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Updated: Jan 13, 2026

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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A Quality Improvement Initiative to Standardize Pneumocystis jirovecii Pneumonia Prophylaxis in Pediatric Patients

Kriti Kumar1,2, Denise M Connolly1,2, Ellen Kellington1

  • 1Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Pediatric Blood & Cancer
|January 6, 2026
PubMed

Insights

Implementing a quality improvement initiative successfully standardized Pneumocystis pneumonia (PJP) prophylaxis in pediatric cancer patients. This approach ensured 100% prophylaxis initiation without toxicity or treatment delays.

Area of Science:

  • Pediatric Oncology
  • Infectious Disease Prevention
  • Quality Improvement in Healthcare

Background:

  • Pediatric patients with solid tumors (ST) undergoing chemotherapy face a heightened risk of Pneumocystis pneumonia (PJP).
  • Limited evidence exists to guide PJP prophylaxis practices in this vulnerable population.
  • A PJP-related fatality prompted a quality improvement initiative to standardize prophylaxis.

Purpose of the Study:

  • To increase PJP prophylaxis initiation rates in pediatric patients with newly diagnosed extracranial ST to over 90%.
  • To achieve this without causing chemotherapy delays or significant prophylaxis-related toxicity.
  • To standardize PJP prophylaxis through a quality improvement initiative.

Main Methods:

  • A quality improvement initiative utilized the Model for Improvement with Plan-Do-Study-Act cycles.
  • Interventions included stakeholder engagement, education, and EHR-integrated prescriptions.
  • Kotter's 8-Step Change Model guided planning and implementation over six months.

Main Results:

  • PJP prophylaxis initiation reached 100% (20/20 eligible patients), an 88.7% relative improvement.
  • This contrasts with a historical cohort's initiation rate of 53% (16/30).
  • No chemotherapy delays or prophylaxis discontinuations due to toxicity were reported.

Conclusions:

  • A universal PJP prophylaxis approach is safe and effective for pediatric ST patients.
  • The initiative demonstrated successful implementation of quality improvement in pediatric oncology.
  • Change management models can effectively support QI initiatives in this setting.
Abstract

Keywords:
PJPpediatricpneumocystisprophylaxissolidtumor

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