101
|
Ceppi F, Beck-Popovic M, Bourquin JP, Renella R. Opportunities and challenges in the immunological therapy of pediatric malignancy: a concise snapshot. Eur J Pediatr 2017; 176:1163-1172. [PMID: 28803259 DOI: 10.1007/s00431-017-2982-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 12/18/2022]
Abstract
Over the last 50 years, collaborative clinical trials have reduced the number of children dying from pediatric cancer significantly. Unfortunately, certain tumor types have remained resistant to conventional surgical, radiotherapy and chemotherapy combinations, and relapsing and/or refractory disease remains associated with dismal outcomes. Recently, renewed attention has been given to the role for immunotherapies in pediatric oncology. In fact, these combine several attractive features, including (but possibly not limited to) the specificity for cancer cells, potentially in vivo persistence and longevity, and potency against refractory disease. In this narrative review designed for the academic pediatrician, we will concisely review the biological underpinnings behind the immunological therapy of pediatric neoplasms and illustrate the current humoral, cellular approaches, and novel drugs targeting the immune checkpoint, oncolytic viruses, and tumor vaccines. We will also comment on the future directions, challenges, and open questions faced by the field. What is Known: • Cancer immunotherapy drives immune cells and its humoral weaponry to eliminate tumor cells. • This occurs by recognizing antigens ideally expressed only on tumoral, but not normal/healthy, cells. What is New: • Clinical immunotherapy trials have shown responses in children with relapsing/refractory neoplasms. • Novel humoral/cellular immunotherapies, immune checkpoint inhibitors, oncolytic viruses, and tumor vaccines are currently being investigated in pediatric oncology.
Collapse
Affiliation(s)
- Francesco Ceppi
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Beck-Popovic
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Bourquin
- Leukemia Research Program and Division of Pediatric Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Raffaele Renella
- Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland.
| |
Collapse
|
102
|
Parkin DM, Stefan C. Editorial: Childhood Cancer in sub-Saharan Africa. Ecancermedicalscience 2017; 11:ed69. [PMID: 28798814 PMCID: PMC5533598 DOI: 10.3332/ecancer.2017.ed69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 02/02/2023] Open
Abstract
Measurement of incidence rates of childhood cancer in Africa is difficult. The study 'Cancer of Childhood in sub Saharan Africa' [Stefan C, Bray F, Ferlay J, Parkin DM and Liu B (2017) Cancer of Childhood in sub-Saharan Africaecancer11(755)] brings together results from 16 population-based registries which, as members of the African Cancer Registry Network (AFCRN), have been evaluated as achieving adequate coverage of their target population. The cancers are classified according to the third revision of the International Classification of Childhood Cancer (ICCC-3) and recorded rates in Africa are compared with those in childhood populations in the UK, France, and the USA. It is clear that, in many centres, lack of adequate diagnostic and treatment facilities, leads to under-diagnosis (and enumeration) of leukaemias and brain cancers. However, for several childhood cancers, incidence rates in Africa are higher than those in high income countries. This applies to infection-related cancers such as Kaposi sarcoma, Burkitt lymphoma, Hodgkin lymphoma and hepatocellular carcinoma, and also to two common embryonal cancers-retinoblastoma and nephroblastoma. These (and other) observations are unlikely to be artefact, and are of considerable interest when considering possible aetiological factors, including ethnic differences in risk (and hence genetic/familial antecedents). The data reported are the most extensive so far available on the incidence of cancer in sub Saharan Africa, and clearly indicate the need for more resources to be devoted to cancer registration, especially in the childhood age range, as part of an overall programme to improve the availability of diagnosis and treatment of this group of cancers, many of which have-potentially-an excellent prognosis.
Collapse
Affiliation(s)
- Donald Maxwell Parkin
- African Cancer Registry Network, INCTR, Prama House, 267 Banbury Road, Oxford OX2 7HT, United Kingdom
- CTSU, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Cristina Stefan
- Medical Research Council, PO Box 19070, Tygerberg 7505, Republic of South Africa
| |
Collapse
|
103
|
Rivera-Luna R, Zapata-Tarres M, Shalkow-Klincovstein J, Velasco-Hidalgo L, Olaya-Vargas A, Finkelstein-Mizrahi N, Cárdenas-Cardós R, Aguilar-Ortiz MR. The burden of childhood cancer in Mexico: Implications for low- and middle-income countries. Pediatr Blood Cancer 2017; 64. [PMID: 27905680 DOI: 10.1002/pbc.26366] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/03/2016] [Accepted: 10/28/2016] [Indexed: 12/29/2022]
Abstract
In Mexico, childhood cancer incidence and mortality have increased in the last decade. Through government actions since 2005, the Popular Medical Insurance (PMI) program for childhood cancer was created. The objective of PMI was to offer early cancer diagnosis, standardized treatment regimens, and numerous pediatric oncology residency programs. It has also accredited 55 national hospitals for the care of these children. Current problems still present under the PMI include shortage of pediatric oncologists and nurses and high rate of abandonment of treatment. Our aim is to describe the current scenario of childhood cancer care in Mexico, especially from the perspective of the PMI and how it has impacted human resources, infrastructure, and medical education.
Collapse
Affiliation(s)
- Roberto Rivera-Luna
- Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico.,Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Marta Zapata-Tarres
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Jaime Shalkow-Klincovstein
- Program of the National Council for the Prevention and Treatment of Childhood Cancer, CENSIA, Mexico City, Mexico
| | - Liliana Velasco-Hidalgo
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Alberto Olaya-Vargas
- Bone Marrow Transplant Unit, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Nicole Finkelstein-Mizrahi
- General Direction of Development of Health Services, Office of the Fund for Protection Against Catastrophic Expenses for Childhood Cancer from the Popular Medical Insurance, Mexico City, Mexico
| | - Rocío Cárdenas-Cardós
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Marco R Aguilar-Ortiz
- Department of Pediatric Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| |
Collapse
|
104
|
|
105
|
Rivera-Luna R, Velasco-Hidalgo L, Zapata-Tarrés M, Cárdenas-Cardos R, Aguilar-Ortiz MR. Current outlook of childhood cancer epidemiology in a middle-income country under a public health insurance program. Pediatr Hematol Oncol 2017; 34:43-50. [PMID: 28287336 DOI: 10.1080/08880018.2016.1276236] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Mexico, childhood cancer (0-18 years) is treated in a multidisciplinary way while providing care for more than half of the affected children through a public medical insurance. This insurance is given to all children who do not have any health care coverage in Mexico. This program is offered to the poorest of all Mexicans. All the children with this disease are submitted to pathology diagnosis and treatment according to national treatment protocols from 57 accredited medical institutions. From 2007 to 2015, a total of 24,039 children with cancer have been registered; the male gender predominates by 55%. The highest incidence was in the group aged between 0 and 4 years. Every year, there has been an increment in registration. In 2015, there were 3,433 new patients with an incidence of 150.1/million. In the same year, the incidence for all types of leukemia increased to 89.5/million. But for acute lymphoblastic leukemia, the incidence was found to be 79.8/million, which is extremely high. The mortality rate for all these patients in 2015 was 5.3/100,000. However, with regard to children aged between 15 and 18 years, the mortality rate was 8.5/100,000. Abandonment rate was 10%, and there were nine state institutions that had a mortality rate between 25% and 50% among their patients. Coincidentally, as per the Human Development Index, the parameters for education, health, and income were low for those nine institutions. The purpose of this work is to show the epidemiology and the burden we are facing due to this disease.
Collapse
Affiliation(s)
- Roberto Rivera-Luna
- a Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer/Department of Pediatric Oncology , UNAM/Division of Pediatric Hematology/Oncology, National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Liliana Velasco-Hidalgo
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Marta Zapata-Tarrés
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| | - Rocío Cárdenas-Cardos
- c Department of Pediatric Oncology, UNAM/Department of Oncology , National Institute of Pediatrics (NIP)/Program of the National Council for the Prevention and Treatment of Childhood Cancer , Mexico City , Mexico
| | - Marco R Aguilar-Ortiz
- b Department of Pediatric Oncology , National Institute of Pediatrics (NIP) , Mexico City , Mexico
| |
Collapse
|
106
|
Jaime-Pérez JC, Jiménez-Castillo RA, Herrera-Garza JL, Gutiérrez-Aguirre H, Marfil-Rivera LJ, Gómez-Almaguer D. Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:60-68. [DOI: 10.1016/j.clml.2016.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 11/27/2022]
|
107
|
Rees CA, Keating EM, Lukolyo H, Danysh HE, Scheurer ME, Mehta PS, Lubega J, Slone JS. Mapping the Epidemiology of Kaposi Sarcoma and Non-Hodgkin Lymphoma Among Children in Sub-Saharan Africa: A Review. Pediatr Blood Cancer 2016; 63:1325-31. [PMID: 27082516 PMCID: PMC7340190 DOI: 10.1002/pbc.26021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 01/03/2023]
Abstract
Children with human immunodeficiency virus (HIV) have an increased risk of developing Kaposi Sarcoma (KS) and non-Hodgkin lymphoma (NHL) compared to HIV-negative children. We compiled currently published epidemiologic data on KS and NHL among children in sub-Saharan Africa (SSA). Among countries with available data, the median incidence of KS was 2.05/100,000 in the general pediatric population and 67.35/100,000 among HIV-infected children. The median incidence of NHL was 1.98/100,000 among the general pediatric population, while data on NHL incidence among HIV-infected children were lacking. Larger regional studies are needed to better address the dearth of epidemiologic information on pediatric KS and NHL in SSA.
Collapse
Affiliation(s)
- Chris A Rees
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Elizabeth M Keating
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Heather Lukolyo
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Heather E. Danysh
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA,Texas Children’s Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA,Texas Children’s Cancer and Hematology Centers, Houston, TX, USA
| | - Parth S Mehta
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA,Texas Children’s Cancer and Hematology Centers, Houston, TX, USA
| | - Joseph Lubega
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA,Texas Children’s Cancer and Hematology Centers, Houston, TX, USA
| | - Jeremy S Slone
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA,Texas Children’s Cancer and Hematology Centers, Houston, TX, USA
| | | |
Collapse
|
108
|
Mbah Afungchwi G, Challinor J. Addressing Childhood Cancer in Low-Resource Countries: Current Challenges, Strategies, and Recommendations. Oncol Nurs Forum 2016; 43:525-8. [PMID: 27314196 DOI: 10.1188/16.onf.525-528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children and adolescents represent a small, but critically important, number of patients with cancer worldwide (14.1 million newly diagnosed adults versus 160,000 children annually). The life years saved when a child is cured of cancer are about 71 compared to 15 years for an adult in most high-income countries (HICs). In HICs, about 80% of children survive cancer. Unfortunately, in low- and middle-income countries (LMICs), the survival rates are generally 50% or less. In these resource-limited settings, only 15%-37% of children and adolescents have access to cancer treatment, and most are diagnosed with advanced-stage disease, making cure impossible.
Collapse
|
109
|
Enhancement of oncology nursing education in low- and middle-income countries: Challenges and strategies. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
110
|
Gupta S, Morris SK, Suraweera W, Aleksandrowicz L, Dikshit R, Jha P. Childhood Cancer Mortality in India: Direct Estimates From a Nationally Representative Survey of Childhood Deaths. J Glob Oncol 2016; 2:403-411. [PMID: 28717727 PMCID: PMC5493242 DOI: 10.1200/jgo.2015.000935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Although most children with cancer live in low- and middle-income countries, measurements of childhood cancer burden in such countries have been restricted to incidence rates from a few subnational cancer registries and mortality rates from vital statistics. We aimed to provide alternative burden estimates by using nationally representative longitudinal survey–derived mortality rates. Methods We examined cancer deaths in childhood (1 month to 14 years of age) in the Million Death Study, a cohort of > 27,000 pediatric deaths in India on the basis of enhanced verbal autopsies. All deaths potentially due to childhood cancer were identified. Two pediatric specialists independently categorized deaths as definite, probable, possible, or unlikely cancer related. From definite and probable deaths, we estimated national and regional mortality rates attributable to childhood malignancies. Data on symptoms and health care–seeking behavior were abstracted from closed-ended questions and caregiver narratives. Results Of 700 included deaths, 189 were classified as definite or possibly cancer related. The κ-statistic between reviewers was 0.75 (95% CI, 0.71 to 0.78). From these deaths, we estimated that in 2010, 13,700 were a result of childhood cancer in India, which led to a mortality rate of 37 (95% CI, 31 to 42) per million population per year, which exceeds many prior estimates of mortality and even some estimates of incidence. Disparities between mortality estimates were widest in northeast India and for brain tumors. A preponderance of male deaths was seen (male:female ratio, 1.6:1). Conclusion The burden of childhood cancer in India is substantially higher than previously suggested. This information will aid advocacy for national strategies aimed at improving outcomes for Indian children with cancer.
Collapse
Affiliation(s)
- Sumit Gupta
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Shaun K Morris
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Wilson Suraweera
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Lukasz Aleksandrowicz
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Rajesh Dikshit
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| | - Prabhat Jha
- and , Hospital for Sick Children and University of Toronto; , , and , St Michael's Hospital, Toronto, Ontario, Canada; and , Tata Memorial Centre, Mumbai, India
| |
Collapse
|
111
|
Slone JS, Ishigami E, Mehta PS. Pediatric Cancer Recognition Training in Botswana. Glob Pediatr Health 2016; 3:2333794X16635002. [PMID: 27336006 PMCID: PMC4905160 DOI: 10.1177/2333794x16635002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 12/28/2015] [Accepted: 01/18/2016] [Indexed: 11/17/2022] Open
Abstract
Delayed presentation of children with cancer is a significant barrier to improving the survival from children's cancer in low- and middle-income countries (LMICs). Botswana, a country of approximately 2 million people in southern Africa, has only 1 pediatric cancer treatment program, based at Princess Marina Hospital (PMH) in the capital of Gaborone. A pediatric cancer recognition training program was developed that reached 50% of the government hospitals in Botswana teaching 362 health care workers how to recognize and refer children with cancer to PMH. Through evaluation of attendees, limitations in pediatric cancer training and general knowledge of pediatric cancer were identified. Attendees demonstrated improvement in their understanding of pediatric cancer and the referral process to PMH following the workshop.
Collapse
Affiliation(s)
- Jeremy S Slone
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Elise Ishigami
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Parth S Mehta
- Texas Children's Cancer and Hematology Centers, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
112
|
Barr R, Robertson J. Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries. Pediatr Blood Cancer 2016; 63:287-91. [PMID: 26375626 DOI: 10.1002/pbc.25722] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/07/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries. PROCEDURE Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined. RESULTS Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0-18) in low income countries (n = 26) and 14 in lower-middle (n = 42), upper-middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0-8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000). CONCLUSIONS There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries.
Collapse
Affiliation(s)
- Ronald Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jane Robertson
- Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
113
|
|
114
|
Ribeiro RC, Antillon F, Pedrosa F, Pui CH. Global Pediatric Oncology: Lessons From Partnerships Between High-Income Countries and Low- to Mid-Income Countries. J Clin Oncol 2015; 34:53-61. [PMID: 26578620 DOI: 10.1200/jco.2015.61.9148] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Partnerships between medical institutions in high-income countries (HICs) and low- to mid-income countries (LMICs) have succeeded in initiating and expanding pediatric cancer control efforts. The long-term goal is consistently a sustainable national pediatric cancer program. Here, we review the elements required for successful implementation, development, and long-term sustainability of pediatric cancer programs in LMICs that first arise as partnerships with institutions in HICs. Although plans must be adapted to each country's resources, certain components are unfailingly necessary. First, an essential step is provision of treatment regardless of ability to pay. Second, financial support for program development and long-term sustainability must be sought from sources both international and local, public and private. A local leader, typically a well-trained pediatric oncologist who devotes full-time effort to the project, should direct medical care and collaborate with hospital, governmental, and community leadership and international agencies. Third, nurses must be trained in pediatric cancer care and allowed to practice this specialty full-time. It is also essential to develop a grassroots organization, such as a foundation, dedicated solely to pediatric oncology. Its members must be trained and educated to provide pediatric cancer advocacy, fundraising, and (in concert with government) program sustainability. Finally, a project mentor in the HIC is crucial and should explore the possibility of collaborative research in the LMIC, which may offer significant opportunities. Relationships between the partnership's leaders and influential individuals in the community, hospital, grassroots foundation, and government will lay the foundation for productive collaboration and a sustainable pediatric oncology program.
Collapse
Affiliation(s)
- Raul C Ribeiro
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil.
| | - Federico Antillon
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Francisco Pedrosa
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| | - Ching-Hon Pui
- Raul C. Ribeiro and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Federico Antillon, Unidad Nacional de Oncologia Pediatrica and Universidad Francisco Marroquin, Guatemala City, Guatemala; and Francisco Pedrosa, Instituto de Medicina Integral Fernando Figueira, Recife, Brazil
| |
Collapse
|
115
|
Barr R. Developments in paediatric care in Latin America. Lancet Oncol 2015; 16:1401-3. [PMID: 26522155 DOI: 10.1016/s1470-2045(15)00379-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Ronald Barr
- Department of Pediatrics, Division of Hematology-Oncology, McMaster University, Ontario L8S 4J9, Canada.
| |
Collapse
|
116
|
Cellular and Antibody Based Approaches for Pediatric Cancer Immunotherapy. J Immunol Res 2015; 2015:675269. [PMID: 26587548 PMCID: PMC4637498 DOI: 10.1155/2015/675269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Progress in the use of traditional chemotherapy and radiation-based strategies for the treatment of pediatric malignancies has plateaued in the past decade, particularly for patients with relapsing or therapy refractory disease. As a result, cellular and humoral immunotherapy approaches have been investigated for several childhood cancers. Several monoclonal antibodies are now FDA approved and commercially available, some of which are currently considered standard of practice. There are also several new cellular immunotherapy approaches under investigation, including chimeric antigen receptor (CAR) modified T cells, cancer vaccines and adjuvants, and natural killer (NK) cell therapies. In this review, we will discuss previous studies on pediatric cancer immunotherapy and new approaches that are currently being investigated in clinical trials.
Collapse
|
117
|
Israels T, Challinor J, Howard S, Arora RH. Treating Children With Cancer Worldwide--Challenges and Interventions. Pediatrics 2015; 136:607-10. [PMID: 26371201 DOI: 10.1542/peds.2015-0300] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Trijn Israels
- Pediatric Oncology and Hematology Outreach Program, VU University Medical Center, Amsterdam, Netherlands;
| | | | | | | |
Collapse
|
118
|
Robertson J, Magrini N, Barr R, Forte G, Ondari C. Medicines for cancers in children: The WHO model for selection of essential medicines. Pediatr Blood Cancer 2015; 62:1689-93. [PMID: 25929524 PMCID: PMC5132122 DOI: 10.1002/pbc.25564] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/24/2015] [Indexed: 12/15/2022]
Abstract
Pressures to include more cancer medicines in the WHO Model List of Essential Medicines (EML) pose challenges for the Expert Committee responsible for recommending changes to the list. How do medicines for cancer fit within a definition of essential medicines as those meeting the priority health needs of the population? Will identifying a medicine as "essential" offer some leverage to improve access to effective cancer medicines in low and middle-income countries (LMICs)? The addition of a number of medicines for the treatment of cancers in children to the Model List of Essential Medicines for Children (EMLc) in 2011 provides important insights into previous Expert Committee decision-making and offers a platform for future deliberations. As combination chemotherapy is required for effective treatment of many malignancies, a disease-based approach makes more sense than an agent-based approach. Inadequate financing to purchase essential medicines is a reality in many LMICs, thus a consideration of health impact is central to decisions on the selection and procurement of medicines. Inclusion in national EMLs should identify medicines that have priority for procurement in the public sector. This article will discuss some of the factors taken into account by the Expert Committee in developing the WHO EMLc. We argue that the disease-based approach coupled with the assessment of the magnitude of the clinical benefit provides an appropriate approach for considering further additions of medicines for pediatric cancers and for the review of the adult cancer section of the Model List.
Collapse
Affiliation(s)
- Jane Robertson
- Essential Medicines and Health Products DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Nicola Magrini
- Essential Medicines and Health Products DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Ronald Barr
- Departments of PediatricsPathology and MedicineMcMaster University and McMaster Children's HospitalHamiltonOntarioCanada
| | - Gilles Forte
- Essential Medicines and Health Products DepartmentWorld Health OrganizationGenevaSwitzerland
| | - Clive Ondari
- Essential Medicines and Health Products DepartmentWorld Health OrganizationGenevaSwitzerland
| |
Collapse
|
119
|
Friedrich P, Lam CG, Itriago E, Perez R, Ribeiro RC, Arora RS. Magnitude of Treatment Abandonment in Childhood Cancer. PLoS One 2015; 10:e0135230. [PMID: 26422208 PMCID: PMC4589240 DOI: 10.1371/journal.pone.0135230] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Treatment abandonment (TxA) is recognized as a leading cause of treatment failure for children with cancer in low-and-middle-income countries (LMC). However, its global frequency and burden have remained elusive due to lack of global data. This study aimed to obtain an estimate using survey and population data. METHODS Childhood cancer clinicians (medical oncologists, surgeons, and radiation therapists), nurses, social workers, and psychologists involved in care of children with cancer were approached through an online survey February-May 2012. Incidence and population data were obtained from public sources. Descriptive, univariable, and multivariable analyses were conducted. RESULTS 602 responses from 101 countries were obtained from physicians (84%), practicing pediatric hematology/oncology (83%) in general or children's hospitals (79%). Results suggested, 23,854 (15%) of 155,088 children <15 years old newly diagnosed with cancer annually in the countries analyzed, abandon therapy. Importantly, 83% of new childhood cancer cases and 99% of TxA were attributable to LMC. The annual number of cases of TxA expected in LMC worldwide (26,166) was nearly equivalent to the annual number of cancer cases in children <15 years expected in HIC (26,368). Approximately two thirds of LMC had median TxA ≥ 6%, but TxA ≥ 6% was reported in high- (9%), upper-middle- (41%), lower-middle- (80%), and low-income countries (90%, p<0.001). Most LMC centers reporting TxA > 6% were outside the capital. Lower national income category, higher reliance on out-of-pocket payments, and high prevalence of economic hardship at the center were independent contextual predictors for TxA ≥ 6% (p<0.001). Global survival data available for more developed and less developed regions suggests TxA may account for at least a third of the survival gap between HIC and LMC. CONCLUSION Results show TxA is prevalent (compromising cancer survival for 1 in 7 children globally), confirm the suspected high burden of TxA in LMC, and illustrate the negative impact of poverty on its occurrence. The present estimates may appear small compared to the global burden of child death from malnutrition and infection (measured in millions). However, absolute numbers suggest the burden of TxA in LMC is nearly equivalent to annually losing all kids diagnosed with cancer in HIC just to TxA, without even considering deaths from disease progression, relapse or toxicity-the main causes of childhood cancer mortality in HIC. Results document the importance of monitoring and addressing TxA as part of childhood cancer outcomes in at-risk settings.
Collapse
Affiliation(s)
- Paola Friedrich
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Catherine G. Lam
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- International Outreach Program, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Elena Itriago
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, United States of America
| | - Rafael Perez
- Villa Victoria Center for the Arts, Boston, Massachusetts, United States of America
| | - Raul C. Ribeiro
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | | |
Collapse
|
120
|
Ziani A, El Kababri M, El Khorassani M, Kili A, Khattab M, Hessissen L. Quels sont les besoins des enfants en oncologie pédiatrique alors qu’ils entrent en phase palliative ? Enquête réalisée au Maroc auprès de leurs parents. PSYCHO-ONCOLOGIE 2015. [DOI: 10.1007/s11839-015-0530-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
121
|
Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, Israels T, Jeha S, Harif M, Sullivan MJ, Quah TC, Patte C, Pui CH, Barr R, Gross T. Toward the Cure of All Children With Cancer Through Collaborative Efforts: Pediatric Oncology As a Global Challenge. J Clin Oncol 2015; 33:3065-73. [PMID: 26304881 DOI: 10.1200/jco.2014.60.6376] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Advances in the treatment of childhood cancers have resulted in part from the development of national and international collaborative initiatives that have defined biologic determinants and generated risk-adapted therapies that maximize cure while minimizing acute and long-term effects. Currently, more than 80% of children with cancer who are treated with modern multidisciplinary treatments in developed countries are cured; however, of the approximately 160,000 children and adolescents who are diagnosed with cancer every year worldwide, 80% live in low- and middle-income countries (LMICs), where access to quality care is limited and chances of cure are low. In addition, the disease burden is not fully known because of the lack of population-based cancer registries in low-resource countries. Regional and ethnic variations in the incidence of the different childhood cancers suggest unique interactions between genetic and environmental factors that could provide opportunities for etiologic research. Regional collaborative initiatives have been developed in Central and South America and the Caribbean, Africa, the Middle East, Asia, and Oceania. These initiatives integrate regional capacity building, education of health care providers, implementation of intensity-graduated treatments, and establishment of research programs that are adjusted to local capacity and local needs. Together, the existing consortia and regional networks operating in LMICs have the potential to reach out to almost 60% of all children with cancer worldwide. In summary, childhood cancer burden has been shifted toward LMICs and, for that reason, global initiatives directed at pediatric cancer care and control are needed. Regional networks aiming to build capacity while incorporating research on epidemiology, health services, and outcomes should be supported.
Collapse
Affiliation(s)
- Carlos Rodriguez-Galindo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD.
| | - Paola Friedrich
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Patricia Alcasabas
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Federico Antillon
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Shripad Banavali
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Luis Castillo
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Trijn Israels
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Sima Jeha
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Mhammed Harif
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Michael J Sullivan
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thuan Chong Quah
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Catherine Patte
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ching-Hon Pui
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Ronald Barr
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| | - Thomas Gross
- Carlos Rodriguez-Galindo and Paola Friedrich, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Patricia Alcasabas, Philippines General Hospital, Manila, Philippines; Federico Antillon, Unidad Nacional de Oncología Pediátrica, and Francisco Marroquín Medical School, Guatemala City, Guatemala; Shripad Banavali, Tata Memorial Hospital, Mumbai, India; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Trijn Israels, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Sima Jeha and Ching-Hon Pui, St Jude Children's Research Hospital, Memphis, TN; Mhammed Harif, Centre Hospitalier Universitaire Mohammed VI, Marrakech, Morocco; Michael J. Sullivan, Royal Children's Hospital, Melbourne, Australia; Thuan Chong Quah, National University Health System, Singapore; Catherine Patte, Institute Gustave-Roussy, Villejuif, France; Ronald Barr, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada; and Thomas Gross, National Cancer Institute Center for Global Health, Bethesda, MD
| |
Collapse
|
122
|
Caruso Brown AE, Howard SC, Baker JN, Ribeiro RC, Lam CG. Reported availability and gaps of pediatric palliative care in low- and middle-income countries: a systematic review of published data. J Palliat Med 2015; 17:1369-83. [PMID: 25225748 DOI: 10.1089/jpm.2014.0095] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The majority of young people in need of palliative care live in low- and middle-income countries, where curative treatment is less available. OBJECTIVE We systematically reviewed published data describing palliative care services available to young people with life-limiting conditions in low- and middle-income countries and assessed core elements with respect to availability, gaps, and under-reported aspects. METHODS PubMed, CINAHL, EMBASE (1980-2013), and secondary bibliographies were searched for publications that included patients younger than 25 years with life-limiting conditions and described palliative care programs in low- and middle-income countries. A data extraction checklist considered 15 items across seven domains: access, education/capacity building, health system support, pain management, symptom management, end-of-life care, and bereavement. Data were aggregated by program and country. RESULTS Of 1572 records, 238 met criteria for full-text review; 34 qualified for inclusion, representing 30 programs in 21 countries. The median checklist score was 7 (range, 1-14) of 10 reported (range, 3-14). The most pervasive gaps were in national health system support (unavailable in 7 of 17 countries with programs reporting), specialized education (unavailable in 7 of 19 countries with programs reporting), and comprehensive opioid access (unavailable in 14 of 21 countries with programs reporting). Underreported elements included specified practices for pain management and end-of-life support. CONCLUSION Comprehensive pediatric palliative care provision is possible even in markedly impoverished settings. Improved national health system support, specialized training and opioid access are key targets for research and advocacy. Application of a checklist methodology can promote awareness of gaps to guide program evaluation, reporting, and strengthening.
Collapse
Affiliation(s)
- Amy E Caruso Brown
- 1 Center for Bioethics and Humanities, and Department of Pediatrics, SUNY Upstate Medical University , Syracuse, New York
| | | | | | | | | |
Collapse
|
123
|
Chan MH, Boop F, Qaddoumi I. Challenges and opportunities to advance pediatric neuro-oncology care in the developing world. Childs Nerv Syst 2015; 31:1227-37. [PMID: 26040936 DOI: 10.1007/s00381-015-2771-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/25/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE As the morbidity and mortality associated with communicable diseases continue to decrease in the developing world, the medical burden of childhood cancer continues to expand. Although international aid and relief groups such as the World Health Organization recognize the importance of childhood cancer, their main emphasis is on the more easily treated malignancies, such as leukemias and lymphomas, and not pediatric brain tumors, which are the second most common malignancy in children and the leading cause of cancer-related deaths in the pediatric population. Addressing the needs of these children is a growing concern of several professional neuro-oncology-related societies. Thus, the goal of this review is to describe the current state of pediatric neuro-oncology care in the developing world, address the current and future needs of the field, and help guide professional societies' efforts to contribute in a more holistic and multidisciplinary manner. METHODS We reviewed the literature to compare the availability of neuro-oncology care in various regions of the developing world with that in higher income nations, to describe examples of successful initiatives, and to present opportunities to improve care. RESULTS The current challenges, previous successes, and future opportunities to improve neuro-oncology care are presented. The multidisciplinary nature of neuro-oncology depends on large teams of highly specialized individuals, including neuro-oncologists, neurosurgeons, neurologists, radiologists, radiation oncologists, pathologists, palliative care specialists, oncology nurses, physical therapists, occupational therapists, speech therapists, pediatric intensivists, and social workers, among others. CONCLUSION Pediatric neuro-oncology is one of the most complex types of medical care to deliver, as it relies on numerous specialists, subspecialists, support staff, and physical resources and infrastructure. However, with increasing collaboration and advancing technologies, developed nations can help substantially improve neuro-oncology care for children in developing nations.
Collapse
Affiliation(s)
- Michael H Chan
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, 80045, USA
| | | | | |
Collapse
|
124
|
Moreno F, Dussel V, Orellana L. Childhood cancer in Argentina: Survival 2000–2007. Cancer Epidemiol 2015; 39:505-10. [DOI: 10.1016/j.canep.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/20/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
|
125
|
Harford JB. Barriers to overcome for effective cancer control in Africa. Lancet Oncol 2015; 16:e385-93. [DOI: 10.1016/s1470-2045(15)00160-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
|
126
|
Waddell KM, Kagame K, Ndamira A, Twinamasiko A, Picton SV, Simmons IG, Revill P, Johnston WT, Newton R. Improving survival of retinoblastoma in Uganda. Br J Ophthalmol 2015; 99:937-42. [PMID: 25583281 DOI: 10.1136/bjophthalmol-2014-306206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/17/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Diagnostic delay results in relatively high mortality among children with retinoblastoma in Uganda, where treatment was limited to surgery and, for some, radiotherapy. In order to improve outcomes, a simple programme of neoadjuvant and adjuvant chemotherapy was introduced. Here we report survival before and after this change to medical practice. METHODS Affordable standard off-patent chemotherapy agents were administered by trained paramedical staff to groups of patients at the same time. Survival before and after the introduction of chemotherapy was monitored. Between 2006 and 2013 a total of 270 patients with retinoblastoma were included, 181 treated prior to chemotherapy and 89 after (beginning in 2009). We had 94% follow-up and 249 had histological verification of diagnosis. RESULTS Using a proportional hazards model adjusted for age, sex and laterality, children treated after chemotherapy was introduced had a 37% lower risk of dying (HR 0.63, 95% CI 0.41 to 0.99) compared with children treated before. Prior to the introduction of chemotherapy only 15% of children who survived bilateral disease retained vision after treatment compared with 71% after chemotherapy. CONCLUSIONS The introduction of chemotherapy proved safe and cost-effective in non-specialist hands and was associated with significant improvements in survival and, among bilateral cases, in preserving vision.
Collapse
Affiliation(s)
- Keith M Waddell
- Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kenneth Kagame
- Ruharo Eye Hospital, Mbarara, Uganda Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Andrew Ndamira
- Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Amos Twinamasiko
- Departments of Ophthalmology and Paediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Susan V Picton
- Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian G Simmons
- Departments of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - W Tom Johnston
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Robert Newton
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Research Unit on AIDS, Entebbe, Uganda International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
127
|
Building a National Pediatric Cancer Center and Network in Paraguay: Lessons for Addressing Challenges in a Low-income Country. J Pediatr Hematol Oncol 2015; 37:383-90. [PMID: 25929610 DOI: 10.1097/mph.0000000000000338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Paraguay, cancer is among the leading causes of death among children. We report challenges and solutions for building the country's first pediatric cancer center at the National University School of Medicine (PCC-SM) and describe the outcomes of the National Network for Pediatric Cancer. We found that children with acute lymphoblastic leukemia treated between 2008 and 2012 had higher 3-year survival rates and lower treatment abandonment rates than did children treated between 2000 and 2007 before the network was established. This improvement directly coincided with the increased treatment capacity of the PCC-SM. Herein, we describe the role of local, national, and international contributors in improving the health care at Paraguay's PCC-SM and discuss how expediting access to specialized cancer diagnosis and care and implementing a system for referral and follow-up visits can improve cancer outcomes in other low-resource countries.
Collapse
|
128
|
Weaver MS, Yao AJJ, Renner LA, Harif M, Lam CG. The prioritisation of paediatrics and palliative care in cancer control plans in Africa. Br J Cancer 2015; 112:1845-56. [PMID: 26042935 PMCID: PMC4580392 DOI: 10.1038/bjc.2015.158] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/15/2015] [Accepted: 04/06/2015] [Indexed: 01/03/2023] Open
Abstract
Background: Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans. Methods: We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance. Results: Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion. Conclusions: Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.
Collapse
Affiliation(s)
- M S Weaver
- Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, USA
| | - A J J Yao
- Pediatric Oncology Service, Hôpital de Treichville, Abidjan, Côte d'Ivoire
| | - L A Renner
- Department of Child Health, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - M Harif
- Cheikh Khalifa Hospital, Casablanca, Morocco
| | - C G Lam
- 1] Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, USA [2] International Outreach Program, St Jude Children's Research Hospital, Memphis, TN, USA
| |
Collapse
|
129
|
Mucormycosis Rhinosinusitis at Diagnosis of Acute Lymphoblastic Leukemia: Diagnostics and Management Challenges in a Low-Middle-income Country. J Pediatr Hematol Oncol 2015; 37:e173-7. [PMID: 24942033 DOI: 10.1097/mph.0000000000000198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present the case of an adolescent with mucor rhinosinusitis diagnosed concomitantly with acute lymphoblastic leukemia at a hospital in Tegucigalpa, Honduras. We also discuss the challenges faced in the dual management of hematologic malignancies and invasive fungal disease in a low-middle-income country, such as access to diagnostics, immunosuppressants, imaging, and antifungals. Despite these shortcomings, the patient was successfully treated for both the diseases. Low-middle-income country hospitals can effectively treat invasive fungal diseases by providing adequate diagnostic and support services, which can improve the outcomes of pediatric cancer patients.
Collapse
|
130
|
Abstract
BACKGROUND Information about pediatric oncology in most of Africa is not widely available. The aim of this study was to provide an overview of childhood cancer and resources for patient care in a cross-section of African hospitals. METHODS Between 2011 and 2013, 49 health professionals involved in the care of children with cancer, from 38 hospitals in 29 African countries, were asked to respond to a questionnaire about the types and number of childhood cancers seen in their facilities; types and numbers of health care professionals; diagnostic, therapeutic, and palliative capabilities; survival statistics and compliance with treatment; support from parent groups; opportunities for ongoing medical training; and perceived challenges to care delivery. RESULTS New diagnoses annually ranged from 10 to 350, with nephroblastoma, leukemia, retinoblastoma, and Burkitt lymphoma being the most common in most centers. Care was provided often by nonpediatric oncologists. Radiotherapy was available in 21/38 hospitals, palliation in 27/38, and tumor registries in 21/38 centers. CONCLUSIONS Capabilities for care of children with cancer varied widely. Recommendations for improving care are discussed.
Collapse
|
131
|
Rivera-Luna R, Shalkow-Klincovstein J, Velasco-Hidalgo L, Cárdenas-Cardós R, Zapata-Tarrés M, Olaya-Vargas A, Aguilar-Ortiz MR, Altamirano-Alvarez E, Correa-Gonzalez C, Sánchez-Zubieta F, Pantoja-Guillen F. Descriptive Epidemiology in Mexican children with cancer under an open national public health insurance program. BMC Cancer 2014; 14:790. [PMID: 25355045 PMCID: PMC4228174 DOI: 10.1186/1471-2407-14-790] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 10/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background All the children registered at the National Council for the Prevention and Treatment of Childhood Cancer were analyzed. The rationale for this Federal Government Council is to financially support the treatment of all children registered into this system. All patients are within a network of 55 public certified hospitals nationwide. Methods In the current study, data from 2007 to 2012 are presented for all patients (0–18 years) with a pathological diagnosis of leukemia, lymphoma and solid tumors. The parameters analyzed were prevalence, incidence, mortality, and abandonment rate. Results A diagnosis of cancer was documented in 14,178 children. The incidence was of 156.9/million/year (2012). The median age was 4.9. The most common childhood cancer is leukemia, which occurs in 49.8% of patients (2007–2012); and has an incidence rate of 78.1/million/year (2012). The national mortality rate was 5.3/100,000 in 2012, however in the group between 15 to 18 years it reaches a level of 8.6. Conclusions The study demonstrates that there is a high incidence of childhood cancer in Mexico. In particular, the results reveal an elevated incidence and prevalence of leukemia especially from 0 to 4 years. Only 4.7% of these patients abandoned treatment. The clinical outcome for all of the children studied improved since the establishment of this national program.
Collapse
Affiliation(s)
- Roberto Rivera-Luna
- Head of the Division of Pediatric Hem/Oncology, National Institute of Pediatrics (NIP), Coordinator for the Technical Committee of the National Council for the Prevention and Treatment of Childhood Cancer, Mexico City, Mexico.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
132
|
Ataş E, Kutluk MT, Akyüz C, Kale G, Varan A, Yalçın B, Aydın B, Büyükpamukçu M. Clinical features and treatment results of children with diffuse large B-cell lymphoma. Pediatr Hematol Oncol 2014; 31:509-17. [PMID: 25116464 DOI: 10.3109/08880018.2014.940434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The demographic, clinical characteristics, and treatment groups of 33 children with diffuse large B-cell lymphoma (DLBCL) were recorded and analyzed among 1486 non-Hodgkin lymphoma (NHL) cases since 1972. The median age was 9.7 years (range 1.4-16.9) and male/female ratio was 24/9 = 2.6. Kaplan-Meier methods and logrank tests were used in treatment analysis. The frequency of DLBCL among 1486 NHL cases was 2.2%, however, the percentage was 9.3% in cases diagnosed after 2000. The event-free survival (EFS) and overall survival (OS) rates for 33 children were 61% and 65.1% at 5 years, respectively. The EFS and OS rates of low stage (stages I and II) disease decreased to lower level in advanced stage (stages III and IV) disease. Associated conditions and ages older than 14 years were found as poor prognostic factors in multivariate analysis. The survival rates in children with DLBCL need further improvement. This is mainly related with late referral of those children with advanced disease. The proper diagnosis and early referral is essential in these children for a better survival rate. The children with associated conditions and older children must be handled with care since these are found as poor prognostic factors.
Collapse
Affiliation(s)
- Erman Ataş
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | | | | | | | | | | | | | | |
Collapse
|
133
|
Rivera GK, Ribeiro RC. Improving treatment of children with acute lymphoblastic leukemia in developing countries through technology sharing, collaboration and partnerships. Expert Rev Hematol 2014; 7:649-57. [PMID: 25174644 DOI: 10.1586/17474086.2014.949233] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cure rates for pediatric acute lymphoblastic leukemia differ markedly in higher- and lower-income countries due to disparate hospital infrastructure and resources. Where means are limited, treatment-related mortality is higher and compliance may be suboptimal. Upfront risk assignment is aimed at individualizing therapy according to presenting features in order to avoid over- or under-treatment. However, the necessary technical resources and expertise are not always readily available. The authors provide suggestions for management of childhood acute lymphoblastic leukemia in developing nations. To improve patient care locally, the authors recommend that communication technology be used to sustain partnerships between sponsoring and partner pediatric oncology programs. The aims of these collaborations should be to prioritize resources, identify existing problems and reduce treatment intensity and hence treatment-related morbidity and mortality in patients at lower risk of relapse.
Collapse
Affiliation(s)
- Gaston K Rivera
- International Outreach Program and Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | | |
Collapse
|
134
|
Educational Needs and Strategies of Pediatric Oncology Nurses in Low- and Middle-Income Countries. Cancer Nurs 2014; 37:E36-47. [DOI: 10.1097/ncc.0000000000000100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
135
|
Gupta S, Rivera-Luna R, Ribeiro RC, Howard SC. Pediatric oncology as the next global child health priority: the need for national childhood cancer strategies in low- and middle-income countries. PLoS Med 2014; 11:e1001656. [PMID: 24936984 PMCID: PMC4061014 DOI: 10.1371/journal.pmed.1001656] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dr. Sumit Gupta and colleagues discuss the need for national cancer strategies for children in low- and middle-income countries and suggest how such strategies could be implemented. Please see later in the article for the Editors' Summary
Collapse
Affiliation(s)
- Sumit Gupta
- Division of Paediatric Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Roberto Rivera-Luna
- Division of Pediatric Hematology/Oncology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | - Raul C. Ribeiro
- Division of Pediatric Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| | - Scott C. Howard
- Division of Pediatric Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, United States of America
| |
Collapse
|
136
|
Sharma JD, Kalit M, Nirmolia T, Saikia SP, Sharma A, Barman D. Cancer: Scenario and Relationship of Different Geographical Areas of the Globe with Special Reference to North East-India. Asian Pac J Cancer Prev 2014; 15:3721-9. [DOI: 10.7314/apjcp.2014.15.8.3721] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
137
|
Kirby J, Dolendo M, Guimera D, Castillo C, Johnson KM, Mzayek F, Nolan VG, Relyea G, Caniza MA. Predictors of wait-time for antibiotic initiation and association of wait-time with hospital length of stay and ICU admission among children with cancer at the Southern Philippines Medical Center. Pediatr Blood Cancer 2014; 61:680-6. [PMID: 24660227 DOI: 10.1002/pbc.24836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Expedited antibiotic administration improves the survival of children with cancer and infection. A 1-hour antibiotic wait-time (AWT) post-hospital arrival is a quality-of-care bench mark in healthcare. However, multiple factors preclude achieving this goal in developing countries. Predictors of AWT and its association with hospital length of stay (LOS) and intensive care unit (ICU) admission at the Southern Philippines Medical Center (SPMC) were identified. PROCEDURES Health and socioeconomic characteristics of 55 children in 92 admissions who required antibiotics were reviewed;and SPMC care providers about institutional capacity and response to suspected infection were surveyed. RESULTS The mean total AWT was 3 days and 15 hours. For admissions of established patients, mean total AWT and mean LOS were approximately half that for new patients. Admissions from high-income households waited an average 44% less for antibiotics and were discharged 43% sooner than those from medium-income households. Admissions from residence owner families waited 31% less to receive antibiotics, and total AWT for admissions of patients with no insurance was 32% less than for those with insurance. The likelihood of ICU admission increased 20% with every 1-day increase in total AWT (95% CI: 1.021.42). Only 59% of nurses recognized fever as an emergency. CONCLUSIONS AWT is complex and multifactorial; it may be reduced by educating parents and care providers about infection and infection control and improving the availability of antibiotics and associated supplies. These interventions will most likely reduce ICU admissions and possibly LOS and increase the survival of pediatric oncology patients at SPMC.
Collapse
Affiliation(s)
- Jeannette Kirby
- School of Public Health; University of Memphis; Memphis Tennessee
| | - Mae Dolendo
- Children's Cancer and Blood Disease Unit of the Southern Philippines Medical Center; Davao City Philippines
| | - Don Guimera
- Department of Infectious Diseases; St. Jude Children's Research Hospital; Memphis Tennessee
| | - Czarina Castillo
- Children's Cancer and Blood Disease Unit of the Southern Philippines Medical Center; Davao City Philippines
| | - Kyle M. Johnson
- Department of Infectious Diseases; St. Jude Children's Research Hospital; Memphis Tennessee
| | - Fawaz Mzayek
- School of Public Health; University of Memphis; Memphis Tennessee
| | - Vikki G. Nolan
- School of Public Health; University of Memphis; Memphis Tennessee
| | - George Relyea
- School of Public Health; University of Memphis; Memphis Tennessee
| | - Miguela A. Caniza
- Department of Infectious Diseases; St. Jude Children's Research Hospital; Memphis Tennessee
- International Outreach Program; St. Jude Children's Research Hospital; Memphis TN
- Department of Pediatrics; College of Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| |
Collapse
|
138
|
Kruger M, Hendricks M, Davidson A, Stefan CD, van Eyssen AL, Uys R, van Zyl A, Hesseling P. Childhood cancer in Africa. Pediatr Blood Cancer 2014; 61:587-92. [PMID: 24214130 DOI: 10.1002/pbc.24845] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/09/2013] [Indexed: 12/11/2022]
Abstract
The majority of children with cancer live in low- and middle-income countries (LMICs) with little or no access to cancer treatment. The purpose of the paper is to describe the current status of childhood cancer treatment in Africa, as documented in publications, dedicated websites and information collected through surveys. Successful twinning programmes, like those in Malawi and Cameroon, as well as the collaborative clinical trial approach of the Franco-African Childhood Cancer Group (GFAOP), provide good models for childhood cancer treatment. The overview will hopefully influence health-care policies to facilitate access to cancer care for all children in Africa.
Collapse
Affiliation(s)
- Mariana Kruger
- Department of Paediatrics and Child Health, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | | | | | | | | | | | | | | |
Collapse
|
139
|
Denburg AE, Knaul FM, Atun R, Frazier LA, Barr RD. Beyond the bench and the bedside: economic and health systems dimensions of global childhood cancer outcomes. Pediatr Blood Cancer 2014; 61:572-6. [PMID: 24249518 DOI: 10.1002/pbc.24858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022]
Abstract
Globally, the number of new cases of childhood cancer continues to rise, with a widening gulf in outcomes across countries, despite the availability of effective cure options for many pediatric cancers. Economic forces and health system realities are deeply embedded in the foundation of disparities in global childhood cancer outcomes. A truly global effort to close the childhood cancer divide therefore requires systemic solutions. Analysis of the economic and health system dimensions of childhood cancer outcomes is essential to progress in childhood cancer survival around the globe. The conceptual power of this approach is significant. It provides insight into how and where pediatric oncology entwines with broader political and economic conditions, and highlights the mutual benefit derived from systems-oriented solutions.
Collapse
Affiliation(s)
- Avram E Denburg
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; Dana-Farber Children's Cancer Center, Boston, Massachusetts; Harvard Global Equity Initiative, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | | |
Collapse
|
140
|
Slone JS, Chunda-Liyoka C, Perez M, Mutalima N, Newton R, Chintu C, Kankasa C, Chipeta J, Heimburger DC, Vermund SH, Friedman DL. Pediatric malignancies, treatment outcomes and abandonment of pediatric cancer treatment in Zambia. PLoS One 2014; 9:e89102. [PMID: 24586527 PMCID: PMC3931678 DOI: 10.1371/journal.pone.0089102] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/14/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia. METHODS Using an established database, a retrospective cohort study was conducted of children aged 0-15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records. RESULTS Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR] = 0.48 (95% confidence interval [CI] 0.23-0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR = 1.65; 95% CI 1.05-2.58). CONCLUSIONS Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome.
Collapse
Affiliation(s)
- Jeremy S. Slone
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
| | - Catherine Chunda-Liyoka
- Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia
| | - Marta Perez
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Nora Mutalima
- Epidemiology and Cancer Statistics Group, University of York, York, England, United Kingdom
| | - Robert Newton
- Epidemiology and Cancer Statistics Group, University of York, York, England, United Kingdom
- Medical Research Council/Uganda Virus Research Institute Research Unit on Acquired Immune Deficiency Syndrome (AIDS), Entebbe, Uganda
| | - Chifumbe Chintu
- Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia
| | - Chipepo Kankasa
- Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia
| | - James Chipeta
- Department of Pediatrics and Child Health, University Teaching Hospital, and University of Zambia School of Medicine, Lusaka, Zambia
| | - Douglas C. Heimburger
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Debra L. Friedman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center; Nashville, Tennessee, United States of America
| |
Collapse
|
141
|
Barr RD, Antillón Klussmann F, Baez F, Bonilla M, Moreno B, Navarrete M, Nieves R, Peña A, Conter V, De Alarcón P, Howard SC, Ribeiro RC, Rodriguez-Galindo C, Valsecchi MG, Biondi A, Velez G, Tognoni G, Cavalli F, Masera G. Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): a model for sustainable development in pediatric oncology. Pediatr Blood Cancer 2014; 61:345-54. [PMID: 24376230 DOI: 10.1002/pbc.24802] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/10/2013] [Indexed: 11/06/2022]
Abstract
Bridging the survival gap for children with cancer, between those (the great majority) in low and middle income countries (LMIC) and their economically advantaged counterparts, is a challenge that has been addressed by twinning institutions in high income countries with centers in LMIC. The long-established partnership between a Central American consortium--Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA)--and institutions in Europe and North America provides a striking example of such a twinning program. The demonstrable success of this endeavor offers a model for improving the health outcomes of children with cancer worldwide. As this remarkable enterprise celebrates its 15th anniversary, it is appropriate to reflect on its origin, subsequent growth and development, and the lessons it provides for others embarking on or already engaged in similar journeys. Many challenges have been encountered and not all yet overcome. Commitment to the endeavor, collaboration in its achievements and determination to overcome obstacles collectively are the hallmarks that stamp AHOPCA as a particularly successful partnership in advancing pediatric oncology in the developing world.
Collapse
Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
142
|
Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, Dimitrova N, Jakab Z, Kaatsch P, Lacour B, Mallone S, Marcos-Gragera R, Minicozzi P, Sánchez-Pérez MJ, Sant M, Santaquilani M, Stiller C, Tavilla A, Trama A, Visser O, Peris-Bonet R. Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5--a population-based study. Lancet Oncol 2013; 15:35-47. [PMID: 24314616 DOI: 10.1016/s1470-2045(13)70548-5] [Citation(s) in RCA: 688] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. METHODS We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated observed, country-weighted 1-year, 3-year, and 5-year survival for major cancers and all cancers combined. For comparison between countries, we used the corrected group prognosis method to provide survival probabilities adjusted for multiple confounders (sex, age, period of diagnosis, and, for all cancers combined without CNS cancers, casemix). Age-adjusted survival differences by area and calendar period were calculated with period analysis and were given for all cancers combined and the major cancers. FINDINGS We analysed 59,579 cases. For all cancers combined for children diagnosed in 2000-07, 1-year survival was 90.6% (95% CI 90.2-90.9), 3-year survival was 81.0 % (95% CI 80.5-81.4), and 5-year survival was 77.9% (95% CI 77.4-78.3). For all cancers combined, 5-year survival rose from 76.1% (74.4-77.7) for 1999-2001, to 79.1% (77.3-80.7) for 2005-07 (hazard ratio 0.973, 95% CI 0.965-0.982, p<0.0001). The greatest improvements were in eastern Europe, where 5-year survival rose from 65.2% (95% CI 63.1-67.3) in 1999-2001, to 70.2% (67.9-72.3) in 2005-07. Europe-wide average yearly change in mortality (hazard ratio) was 0.939 (95% CI 0.919-0.960) for acute lymphoid leukaemia, 0.959 (0.933-0.986) for acute myeloid leukaemia, and 0.940 (0.897-0.984) for non-Hodgkin lymphoma. Mortality for all of Europe did not change significantly for Hodgkin's lymphoma, Burkitt's lymphoma, CNS tumours, neuroblastoma, Wilms' tumour, Ewing's sarcoma, osteosarcoma, and rhabdomyosarcoma. Disparities for 5-year survival persisted between countries and regions, ranging from 70% to 82% (for 2005-07). INTERPRETATION Several reasons might explain persisting inequalities. The lack of health-care resources is probably most important, especially in some eastern European countries with limited drug supply, lack of specialised centres with multidisciplinary teams, delayed diagnosis and treatment, poor management of treatment, and drug toxicity. In the short term, cross-border care and collaborative programmes could help to narrow the survival gaps in Europe. FUNDING Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation.
Collapse
Affiliation(s)
- Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy.
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Silvia Rossi
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Tiiu Aareleid
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | | | - Jacqueline Clavel
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Mainz, Germany
| | - Brigitte Lacour
- INSERM UMRS1018, Paris-Sud University, Villejuif, France; French National Registry of Childhood Solid Tumours, CHU, Nancy, France
| | - Sandra Mallone
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health and Catalan Institute of Oncology, Girona, Spain
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Maria-José Sánchez-Pérez
- Escuela Andaluza de Salud Pública, Granada, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | | | - Charles Stiller
- Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Andrea Tavilla
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCSS "Istituto Nazionale dei Tumori", Milano, Italy
| | - Otto Visser
- Comprehensive Cancer Center the Netherlands, Utrecht, Netherlands
| | - Rafael Peris-Bonet
- Spanish National Registry of Childhood Tumours (RNTI-SEHOP), University of Valencia, Valencia, Spain
| | | |
Collapse
|
143
|
Calaminus G, Birch JR, Hollis R, Pau B, Kruger M. The role of SIOP as a platform for communication in the global response to childhood cancer. Pediatr Blood Cancer 2013; 60:2080-6. [PMID: 23940113 DOI: 10.1002/pbc.24728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/16/2013] [Indexed: 11/07/2022]
Abstract
Since the year 2000, there has been a 35% annual decrease in mortality among children under the age of five worldwide. The decrease is mainly attributed to the decrease in childhood epidemic infections, for example, due to vaccination programs. In the near future, this decrease will draw attention to paediatric non-communicable diseases (NCDs), and cancer is one of the most common. Access to care for children with cancer and survival rates have improved dramatically in high-income countries. However, it is important that a global perspective addresses problems in developing countries in particular. To meet this challenge, it is critical that emphasis is placed on demands such as access to care and drugs that are known to be effective, and which can be safely administered in resource-limited settings. Additionally, cancer registries and improved health care structures that include care for children with cancer, are paramount for further progress to increase awareness and the survival of children with cancer. The purpose of this paper is to describe current worldwide interventions to improve childhood cancer from the perspective of the International Society of Paediatric Oncology (SIOP). This global perspective will serve as an introduction to a series of papers from six SIOP continental branches, which will highlight the specific and/or common issues related to children with cancer worldwide. To strengthen the communication among and synergistic effects of various paediatric cancer stakeholders, SIOP could serve as a global platform for a proposed Global Paediatric Cancer Network through the interaction of its continental branches and partner collaborations.
Collapse
Affiliation(s)
- Gabriele Calaminus
- University of Muenster, Paediatric Haematology and Oncology, Muenster, Germany
| | | | | | | | | |
Collapse
|
144
|
Calaminus, Chestnov O. A plea for a global communication platform for paediatric cancer networks. Pediatr Blood Cancer 2013; 60:2079. [PMID: 24000243 DOI: 10.1002/pbc.24732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Calaminus
- International Society of Paediatric Oncology, World Health Organization
| | | |
Collapse
|
145
|
Santiago TC, Jenkins JJ. Histopathologic Diagnosis of Pediatric Neoplasms: A Review of International Consultations. Arch Pathol Lab Med 2013; 137:1648-53. [DOI: 10.5858/arpa.2012-0571-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Correct histopathologic diagnosis is fundamental to defining proper treatment and improving outcomes in children with malignancies. The Department of Pathology at St. Jude Children's Research Hospital (SJCRH) has collaborated with SJCRH International Outreach Program partner sites to improve the accuracy of histopathologic diagnoses in countries with limited resources. Pathologists at SJCRH provide review and evaluation of cases that are considered difficult or complex.
Objectives.—To determine the quality of pathology diagnosis and to identify areas for improvement in our international partner sites, we retrospectively analyzed all the international cases that were submitted for review. A comparison of our data with selected reports of surgical pathology error rates published in the medical literature was performed.
Design.—From January 2009 through December 2011, SJCRH received 763 cases submitted by international pathologists from 37 countries for histopathologic review and evaluation. Of 763 cases reviewed, 705 (92.4%) met the criteria for inclusion in this study. Rates of concordance between the submitted diagnoses and SJCRH reviewed diagnoses were analyzed.
Results.—Overall concordance, minor disagreement, and major disagreement rates between submitted diagnoses and SJCRH reviewed diagnoses were 430 (61.0%), 98 (13.9%), and 177 (25.1%) of the cases, respectively. Major disagreement rates ranged from 13.7% to 37.1% among studied countries.
Conclusions.—The major disagreement rate between referring international sites and SJCRH was substantially higher than the major disagreement rate among US institutions. Lack of the availability of immunohistochemistry and the training of pathologists in the diagnosis of pediatric neoplasms may have contributed to the discrepancies.
Collapse
Affiliation(s)
- Teresa C. Santiago
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Santiago); and the Department of Pathology, St. Jude Children's Research Hospital, Memphis (Dr Jenkins)
| | - Jesse J. Jenkins
- From the Department of Pathology, University of Tennessee Health Science Center, Memphis (Dr Santiago); and the Department of Pathology, St. Jude Children's Research Hospital, Memphis (Dr Jenkins)
| |
Collapse
|
146
|
Yeoh AEJ, Tan D, Li CK, Hori H, Tse E, Pui CH. Management of adult and paediatric acute lymphoblastic leukaemia in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013. Lancet Oncol 2013; 14:e508-23. [PMID: 24176570 PMCID: PMC4059516 DOI: 10.1016/s1470-2045(13)70452-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Survival for adults and children with acute lymphoblastic leukaemia has risen substantially in recent years because use of improved risk-directed treatments and supportive care has widened. In nearly all developed countries, multidisciplinary panels of leukaemia experts have formulated clinical practice guidelines in which standard treatment approaches are recommended on the basis of current evidence. However, those guidelines do not take into account resource limitations in low-income countries, including financial and technical challenges. In Asia, huge disparities in economy and infrastructure exist between countries, and even among different regions in some large countries. At a consensus session held as part of the 2013 Asian Oncology Summit in Bangkok, Thailand, a panel of experts summarised recommendations for management of adult and paediatric acute lymphoblastic leukaemia. Strategies were developed for Asian countries on the basis of available financial, skill, and logistical resources and were stratified in a four-tier system according to the resources available in a particular country or region (basic, limited, enhanced, and maximum).
Collapse
Affiliation(s)
- Allen E J Yeoh
- Department of Paediatrics, National University Hospital, National University of Singapore, Singapore
| | | | | | | | | | | |
Collapse
|
147
|
Friedrich P, Ortiz R, Fuentes S, Gamboa Y, Ah Chu-Sanchez MS, Arambú IC, Montero M, Báez F, Rodríguez-Galindo C, Antillón-Klussmann F. Barriers to effective treatment of pediatric solid tumors in middle-income countries: can we make sense of the spectrum of nonbiologic factors that influence outcomes? Cancer 2013; 120:112-25. [PMID: 24132910 DOI: 10.1002/cncr.28339] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/15/2013] [Accepted: 07/24/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The delivery of effective treatment for pediatric solid tumors poses a particular challenge to centers in middle-income countries (MICs) that already are vigorously addressing pediatric cancer. The objective of this study was to improve the current understanding of barriers to effective treatment of pediatric solid tumors in MICs. METHODS An ecologic model centered on pediatric sarcoma and expanded to country as the environment was used as a benchmark for studying the delivery of solid tumor care in MICs. Data on resources were gathered from 7 centers that were members of the Central American Association of Pediatric Hematologists and Oncologists (AHOPCA) using an infrastructure assessment tool. Pediatric sarcoma outcomes data were available, were retrieved from hospital-based cancer registries for 6 of the 7 centers, and were analyzed by country. Patients who were diagnosed from January 1, 2000 to December 31, 2009 with osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, and other soft tissue sarcomas were included in the analysis. To explore correlations between resources and outcomes, a pilot performance index was created. RESULTS The analyses identified specific deficits in human resources, communication, quality, and infrastructure. The treatment abandonment rate, the proportion of metastatic disease at diagnosis, the relapse rate, and the 4-year abandonment-sensitive overall survival (AOS) rate varied considerably by country, ranging from 1% to 38%, from 15% to 54%, from 24% to 52%, and from 21% to 51%, respectively. The treatment abandonment rate correlated inversely with health economic expenditure per capita (r = -0.86; P = .03) and life expectancy at birth (r = -0.93; P = .007). The 4-year AOS rate correlated inversely with the mortality rate among children aged <5 years (r = -0.80; P = 0.05) and correlated directly with the pilot performance index (r = 0.98; P = 0.005). CONCLUSIONS Initiatives to improve the effectiveness of treatment for pediatric solid tumors in MICs are warranted, particularly for pediatric sarcomas. Building capacity and infrastructure, improving supportive care and communication, and fostering comprehensive, multidisciplinary teams are identified as keystones in Central America. A measure that meaningfully describes performance in delivering pediatric cancer care is feasible and needed to advance comparative, prospective analysis of pediatric cancer care and to define resource clusters internationally.
Collapse
Affiliation(s)
- Paola Friedrich
- Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
148
|
Hessissen L, Khtar R, Madani A, El Kababri M, Kili A, Harif M, Khattab M, Sahraoui S, Benjaafar N, Ahid S, Howard SC, Benchekroun S. Improving the prognosis of pediatric Hodgkin lymphoma in developing countries: a Moroccan Society of Pediatric Hematology and Oncology study. Pediatr Blood Cancer 2013; 60:1464-9. [PMID: 23606223 DOI: 10.1002/pbc.24534] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 02/19/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries. PROCEDURE A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5 Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events. RESULTS From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70 ± 4% and overall survival 88 ± 3%. CONCLUSIONS Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.
Collapse
|
149
|
Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa. Nat Rev Clin Oncol 2013; 10:599-604. [PMID: 23897077 DOI: 10.1038/nrclinonc.2013.137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Over 80% of children with cancer live in low and middle-income countries where survival rates are much lower than high-income countries. Challenges to successful treatment of paediatric cancers in these countries include late presentation, malnutrition, failure to complete treatment and less-intense supportive care leading to increased treatment-related mortality and the need to reduce the intensity of treatment. Clinical trials can contribute to improved care and survival by providing objective information on the number of patients treated, accuracy of diagnosis, causes of treatment failure and the efficacy of specific interventions. Clinical trials can also help to build capacity (salary support and training), improve facilities (equipment) and fund treatment or essential associated costs (social support, nutritional support and follow-up care). In this article, we discuss our experience with clinical trials in Malawi and sub-Saharan Africa with emphasis on the treatment of children with Wilms tumour.
Collapse
|
150
|
Harif M, Traoré F, Hessissen L, Moreira C, Atteby JJ. Challenges for paediatric oncology in Africa. Lancet Oncol 2013; 14:279-81. [PMID: 23561740 DOI: 10.1016/s1470-2045(12)70569-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|