Nick Cost, MD, New Lead of COG’s Renal Tumor Committee

When you're the best at what you do, how do you leverage your expertise to help those you don't directly care for?

Nicholas Cost, MD, co-director of the Surgical Oncology Program at Children’s Colorado, is one of the nation’s few physicians who is fellowship trained as both a pediatric urologist and urologic oncologist. He operates on 10 to 12 pediatric renal tumors a year — an impressive amount, considering they’re rare. For context, most pediatric urologists, surgeons and oncologists care for one patient or less with a renal tumor each year.

Physicians who don’t commonly see these cases are exactly who Dr. Cost is hoping to reach as the newly appointed Surgical Discipline Lead of the Children’s Oncology Group’s (COG) Renal Tumor Committee.

Children’s Oncology Group (COG)

Known widely as the world’s largest pediatric cancer research organization, COG works with more than 230 children’s hospitals across North America to lead pediatric cancer studies. It also provides protocol-dictated, clinical guidelines. Dr. Cost isn’t the only Children’s Colorado specialist in a leadership position with COG. Pediatric oncologist Lia Gore, MD, serves as the COG vice chair, helping to oversee the entire operation.

For their part, Dr. Cost and the 13 other surgeons on the Renal Tumor Committee support all of the pediatric urologists, surgeons and oncologists in North America who care for kids with renal tumors. That work has primarily involved educating pediatric urologists and surgeons about COG’s trials: the format, the part a surgeon plays and how to ensure that surgical care remains within study guidelines.

More recently, the committee has worked to expand its role. “We give advice and offer up our experiences on past cases to help surgeons across the continent prepare for and manage these tumors,” says Dr. Cost.

Driving optimal outcomes for patients with renal tumors

For a pediatric urologist, surgeon or oncologist confronted with a renal tumor they’re not used to seeing, education from 14 of the continent’s most experienced pediatric urologists and surgeons can prove extremely valuable.

“Subspecialty expertise and volume in a rare clinical scenario like this drives optimal patient outcomes,” he says. “A protracted lapse in caring for these cases can make it easy to forget critical nuance in patient care and how to effectively interface with the other important disciplines. These are crucial skills that can affect quality of care.”

Equally beneficial is having access to surgeons who’ve operated on some of the most complex and rarest of these rare-type cases. How about a bilateral renal tumor that required a complex bilateral partial nephrectomy to remove and cure the cancer while also preserving kidney function? Or maybe metastatic kidney cancer presenting in adolescence where it was difficult to know whether it was an adult cancer (renal cell carcinoma) or a pediatric kidney cancer (Wilms tumor)?

By regularly underscoring standards of care, sharing knowledge and being easily accessible, Dr. Cost and the committee hope to bolster surgeons’ confidence and, in turn, patients’ outcomes. “I’m extremely fortunate to work at Children’s Colorado where I have the support to focus in a subspecialty area like this,” says Dr. Cost. “Working to grow our Surgical Oncology Program here really set me up to earn this complement position with COG. My ultimate goal is to positively affect as many of these kids as I can, and I’m going to be much more impactful if I can also provide support to patients that I don’t personally have the chance to operate on.”