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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 Unpublished, ongoing work and initiatives of international organizations are also described.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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Siddiqui AK, Belgaumi AF. Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges. Ecancermedicalscience 2024; 18:1677. [PMID: 38439809 PMCID: PMC10911667 DOI: 10.3332/ecancer.2024.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 03/06/2024] Open
Abstract
The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.
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Affiliation(s)
- Arsalan Kabir Siddiqui
- All authors have contributed to this manuscript and take responsibility for its contents
| | - Asim Fakhruddin Belgaumi
- All authors have contributed to this manuscript and take responsibility for its contents
- https://orcid.org/0000-0002-0135-7509
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Schneider NM, Rossell N, Khan MS. Psychosocial services for pediatric oncology patients in low- and middle-income countries from health care providers' perspectives: A survey-based report from the SIOP Global Health Network Psychosocial Working Group. Psychooncology 2023; 32:1710-1717. [PMID: 37795966 DOI: 10.1002/pon.6222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES While pediatric cancer survival rates have improved in high-income countries, they remain much lower in low- and middle-income countries (L/MICs). While much focus in recent years has been on remediating the survivorship gap, less is known about the psychosocial needs and availability of psychosocial services for this population. METHODS A questionnaire was created by the SIOP Global Health Network Psychosocial Working Group to assess psychosocial needs and services in L/MIC. The questionnaire was distributed to pediatric oncology professionals, both in-person at the SIOP Annual Congress in Lyon (2019) conference and then electronically. Individuals not part of SIOP were also invited to participate via social media posts. RESULTS Sixty-six respondents from 31 countries completed the questionnaire. The majority of participants were physicians, followed by nurses. Participants from low- and lower-middle-income countries (L/LMICs) perceived patients as having higher rates of anxiety and caregivers as having higher rates of depression as compared to those in upper-middle-income countries (UMICs). Across all L/MICs represented, 85% of physicians reported that psychosocial issues sometimes, frequently, or always affect their clinical obligations. Participants reflected on the availability of professionals who treat mental health concerns; the availability of social workers, psychologists, and non-professional volunteers differed significantly between L/LMICs and UMICs. Treatment abandonment and myths/disinformation were highlighted as the most pressing psychosocial priorities. CONCLUSION Our study highlights pediatric oncology providers' perceptions of psychosocial concerns. Based on responses, proposals for minimum standards of care are made, as well as the importance of training existing providers and funding additional psychosocially-focused professionals.
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Affiliation(s)
- Nicole M Schneider
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
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Moreira DC, Metzger ML, Antillón-Klussmann F, González-Ramella O, Gao Y, Bazzeh F, Middlekauff J, Fox Irwin L, Gonzalez ML, Chantada G, Barr RD, Garrington T, Hastings C, Kutluk T, Saab R, Khan MS, Saha V, Rodríguez-Galindo C, Friedrich P. Development of EPAT: An assessment tool for pediatric hematology/oncology training programs. Cancer 2023; 129:3448-3456. [PMID: 37417913 DOI: 10.1002/cncr.34946] [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: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE In the absence of a standardized tool to assess the quality of pediatric hematology/oncology training programs, the Education Program Assessment Tool (EPAT) was conceptualized as a user-friendly and adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for training programs around the world. METHODS The development of EPAT consisted of three main phases: operationalization, consensus, and piloting. After each phase, the tool was iteratively modified based on feedback to improve its relevance, usability, and clarity. RESULTS The operationalization process led to the development of 10 domains with associated assessment questions. The two-step consensus phase included an internal consensus phase to validate the domains and a subsequent external consensus phase to refine the domains and overall function of the tool. EPAT domains for programmatic evaluation are hospital infrastructure, patient care, education infrastructure, program basics, clinical exposure, theory, research, evaluation, educational culture, and graduate impact. EPAT was piloted in five training programs in five countries, representing diverse medical training and patient care contexts for proper validation of the tool. Face validity was confirmed by a correlation between the perceived and calculated scores for each domain (r = 0.78, p < .0001). CONCLUSIONS EPAT was developed following a systematic approach, ultimately leading to a relevant tool to evaluate the different core elements of pediatric hematology/oncology training programs across the world. With EPAT, programs will have a tool to quantitatively evaluate their training, allowing for benchmarking with centers at the local, regional, and international level.
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Affiliation(s)
| | | | - Federico Antillón-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | | | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
| | | | | | | | | | - Guillermo Chantada
- Fundacion Pérez Scremini-Hospital Pereira Rossell, Montevideo, Uruguay
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ronald D Barr
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Tezer Kutluk
- Hacettepe University Faculty of Medicine & Cancer Institute, Ankara, Turkey
| | - Raya Saab
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Muhammad Saghir Khan
- King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
| | | | | | - Paola Friedrich
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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van Heerden J, Lisa Christine I, Downing J, Davidson A, Hessissen L, Schoeman J, Ladas EJ, Abdelhafeez H, Georgia Odongo Arao S, Fentie AM, Kamal S, Parkes J, Naiker T, Ludick A, Balagadde-Kambugu J, Geel J. Current status of African pediatric oncology education efforts aligned with the Global Initiative for Childhood Cancer. Pediatr Hematol Oncol 2023; 40:224-241. [PMID: 36083006 DOI: 10.1080/08880018.2022.2117882] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for. LEARNING POINTSThe African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge.African pediatric oncology teams rely on a multitude of international sources for training while developing their own.There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses.Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced.Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.
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Affiliation(s)
- Jaques van Heerden
- Pediatric Hematology and Oncology, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Pediatric Hematology and Oncology, Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Irumba Lisa Christine
- Advocacy and Research Officer, Palliative Care Association of Uganda, Kampala, Uganda
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, UK
- Palliative care Education and Research Consortium, Kampala, Uganda
| | - Alan Davidson
- Pediatric Hematology-Oncology Service, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Laila Hessissen
- Pediatric Oncology Department, Children's Hospital, University Mohammed V, Rabat, Morocco
| | - Judy Schoeman
- Department of Pediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Elena J Ladas
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Columbia University Irving Medical Center, New York, New York, USA
| | - Hafeez Abdelhafeez
- Department of Surgery, St. Jude Children Research Hospital, Memphis, Tennessee, USA
| | | | - Atalay Mulu Fentie
- Tikur Anbessa Specialized Hospital, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sherif Kamal
- Pharmacy Manager, Children's Hospital, Cairo, Egypt
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Adri Ludick
- Program Development Manager, Childhood Cancer Foundation South Africa (CHOC) National Office, Johannesburg, South Africa
| | | | - Jennifer Geel
- University of the Witwatersrand, Division of Pediatric Hematology-Oncology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Corrigendum. Pediatr Blood Cancer 2022; 69:e29998. [PMID: 36184698 DOI: 10.1002/pbc.29998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Simonyan J, Hakobyan L, Anastasiadi M, Sargsyan L, Vagharshakyan L, Papyan R, Krmoyan L, Martirosyan M, Danielyan S, Muradyan A, Tamamyan G. Comment on: Pediatric oncology infrastructure and workforce training needs: A report from the Pediatric Oncology East and Mediterranean (POEM) Group. Pediatr Blood Cancer 2022; 69:e29357. [PMID: 34954896 DOI: 10.1002/pbc.29357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | - Lusine Hakobyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | - Medea Anastasiadi
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | - Lilit Sargsyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | - Lala Vagharshakyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | - Ruzanna Papyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | - Lusine Krmoyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
| | | | | | | | - Gevorg Tamamyan
- Yerevan State Medical University, Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, Yerevan, Armenia
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Moleti ML, Testi AM, Foà R. Childhood aggressive B-cell non-Hodgkin lymphoma in low-middle-income countries. Br J Haematol 2021; 196:849-863. [PMID: 34866182 DOI: 10.1111/bjh.17979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
In high-income countries (HICs) paediatric aggressive B-cell lymphomas are curable in about 90% of cases. Much worse results, with cure rates ranging from less than 30% to about 70%, are achieved in low- and middle-income countries (LMICs), where 90% of paediatric non-Hodgkin lymphomas occur. Low socio-economic and cultural conditions, the lack of optimal diagnostic procedures, laboratory facilities and adequate supportive care exert a strong negative impact on compliance, treatment delivery, toxicity and, consequently, on the clinical outcome. Published data are scarce, generally originating from single institutions, and are difficult to compare. National and international cooperation projects have been undertaken to reduce the unacceptable gap between HICs and LMICs in the management of children with cancer, by promoting the sharing of knowledge and by implementing adequate local healthcare facilities, with initial promising results. In the present review, we will summarize the results so far obtained in the management of paediatric aggressive B-cell NHL in LMICs.
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Affiliation(s)
- Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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