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Pio L, Loh A, Harrison D, Gonzalez G, Qureshi S, Lakhoo K, Abib S, Abdelhafeez AH. Childhood cancer surgery in low- and middle-income countries. Pediatr Blood Cancer 2024:e31238. [PMID: 39099136 DOI: 10.1002/pbc.31238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024]
Abstract
This report summarizes the status of pediatric surgical oncology services in low- and middle-income countries. Factors such as surgical capacity and enablers, and barriers to providing pediatric surgical oncology services are discussed. A review of the literature was conducted to examine the evidence for the capacity of low- and middle-income countries to provide childhood cancer surgery services, focusing on general surgery. Unpublished, ongoing work and initiatives of international organizations are also described.
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Affiliation(s)
- Luca Pio
- Paediatric Surgery Unit, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amos Loh
- SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatric Surgery and KKH Children's Blood and Cancer Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Derek Harrison
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Sajid Qureshi
- Department of Pediatric Surgery, Tata Memorial Hospital, Mumbai, India
| | - Kokila Lakhoo
- Oxford Global Surgery, Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| | - Simone Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Noun D, Obeid A, Belgaumi A, Sidhom I, Jadiry MA, Al-Saeed R, Khalifa N, Trehan A, Ghanem K, AbdelHafeez H, Rodriguez-Galindo C, Jeha S, Saab R. A regional virtual case discussion forum in pediatric oncology: Experience of the Pediatric Oncology East and Mediterranean Group. Pediatr Blood Cancer 2024; 71:e30838. [PMID: 38149824 DOI: 10.1002/pbc.30838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The Pediatric Oncology East and Mediterranean (POEM) group that aims to share expertise among pediatric oncology providers across the Middle East, North Africa, and East Asia region initiated a virtual Case Discussion Forum (CDF) in 2013. METHODS Meeting records from September 2013 till June 2021 were reviewed. Detailed minutes were available starting August 2016; case data were analyzed including diagnoses, purpose of presentation and recommendations. A 38-item survey assessing perception of benefits, challenges, and opportunities of the forum was distributed to members of the POEM group and results analyzed. RESULTS A total of 140 cases were presented from 14 countries. After August 2016, 67 cases were presented, and those were analyzed regarding reasons for discussion, barriers, and recommendations. Details are presented in this report, and the most common challenges identified were related to histopathologic/molecular diagnosis (24%), imaging interpretation (18%), resource limitations (12%), and surgical difficulties (9%). A survey was distributed to all POEM members in 28 countries, and 76 responded. The main benefit reported was the provision of recommendations regarding treatment and evaluation, while the main challenges reported were time zone difference and workload. Recognized opportunities included conducting regionally relevant research studies based on clinical problems identified during discussions, and setting guidelines for resource-adapted treatment regimens. CONCLUSIONS The POEM CDF identified areas for multi-institutional regional studies and led to a twinning project between two centers in the region for improving diagnostic infrastructure. Such forums can identify specific resource limitations in pediatric cancer and direct efforts for targeted capacity building.
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Affiliation(s)
- Dolly Noun
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anas Obeid
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asim Belgaumi
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Iman Sidhom
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children Cancer Hospital Egypt, Cairo, Egypt
| | - Mazin Al Jadiry
- Department of Pediatrics, Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Raghad Al-Saeed
- Department of Pediatrics, Oncology Unit, Children Welfare Teaching Hospital, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Nisreen Khalifa
- Pediatric Hematology Oncology Unit, National Bank of Kuwait Specialized Hospital for Children, Sabah, Kuwait
| | - Amita Trehan
- Pediatric Hematology Oncology Unit, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Khaled Ghanem
- BASMA Pediatric Oncology Unit, Al Bayrouni Hospital, Damascus, Syria
| | - Hafeez AbdelHafeez
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sima Jeha
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Raya Saab
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
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Mushtaq N, Qureshi BM, Javed G, Sheikh NA, Bakhshi SK, Laghari AA, Enam SA, Anwar SSM, Hilal K, Kabir A, Ahmad A, Goraya A, Mistry AS, Rashid A, Maaz AUR, Munawar MA, Khan AA, Bashir F, Hashmi H, Saeed K, Khandwala K, Rehman L, Dewan MC, Khan MS, Karim MU, Shaheen N, Zia N, Yasmeen N, Mahmood R, Memon RAR, Kirmani S, Resham S, Kadri S, Riaz S, Hamid SA, Ghafoor T, Imam U, Mushtaq YR, Rana ZA, Bouffet E, Minhas K. Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S. Front Oncol 2024; 14:1325167. [PMID: 38487721 PMCID: PMC10938908 DOI: 10.3389/fonc.2024.1325167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant. Methods We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints. Results A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three. Discussion The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care.
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Affiliation(s)
- Naureen Mushtaq
- Peadiatric Oncology Section, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Bilal Mazhar Qureshi
- Radiation Oncology Section, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Gohar Javed
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nabeel Ashfaque Sheikh
- Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Altaf Ali Laghari
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Neurosurgery Section, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Arsalan Kabir
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Alia Ahmad
- Department of Pediatric Oncology, Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | - Amber Goraya
- Department of Radiology Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | | | - Aqeela Rashid
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Muhammad Atif Munawar
- Department of Radiation Oncology, Northwest General Hospital and Research Center, Peshawar, Pakistan
| | - Atiq Ahmed Khan
- Department of Neurosurgery, Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan
| | | | - Hina Hashmi
- Jinnah Postgraduate Medical Centre, Aga Khan University, Karachi, Pakistan
| | - Kamran Saeed
- Jinnah Postgraduate Medical Centre, Aga Khan University, Karachi, Pakistan
| | | | - Lal Rehman
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Michael C. Dewan
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia
| | - Muneeb uddin Karim
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nida Zia
- Indus Hospital & Health Network, Karachi, Pakistan
| | - Nuzhat Yasmeen
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Raheela Mahmood
- Atomic Energy Medical Centre, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Shazia Kadri
- Jinnah Medical College and Teaching Hospital, Peshawar, Pakistan
| | - Shazia Riaz
- Children’s Hospital and Institute of Child Health, Lahore, Pakistan
| | | | | | - Uzma Imam
- Child Aid Association, National Institute of Child Health, Karachi, Pakistan
| | | | - Zulfiqar Ali Rana
- Children’s Hospital & The Institute of Child Health Multan, Multan, Pakistan
| | - Eric Bouffet
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
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Ali N, Amare E, Fekadu A, Awol M, Kayode O, Gebresenbet M, Nasir K, Dresser SA, Schriebmann E, Seife E, Esiashvili N. Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally. JCO Glob Oncol 2024; 10:e2300345. [PMID: 38359372 PMCID: PMC10881094 DOI: 10.1200/go.23.00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. METHODS Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. RESULTS Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. CONCLUSION Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.
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Affiliation(s)
- Naba Ali
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Elias Amare
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adugna Fekadu
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Munir Awol
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Molalgn Gebresenbet
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Keyru Nasir
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Edom Seife
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Troschke T, Wieczorek A, Kulinski K, Ociepa T, Zielezinska K, Lode HN, Urasinski T. Pediatric Hematology and Oncology Center Integrated by Telemedicine: Experience, Challenges and First Results of a Cross Border Network. Healthcare (Basel) 2023; 11:healthcare11101431. [PMID: 37239717 DOI: 10.3390/healthcare11101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This article reports on the development, implementation and management of a German-Polish telemedicine network in the field of pediatric oncology and hematology in the Euroregion Pomerania. The achievements and challenges of joint medical case reviews involving patients and their care givers, as well as cross-border education activities for physicians, students and nursing staff, are presented. In addition to a progress report, the results of an evaluation of the participants and teachers, likewise the measurement of knowledge growth, are given.
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Affiliation(s)
- Tabea Troschke
- Department of Pediatric Hematology and Oncology, University Medicine of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Aleksandra Wieczorek
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 265 Wielicka Str., 30-663 Krakow, Poland
| | - Konrad Kulinski
- Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, 265 Wielicka Str., 30-663 Krakow, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Karolina Zielezinska
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine of Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Tomasz Urasinski
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
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