St. Jude Global and the International Society of Paediatric Oncology (SIOP) have partnered with several leading global organizations, such as the Paediatic Radiation Oncology Society (PROS), Childhood Cancer International (CCI), and the International Society of Paediatric Surgical Oncology (IPSO) to create resource-stratified, evidence based guidelines to ensure that health care professionals all over the world have the necessary information to safely diagnose, treat and manage childhood and adolescent cancers whenever they practice.
What is the ARIA Guide?
The ARIA (Adapted Resource and Implementation Application) Guide is a web-based clinical decision support tool designed to provide resource-stratified childhood cancer treatment guidance. Developed through global collaboration, the ARIA Guide helps clinicians tailor treatment strategies based on available resources, improving outcomes for children with cancer, particularly in lower-resourced settings while also providing guidance for higher-resourced settings.
The WHO Global Initiative for Childhood Cancer (GICC) aims to raise the survival rate for children with cancer to 60% by 2030. Meeting this goal requires the development of adaptable treatment guidelines that can be applied globally, regardless of local resources. The ARIA initiative is a direct response to this global call for action, offering comprehensive guidance that adapts to varying healthcare settings.
Key Components of the ARIA Guide
ARIA Guide: Web-Based Clinical Decision Aid
The ARIA Guide is a web-based platform that provides clinicians with access to resource-stratified clinical treatment and management guidance. Developed by St. Jude and supported by SIOP and our partners, this tool is designed for easy use in healthcare settings of all resource levels.
ARIA Guide Adapted Management Guidelines (AMGs)
ARIA Guide AMGs are comprehensive, resource-stratified guidance documents designed to assist clinicians in decision-making. While they provide detailed guidance for treating specific cancers, ARIA Guide AMGs are not rigid protocols but flexible guidelines that can be tailored to individual patient needs and available local resources.
Key Features:
Based on evidence and expert consensus.
Adaptable to local healthcare settings.
Periodically updated based on new research.
The first ARIA Guide AMG fully available is the ARIA Guide Hodgkin Lymphoma Adapted Management Guideline, is now available!
How the ARIA Guide Works
The ARIA Guide adapted management guidelines are developed through a systematic process led by disease-specific working groups. By combining expert opinion, literature review, and stakeholder input, these guidelines provide practical, real-world solutions that improve paediatric cancer treatment in any healthcare environment.
The ARIA Guide methodology process:
The ARIA Guide Team
The ARIA Guide is a collaborative effort between leading global organisations in paediatric oncology, including:
- International Society of Paediatric Oncology (SIOP)
- St. Jude Global (as part of St. Jude Children’s Research Hospital)
- International Society of Paediatric Surgical Oncology (IPSO)
- Paediatric Radiation Oncology Society (PROS)
- Childhood Cancer International (CCI)
Together, these organisations are developing resource-adapted guidelines for use worldwide, ensuring that clinicians everywhere have the tools they need to provide the best care possible, no matter the circumstances.
SIOP’s Role Within the ARIA Guide
ARIA Guide Governance Coordinator
Ira Dunkel
I assist Dr. Jeannette Parkes (ARIA steering committee chair), Dr. Victor Santana (ARIA governance coordinator), and the ARIA team in setting agendas, orienting new members, and ensuring adherence to the charter. I also provide Dr. Chantada (SIOP President) with regular updates, focusing on any impact to SIOP.
ARIA Guide Co-Director
Michael Sullivan
As an ARIA Guide Co-Director and SIOP representative for this global mission, I serve as one of the main points of contact for the ARIA Guide. It is exciting to participate in key meetings, shape the guideline development work, answer vital questions, and share the progress to our global supporters.
ARIA Guide Core Steering Committee Member
Laila Hessissen
I advise and offer recommendations to the ARIA Guide Co-Directors on matters related to the strategy, implementation, and success of the ARIA Guide global initiative. It is an honor to witness the steady progress of this global work to assist all healthcare professionals who provide care to children with cancer.
How to Get Involved
Whether you’re a clinician, researcher, or advocate, you can help improve access to paediatric cancer care worldwide by using the ARIA Guide, contributing feedback, or joining SIOP’s efforts to expand its reach. Learn how you can support the global initiative to meet the WHO’s 2030 survival goal.
Frequently Asked Questions
General
The ARIA Guide AMGs and the ARIA Guide CPRs both aim to provide comprehensive guidance adapted to the resources of providers serving children with cancer, no matter where they live. The ARIA Guide AMGs are disease-specific guidelines, whereas the ARIA Guide CPRs provide unified recommendations to manage problems in supportive care, palliative care, and survivorship which are shared across multiple disease types. Both sets of guidance documents aim to support locations with limited workforce capacity and/or variability in local resources by informing decision making for individual patients and are updated periodically. The ARIA Guide AMGs and the ARIA Guide CPRs may be found on the Library page of the ARIA Guide web portal.
The ARIA Guide web portal is a web- and mobile-based clinical decision aid tool and platform to disseminate global guidance for the management of children with cancer. Contents include the ARIA Guide AMGs and the ARIA Guide CPRs. Most of the content on the web portal may be accessed online or offline.
The ARIA Guide web portal includes a space which stores each of the full-length ARIA Guide AMGs and the ARIA Guide CPRs. They may be downloaded for offline use.
Over the past decade, several organizations have worked hard to create important guidance documents to support treatment decision-making and clinical recommendations for a select number of childhood cancer tumor types. However, many were not originally planned to guide detailed and specific clinical decision-making guidance for individual patients. Vital information such as work-up recommendations, dose modifications due to toxicities, alternate regimens during drug shortages, and/or response evaluations were omitted. These aspects of care are needed and particularly important when trainees and/or general pediatricians without formal pediatric oncology training are tasked with delivering care for children with cancer.
To support clinicians working at centers worldwide with limited workforce capacity and/or limitations in local resource available, St. Jude, SIOP and several additional key global partner organizations continue to collaborate daily in order to develop the ARIA Guide AMGs and the ARIA Guide CPRs that build on previous efforts to effectively support comprehensive care for all children with cancer.
- Jude Global (a department of St. Jude Children’s Research Hospital)
https://global.stjude.org/
- Société Internationale d’Oncologie Pédiatrique/International Society of Paediatric Oncology (SIOP)
https://siop-online.org/
- Paediatric Radiation Oncology Society (PROS)
https://intpros.org/
- International Society of Paediatric Surgical Oncology (IPSO)
https://ipso-online.org/
- Childhood Cancer International (CCI)
https://www.childhoodcancerinternational.org/
The use of the ARIA Guide web portal, the ARIA Guide AMGs and/or the ARIA Guide CPRs is not restricted to institutions or individuals who have an established relationship with any of the global collaborators. These resources are freely available to all centers and healthcare professionals worldwide.
The ARIA Guide Adapted Management Guidelines (AMGs)
A stratum is defined in two places: 1) within each ARIA Guide AMG document stored in the Library space and 2) on each disease-specific Treatment page of the ARIA Guide web portal. Each stratum will outline the specific resources recommended and needed to properly and effectively diagnose and care for a patient with a specific childhood cancer type. These strata are defined by the minimal and maximum resources available, providing healthcare professionals the flexibility to treat and care for pediatric patients in any practice and resource setting.
In the ARIA Guide AMGs and on the ARIA Guide web portal, strata are defined based on the availability of diagnostic and treatment resources needed to implement a specific management bundle. Each management bundle in a specific stratum is comprised of an adapted treatment regimen according to stage/risk stratification and tumor response at certain timepoints of the treatment.
The ARIA Guide AMGs include information for multidisciplinary childhood cancer care team members including pediatric hematologists/oncologists, surgeons, radiation oncologists, palliative care specialists, pathologists, nurses, trainees at any level, etc.
Keeping in mind that children with advanced disease may not survive high-dose intensity treatment but may live longer, more dignified lives if given low-dose treatment, it is necessary to incorporate resource-adapted upfront palliation within treatment guidelines. Accordingly, the ARIA Guide AMGs incorporate recommendations for metronomic chemotherapy and/or symptom management based on resource strata and tumor stage/risk. All recommendations are based on best available data and/or consensus among a global panel of experts and patients/families with lived experiences.
The ARIA Guide Web Portal
All healthcare providers, with and without formal pediatric oncology training, who are tasked with delivering care for children with cancer. This is inclusive of allied healthcare trainees at any level.
Each stratum (defined by the relevant local resources available) may be determined by the specific center location where the ARIA Guide web portal registered user practices oncology care (within the Account Settings page). However, the ARIA Guide web portal is fully flexible for each registered user to select, and adjust, a stratum in real-time and on-demand on each disease-specific Treatment page.
The ARIA Guide web portal provides the capabilities to download .pdf versions of the ARIA Guide Adapted Management Guidelines (AMGs) and ARIA Guide Clinical Practice Recommendations (CPRs) from the L page. The ARIA Guide web portal may be accessed from any device (mobile phone, tablet, computer) with an internet connection. After a user connects for the first time, key information from the web portal is automatically cached on the device allowing for offline use. It is important, however, that users periodically reconnect offline devices to ensure updates from the portal are downloaded to devices.
The ARIA Guide web portal does not collect and/or store patient data in any form. The ARIA Guide web portal is a clinical decision tool designed to support the use of the ARIA Guide AMGs and/or the ARIA Guide CPRs to provide real-time, resource adapted care.
To discuss how to partner to monitor and track patient outcomes using other tools such as the SJCARES Hospital-Based Cancer Registry, please contact us at: support@ARIAguide.org.
