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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 Unpublished, ongoing work and initiatives of international organizations are also described.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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Mathew A, Davis S, Boby JM, R I A, Suryavanshi M, Dawood SS, Panda PK, Nag SM, Das A, Rohatgi N, Popat S, Shah RN, Thampy C, Parikh AR, Yadav S, Mehta P, Singh R, Mukherji D, Shilpakar R, Mullapally SK, Sirohi B. Discordance in Recommendation Between Next-Generation Sequencing Test Reports and Molecular Tumor Boards in India. JCO Glob Oncol 2024; 10:e2300330. [PMID: 38484196 PMCID: PMC10954076 DOI: 10.1200/go.23.00330] [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: 09/06/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Accurate understanding of the genomic and transcriptomic data provided by next-generation sequencing (NGS) is essential for the effective utilization of precision oncology. Molecular tumor boards (MTBs) aim to translate the complex data in NGS reports into effective clinical interventions. Often, MTB treatment recommendations differ from those in the NGS reports. In this study, we analyze the discordance between these recommendations and the rationales behind the discordances, in a non-high-income setting, with international input to evaluate the necessity of MTB in clinical practice. METHODS We collated data from MTB that were virtually hosted in Chennai, India. We included patients with malignancies who had NGS reports on solid tissue or liquid biopsies, and excluded those with incomplete data. MTB forms and NGS reports of each clinical case were analyzed and evaluated for recommendation concordance. Concordance was defined as an agreement between the first recommendation in the MTB forms and the therapeutic recommendations suggested in the NGS report. Discordance was the absence of the said agreement. The rationales for discordance were identified and documented. RESULTS Seventy MTB reports were analyzed with 49 cases meeting the inclusion criteria. The recommendation discordance was 49% (24 of 49). Discordant recommendations were mainly due to low level of evidence for the drug (75% of cases). CONCLUSION The discordance between MTB and NGS vendor recommendations highlights the clinical utility of MTB. The educational experiences provided by this initiative are an example of how virtual academic collaborations can enhance patient care and provider education across geographic borders.
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Affiliation(s)
- Aju Mathew
- Kerala Cancer Care, Ernakulam Medical Centre and MOSC Medical College, Ernakulam, India
| | | | | | - Anu R I
- Mediclinic City Hospital, Dubai, United Arab Emirates
| | | | | | | | | | | | | | - Sanjay Popat
- Department of Medicine, The Royal Marsden Hospital—NHS Foundation, London, United Kingdom
| | | | | | - Aparna Raj Parikh
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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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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Hou R, Yu Y, Jiang J. Prostaglandin E2 in neuroblastoma: Targeting synthesis or signaling? Biomed Pharmacother 2022; 156:113966. [DOI: 10.1016/j.biopha.2022.113966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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Abstract
Neuroblastomas are tumours of sympathetic origin, with a heterogeneous clinical course ranging from localized or spontaneously regressing to widely metastatic disease. Neuroblastomas recapitulate many of the features of sympathoadrenal development, which have been directly targeted to improve the survival outcomes in patients with high-risk disease. Over the past few decades, improvements in the 5-year survival of patients with metastatic neuroblastomas, from <20% to >50%, have resulted from clinical trials incorporating high-dose chemotherapy with autologous stem cell transplantation, differentiating agents and immunotherapy with anti-GD2 monoclonal antibodies. The next generation of trials are designed to improve the initial response rates in patients with high-risk neuroblastomas via the addition of immunotherapies, targeted therapies (such as ALK inhibitors) and radiopharmaceuticals to standard induction regimens. Other trials are focused on testing precision medicine strategies for patients with relapsed and/or refractory disease, enhancing the antitumour immune response and improving the effectiveness of maintenance regimens, in order to prolong disease remission. In this Review, we describe advances in delineating the pathogenesis of neuroblastoma and in identifying the drivers of high-risk disease. We then discuss how this knowledge has informed improvements in risk stratification, risk-adapted therapy and the development of novel therapies.
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