Why I became a paediatric oncologist – with a focus on supportive care

Leonie Naeije is a Dutch paediatric oncologist, trained in Vancouver, Canada and currently working as a fellow in Auckland, New Zealand. She is currently working on a systematic review for fungal infections, a clinical trial in vitamin D deficiency and updating and designing national guidelines in the field of supportive care.

On the first day back after maternity leave, I was asked to work on the paediatric oncology ward. I was relieved to be sent there, I was half-way through my paediatrics training and knew this department very well. Suddenly I was asked to go to one of the patients, Emily*, 16 years old. Diagnosed with AML and admitted with neutropenic fever after her last round of chemo. She had spiked the day before, no source identified, was on broad spectrum antibiotics. During rounds a few moments before were no major concerns raised. Acutely however, she was in a septic shock. I had met her for the first time a few hours ago, but she held my hand and did not let go. I cannot remember if a parent was present. I kept talking to her and giving instructions to the nurses to give more fluids, to ring PICU and to add antibiotics.

Then everything around me went silence, because she pulled me close, looked me into the eyes and asked if she was going to die. I told her “No, not today”. PICU came and took her, and I had to let go of her. She had a line sepsis and after line removal and antibiotics she recovered from this infectious episode. She was afraid to die, not because of AML, but because of bacteremia. This piqued my interest.

A few years later as an oncology fellow, I met a family with a preteen who had a non-malignant disease, aplastic anaemia.
Hopefully one course of immunosuppressive therapy would cure him. Unfortunately, this did not go according to plan; the toxicities of the treatment were horrendous. His work of breathing increased slowly over time and on imaging of his chest a widespread infection was found, including his heart and both of the lungs. Surgery followed the same night and I spoke with the parents on the PICU. It was unsure if he would make it through the night. It was unsure he could recover from this massive infection. It was a Mucor infection, a potential lethal fungal infection. Hereafter, more toxicities occurred, including nephrotoxicity and chronic pain. This resulted in a depression. In the end, his primary diagnosis became irrelevant and the complications took over his medical care. 

The overall survival rate of our patients has increased in the past years, however the morbidity related to the toxicities of the treatment are still very high. Especially in haemato-oncology and stem cell transplant patients. Dealing with the diagnosis of cancer is a major thing on its own, dealing with the side effects of treatment or all the other possible complications that can occur, takes it to another level. For me, to guide patients and family through all of this, is a privilege. 
Treatment related morbidity is the drive for me as a clinical researcher. I focus on haemato-oncology and supportive care; to increase the quality of life, to decrease the complications and through this increase the overall survival even more.

*Name has been changed