Pediatric (Oncology)

For over 50 years, the Complex Pediatric Structure has been dedicated to the care of children, adolescents, and young adults with solid pediatric tumors. Each year, over 200 new patients receive diagnosis and treatment. At least 75% of these patients participate in international, national, or institutional clinical protocols. 

INT is the only oncological institution in Italy with a Pediatric Oncology unit that follows the study and work methodology typical of oncology while integrating the general medical-surgical expertise of pediatrics. Our Pediatric Oncology unit differs from other pediatric cancer care facilities in Italy, which originate from general pediatric settings, by having a stronger oncological background. 

For a comprehensive patient care approach, clinical activities rely on a multidisciplinary team specialized in pediatric oncology, including radiologists, pathologists, surgeons, radiotherapists, nuclear medicine specialists, endocrinologists, neurologists, clinical psychologists, and pre-clinical biologists. More recently, the team has been expanded to include a pediatric dentist, ophthalmologist, orthoptist, ENT specialists, audiologists, and pediatric rehabilitation therapists. 

Clinical activity is divided between the Inpatient Unit and the Outpatient Clinic/Day Hospital, where all medical staff rotate monthly. Our daily work is based on active communication among all pediatricians, ensuring that each patient's progress is discussed, regardless of direct physician-patient familiarity or individual research interests. 

Upon a patient's first visit, parents/guardians receive an informational consultation with the designated on-call physician, who oversees weekly activities. This physician is supported by a specialist for the specific pathology, who remains available for follow-up discussions, particularly regarding treatment strategies, monitoring schedules, and second-line therapies in case of relapse. 

Clinical activities are supported by a staff that includes social workers, teachers (kindergarten, primary, and secondary), educators, entertainers, and volunteers. These ancillary services take place in dedicated areas near the inpatient and outpatient/Day Hospital spaces. 

• The Structure Includes: 
• Inpatient Unit: 14 rooms with 23 beds/cribs, plus an additional bed for accompanying family members. Four single rooms are designated for autologous hematopoietic stem cell transplants (30-40 per year). 
• Day Hospital: 6 beds dedicated to chemotherapy administration, invasive diagnostic procedures, supportive therapy, and emergencies. Open from 8 AM to 6 PM. 

The Day Hospital - Outpatient Clinic handles an average of 20,000 procedures per year. The same medical team alternates between the Inpatient Unit and the Day Hospital. 

The Day Hospital - Outpatient Clinic operates through different access types: 

• First visits for new diagnoses 
• Various outpatient consultations 
• Short chemotherapy sessions 
• Blood test evaluations for monitoring bone marrow toxicity 
• Emergency visits for treatment-related complications (functioning almost like an emergency room from morning until mid-afternoon) 
• Pain management 
• Follow-up visits for patients who have completed therapy 

Day Hospital services include: 

• Extended infusion chemotherapy 
• Procedures under anesthesia (lumbar punctures, bone marrow aspirations, radiation treatments) 
• Rehabilitation 
• Supportive therapies 

Additionally, there is a dedicated weekly pediatric dental clinic funded by grants (for prevention and treatments) and a bimonthly audiology clinic. 

• Adolescent Care 

Significant efforts are made to minimize hospitalization and disruption for adolescent patients. Infusion chemotherapy, which is often administered on an inpatient basis in other centers, is provided in the Day Hospital. Afternoon therapy sessions are scheduled to allow school attendance. Adolescents can also participate in events organized by the Young Project (Progetto Giovani). 

• Sport Project  

To promote physical activity in patients, gym areas are available on the in-patients floor and in the outpatient clinic, where kinesiologists design adapted training programs in coordination with the treating physicians. Among the objectives is to encourage exercise during and after cancer treatments, particularly for patients for whom, due to the presence of disabilities, physical exercise is recommended but also more challenging to implement. 

• Survivors' Clinic 

Pediatric cancer survivors may experience long-term effects from treatments. These sequelae vary in severity and onset based on multiple factors. Long-term follow-up helps patients manage these issues while also advancing scientific knowledge. 

This afternoon clinic is dedicated to survivors to facilitate their transition from pediatric care to general hospitals and primary care providers. It provides a space specifically for recovered patients, separate from children and adolescents still in active treatment. 

A pediatric oncologist leads the Survivors' Clinic, supported by INT specialists, including: 

• Endocrinologists for neuro-endocrinological complications 
• Cardiologists and pulmonologists for chemo- and radiation-induced cardiopulmonary effects 
• Physiatrists for neuro-rehabilitative and prosthetic needs 
• Neurologists and psychologists for neurocognitive and emotional challenges 
• Surgeons, onco-hematologists, and radiotherapists for secondary cancer management 
• Ophthalmologists, ENT specialists, and plastic surgeons for aesthetic issues related to previous treatments 
• Kinesiologists for pediatric rehabilitation 

For unmet expertise within INT or specific research needs, collaborations exist with: 

• Fondazione IRCCS Policlinico Ca’ Granda (pediatric nephrology, fertility preservation) 
• Fondazione E. Medea (neuro-rehabilitation) 
• Five neurosurgical centers in Milan and Lombardy 
• ASST Istituto Ortopedico G. Pini (oncologic orthopedics) 

Survivors often face work-related challenges, addressed through collaboration with social workers and psychologists.