Improving Care for Children With Cancer in Low- and Middle-Income Countries--a SIOP PODC Initiative

The Paediatric Oncology in Developing Countries (PODC) committee of International Society of Paediatric Oncology (SIOP) has 10 working groups that provide a forum for individuals to engage, network, and implement improvements in the care of children with cancer in low- and middle-income countries. The development of adapted guidelines (medulloblastoma, retinoblastoma, Wilms tumor, neuroblastoma, retinoblastoma, Burkitt lymphoma, supportive care), advocacy and awareness (on hospital detention and essential drugs), education and training, and global mapping (nutritional practice, abandonment rates, and twinning collaborations) have been the initial areas of focus, and the impact of some of these activities is evident, for example, in the SIOP Africa PODC Collaborative Wilms tumor project.

Pediatric oncology services in Nepal

Cancer in children is one of the emerging noncommunicable diseases in Nepal with significant morbidity and mortality. Significant efforts are being made at the government and nongovernment level to provide awareness, early diagnosis, and effective treatment to improve the cure rate of children with cancer. The major challenges include: lack of education, late diagnosis, advanced disease at presentation, financial problems, geographical and transportation difficulties, and inconsistent supply of chemotherapy medicines.

Subsequent publication rate of studies from India presented at the annual congresses of SIOP

Subsequent publication as a complete manuscript is a desirable end-point for studies presented at scientific meetings. Between 2001 and 2005, 191 studies from India were presented at annual congresses of the International Society of Paediatric Oncology. Of these 24 (12.6%) were published with a median time to publication of 20 months. This subsequent publication rate is lower than previous reports of SPR for either paediatric or oncological meetings. A lower proportion of oral presentations and randomised clinical trials (RCTs) could partly explain our findings. Further research is needed to understand barriers to subsequent publication of presented data from India.

Understanding refusal and abandonment in the treatment of childhood cancer

Treatment refusal and abandonment is the principal cause of therapy failure in children with cancer in the developing world. A complex interplay of biological, socio-economic and treatment-related factors underlies this problem. Interventions are likely to succeed when they try and address all of these issues simultaneously, as exemplified by the success of twinning programs linking resource-rich and resource-limited countries. Hitherto, there has been no systematic attempt to understand and address this problem in India. Based on the knowledge gained from research in other parts of the developing world, we offer suggestions for dealing with this problem.

Geographical and temporal distribution of cancer survival in teenagers and young adults in England

Background:

Between 1979 and 2001, an analysis of cancer survival in young people in England, aged 13 to 24 years, showed overall improvements. However, for some diagnostic groups, little or no increases were observed. The aim of this study was to analyse the regional distribution of cancer survival in teenagers and young adults in England in order to identify patterns and potential for improvements at a regional scale.

Methods:

We examined geographical and temporal patterns in relative survival in cancer patients aged 13–24 years in England during the time period 1979–2001. Cancer cases were grouped according to an internationally recognised morphology-based diagnostic scheme.

Results:

For most diagnostic groups, there was little variation in survival between regions, except for testicular germ cell tumours (P=0.006) and colorectal carcinoma (P=0.002). For certain diagnostic groups, the temporal pattern in survival differed between regions. However, in regions that showed poor survival during the early part of the study period, greatest improvements were observed in groups such as acute lymphoid leukaemia, acute myeloid leukaemia, testicular tumours and melanoma.

Conclusion:

In conclusion, there was a reduction in the differences in survival between regions during the study period.

Chronic eosinophilic leukemia with a unique translocation

We report a case of chronic eosinophilic leukemia in a 9 year old girl who presented with anemia, thrombocytopenia, leucocytosis (mostly dysplastic eosinophils), lymphadenopathy and hepatosplenomegaly. There was no increase in blasts but myelofibrosis was seen in the bone marrow. A previously unreported translocation 46,XX,t(1;4)(q24;q35), was found on cytogenetic analysis and involvement of the myocardium was also present. Shortly after commencing steroids, the family abandoned therapy.

The problem of treatment abandonment in children from developing countries with cancer

BACKGROUND

There is an inequality gap between the outcome of childhood cancer in resource, rich and limited countries. Abandonment of treatment is one of the reasons for this.

PROCEDURE

We searched the medical literature for evidence on abandonment, its causes, and any preventative interventions.

RESULTS

Abandonment is a very real problem all across the developing world. Cancers associated with poorer prognosis seem to have higher abandonment rates. It is also related to the socio-economic and educational status of parents, travel time to treatment centers, and affordable, locally available treatment.

CONCLUSIONS

Twinning between institutions, which includes several preventative interventions, has clearly been shown to work.

Enzyme replacement therapy in 12 patients with MPS I-H/S with homozygous p.Leu490Pro mutation

We describe a cohort of 14 Hurler-Scheie patients homozygous for the p.Leu490Pro missense mutation in the alpha-L-iduronidase gene. Now based in the UK, they are all of Pakistani/Kashmiri descent; 64% were female; 11/14 (79%) had a sibling or cousin with MPS I and the parents are consanguineous in all cases. The median age at diagnosis was 1.8 years (range from antenatal diagnosis to 16.5 years). Twelve were on ERT with recombinant human alpha-L-iduronidase (IDUA; Laronidase, Genzyme) for a median duration of 22.5 months (range 2-71 months) and median age at commencement of ERT was 8.6 years (range 0.4-23.1 years). There was clear improvement in the size of liver and spleen as well as reduction in urine glycosaminoglycans (GAGs). The mean (range) urine GAG levels in mg/mmol creatinine were 63.4 (28.9-105.6), 28.3 (10.9-41.4), 22.8 (12.1-43.1), 15.7 (9.2-24.8) and 16.3 (10.1-21.0) at commencement, 3 months post ERT, 6 months post ERT, 12 months post ERT and 24 months post ERT, respectively. Effects on growth were not clear as there does not seem to be an obvious trend of increase or decrease in height after commencement of ERT and this seems to be the case regardless of the age at which ERT was started.

Tolbutamide loading in the initial therapy of diabetes mellitus

A controlled study has been made comparing a loading dose schedule of tolbutamide with a maintenance dose schedule in the initial therapy of fourteen patients with maturity-onset diabetes mellitus. No advantage of one dose schedule over another was found. Since hypoglycemia may occur when large doses of tolbutamide are used, these results provide supporting evidence for those who recommend use of low doses of this drug in the initial therapy of patients with diabetes mellitus.