCT) outpatient patients are located at the SCCA adjacent to the Fred Hutch campus. In 2001 the SCCA was formed to take advantage of the strengths of the local medical institutions — the UW Medical Center, Fred Hutch, and Seattle Children’s. Transplant patients formerly treated at Fred Hutch are now seen under the auspices of the SCCA. Dr. Paul Carpenter heads the pediatric HCT ambulatory care activities at the SCCA. This is a one-month ambulatory care rotation. Fellows will participate in pre-transplant consultations and coordination of transplant regimen. Fellows will develop an understanding of donor identification/selection, preparative regimens, transplantation options including autologous, allogeneic, cord blood and non-myeloablative transplants and prophylaxis and treatment of acute and chronic graft versus host disease. HCT patients are followed pre- and post-transplant for a period of approximately 100 days, after which they are referred back to their referring physician. Fellows will also participate in long-term follow-up clinic to develop knowledge of diagnosis and treatment of chronic graft versus host disease and long-term toxicities of HCT.

Elective

Fellows have a one-month elective block mid-way through year 1 of training.  The clinical responsibilities during this month are flexible to allow timely exposure to pediatric radiation oncology, laboratory medicine, and blood banking. Fellows are also provided with protected time and guidance during this month to investigate options for future research projects and to meet with potential research mentors, including the ability to pursue research within the local biotechnology sector.

Continuity Clinic

All fellows are assigned to a continuity clinic team at the start of fellowship training and attend a half-day clinic each week throughout the 3 years of training. Each continuity clinic is comprised of 2-3 faculty, 3 fellows and a disease-based APP. Fellows follow patients longitudinally through their training to gain exposure to diagnosis, treatment specifics, associated toxicities, transition to survivorship monitoring or treatment for cancer recurrence. The fellows clinic patient panel includes benign hematology, bone marrow failure, and oncology patients.   Fellows participate in a continuity clinic-specific conference weekly that provides an opportunity for patient-based learning, presentation of evidence-based therapy decisions and teaching opportunities for the fellow during years 2 and 3 of training.