This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v4.0.0: STU4) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Extended Pediatric Example

In addition to providing examples of mCODE profiles, this extended example demonstrates how to represent a clinically realistic scenario of a pediatric cancer patient.

• When information in the scenario does not map on to mCODE profiles, we provide examples using USCore or standard FHIR resources.
• We condense some repeated patterns. For example, we only show one example of MedicationAdministration when in reality, there could be multiple cycles, the only difference being the day of the administration.

Patient description

Patient Brian L. is a 3 year old non-Hispanic Asian male with a past medical history of an atrial septal defect that was repaired with surgery. His family history includes a grandmother with breast cancer at age 55.

During January 2024, Brian starts to complain of pain in his knees and his parents notice abnormal bruising. His parents take him to the pediatrician, who orders a complete blood count. The test revealed abnormal blood counts: low hemoglobin (6.7 g/dL), low hematocrit (22.3%), and high white blood cells (88.5 10*3/uL). The pediatrician referred the patient to a hospital for further workup. A bone marrow aspiration and biopsy were performed, which showed a predominance of immature cells, indicating leukemia. To further characterize the cancer, immunophenotyping occurred, which identified the leukemia as B-cell acute lymphoblastic leukemia.

After the initial diagnosis, genetic testing was performed (karyotyping), revealing a chromosomal translocation between chromosomes 12 and 21. To understand if the cancer spread to the brain or spinal cord, a lumbar puncture was performed, revealing negative results.

Treatment options were discussed between the patient's family and the medical oncologist. With a Lansky Play Performance status of 80, the family agreed to receive a 28-day treatment regimen of cyclophosphamide (750 mg/m² IV once per day on days 1 & 8), idarubicin (9 mg/m² IV once per day on days 1, 2, 3, 8), vincristine (2 mg IV once per day on days 1, 8, 15, 22), and prednisone (60 mg/m²/day IV or PO on days 1 to 7, 15 to 21). The medication dosage is normalized based on Brian's body surface area of 0.59 m². After four weeks, a repeat bone marrow aspiration and blood count was performed, showing no evidence of persistent leukemia and normal blood counts. Due to the improved cancer disease status, age, test results, and type of leukemia, Brian was designated as standard risk and then began consolidation therapy.

FHIR instances from mCODE elements

FHIR instances from non-mCODE elements