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Cayrol J, Ilbawi A, Sullivan M, Gray A. The development and education of a workforce in childhood cancer services in low- and middle-income countries: a scoping review protocol. Syst Rev 2022; 11:167. [PMID: 35964146 PMCID: PMC9375391 DOI: 10.1186/s13643-022-02040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An estimated 400,000 children develop cancer worldwide. Of those, 90% occur in low- and middle-income countries, where survival rates can be as low as 30%. To reduce the childhood cancer survival gap between high- and low- and middle-income countries (LMIC), the World Health Organization launched the Global Initiative for Childhood Cancer in 2018, to support governments in building sustainable childhood cancer programs, with the aim to increase access and quality of care for children with cancer. Developing a high-quality and trained workforce is key to the success of childhood cancer services, but more information is needed on the interventions used to develop and train a workforce. The objective of this review is to understand the key factors described in the literature in relation to the development and training of a workforce in childhood cancer (defined here as ages 0-19) in LMIC, including challenges, interventions and their outcomes. METHODS We will include sources of evidence that describe the development or training of a childhood cancer workforce in health services that diagnose, refer or treat children and adolescents with cancer, in low- and middle-income countries as defined by the World Bank. The following databases will be searched: OVID Medline, Embase and Pubmed from 2001 to present with no restriction of language. Grey literature searches will also be performed in Proquest Dissertation and Theses, as well as relevant organizations' websites, and conference proceedings will be searched in conference websites. In addition, references lists will be reviewed manually. Two people will screen abstracts and full-texts and extract data. Data will be presented in a table or chart, with an accompanying narrative summary responding to the review questions. A framework synthesis will be conducted: data will be charted against a framework adapted from the 2016 WHO Global Strategy for Human Resources for Heath: Workforce 2030. DISCUSSION This scoping review will allow to map the existing literature on workforce development in LMIC, identify potential interventions and highlight data and knowledge gaps. This constitutes a first step towards adopting successful strategies more broadly, formulating research priorities and developing effective policies and interventions. SYSTEMATIC REVIEW REGISTRATION Open Science Framework osf.io/3mp7n.
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Affiliation(s)
- Julie Cayrol
- The University of Melbourne, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia. .,World Health Organization, Geneva, Switzerland.
| | | | - Michael Sullivan
- The University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
| | - Amy Gray
- The University of Melbourne, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
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2
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Matthay KK, Hylton J, Penumarthy N, Khattab M, Soh SY, Nguyen HTK, Alcasabas AP, Fawzy M, Saab R, Khan MS, Ghandour K, Chantada G, Parikh NS, Faulkner L, Lam CG, Howard SC. Global Neuroblastoma Network: An international multidisciplinary neuroblastoma tumor board for resource-limited countries. Pediatr Blood Cancer 2022; 69:e29568. [PMID: 35084087 DOI: 10.1002/pbc.29568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/24/2021] [Accepted: 01/02/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tumor boards are part of standard care of patients with complex cancers, but appropriate multidisciplinary expertise and infrastructure are often not available in low- and middle-income countries (LMIC) for pediatric cancers, such as neuroblastoma. Our goal was to review results of a Global Neuroblastoma Network (GNN) tumor board accessible to LMIC. METHODS De-identified clinical cases presented via internet conference during a weekly GNN virtual tumor board from 2010 through 2020 were evaluated in a standardized format, including diagnostic imaging, pathology, therapy information, resource limitations, and questions for discussion. Information summarized included the presentations, a survey of the impact on care, and a resource questionnaire. RESULTS Registered GNN participants included 575 individuals from 77 countries, with a median of 39 participants per session. Total 412 cases were presented from 32 countries, including 351 unique neuroblastoma patients, 52 follow-up cases, and nine non-neuroblastoma diagnoses. Twenty-eight educational sessions were presented. Limited critical resources for diagnostics and staging of cases included MYCN analysis (54.7%), metaiodobenzylguanidine (MIBG) scans (38.7%), and International Neuroblastoma Pathology Classification (49%). Therapies were also limited, with markedly decreased use of radiation and autologous stem cell transplant for high-risk cases, and no availability of anti-GD2 antibody in LMIC. Limited sampling with a post-presentation survey showed that 100% found the GNN helpful, and 70% altered the care plan based on the discussion. CONCLUSION This report shows the utility of an international tumor board for LMIC focused on a challenging solid tumor where local expertise may be limited, with international multidisciplinary expert participation and educational sessions.
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Affiliation(s)
- Katherine K Matthay
- Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jennifer Hylton
- Department of Network Development, Resonance Health, Memphis, Tennessee, USA
| | - Neela Penumarthy
- Department of Pediatrics, Kaiser Permanente, Oakland, California, USA
| | - Mohammed Khattab
- Pediatric Hematology-Oncology Center, Children's Hospital, University Mohammed Vth, Rabat, Morocco
| | - Shui Yen Soh
- Pediatric Hematology-Oncology, KK Women and Children's Hospital, Singapore
| | | | - Ana Patricia Alcasabas
- Division of Pediatric Hematology Oncology, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Mohammed Fawzy
- Children's Cancer Hospital - Egypt (CCHE/57357) and National Cancer Institute, Cairo University, Cairo, Egypt
| | - Raya Saab
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center Al Madinah, Riyadh, Saudi Arabia
| | | | - Guillermo Chantada
- Fundacion Perez-Scremini-Hospital Pereira Rossell, Montevideo, Uruguay and Institute for Translational Research (IIMT) CONICET-Austral University, Pilar, Argentina
| | - Nehal S Parikh
- Department of Pediatrics, Children's Hospital of NJ and Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | - Catherine G Lam
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Scott C Howard
- Acute and Tertiary Care, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, USA
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3
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Monsereenusorn C, Alcasabas AP, Loh AHP, Soh SY, Leung KWP, Kimpo M, Dhamne C, Blair S, Lam C, Photia A, Rujkijyanont P, Traivaree C, Pairojboriboon S, Rodriguez-Galindo C. Impact of treatment refusal and abandonment on survival outcomes in pediatric osteosarcoma in Southeast Asia: A multicenter study. Pediatr Blood Cancer 2022; 69:e29556. [PMID: 35038209 DOI: 10.1002/pbc.29556] [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: 09/15/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment refusal and abandonment (TxRA) are major barriers to improving outcomes among children with sarcomas of the extremities as curative treatment options bearing on amputation or disfiguring surgery, particularly in countries with limited resources. A multi-institutional retrospective study was conducted to determine the predictive factors for TxRA among patients with osteosarcoma associated with survival outcomes across Southeast Asia (SEA). METHODS Pediatric patients with osteosarcoma treated between January 1998 and December 2017 in four SEA pediatric oncology centers from three countries were studied. Nelson-Aalen estimates, Kaplan-Meier method, and Cox's proportion hazard model were applied to address the cumulative incidence, survival outcomes, and to identify prognostic factors associated with TxRA. RESULTS From a total of 208 patients with osteosarcoma enrolled; 18 (8.7%) patients refused and 41 (19.7%) patients abandoned treatment. Income classification of countries, age at diagnosis, tumor size, disease extent, chemotherapy protocols, and types of surgery were associated with TxRA. Tumor size more than 15 cm was an independent risk factor associated with TxRA. The 5-year overall and relapse-free survivals were 49.4% and 50.4%, respectively. However, these rates declined further to 37.9% and 35.8%, respectively, when TxRA were considered as events. Tumor size larger than 15 cm and metastatic disease were independent risk factors associated with TxRA-sensitive outcomes. CONCLUSION The prevalence of TxRA was high in SEA, particularly in lower middle-income countries. Factors associated with TxRA related to tumor burden. Treatment outcomes could be substantially improved by lowering the refusal and abandonment rates.
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Affiliation(s)
- Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ana Patricia Alcasabas
- Section of Hematology-Oncology, Department of Pediatrics, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Amos Hong Pheng Loh
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Shui Yen Soh
- Duke-NUS Medical School, Singapore.,Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | | | - Miriam Kimpo
- Division of Pediatric Hematology/Oncology & Bone Marrow and Cord Blood Transplantation, University Children's Medical Institute, National University Hospital, Singapore
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sally Blair
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Catherine Lam
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sutipat Pairojboriboon
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Nagabushan S, Rao PJ, Ganta R, Chaturvedi S. Building a Foundation for the Care of Children with Cancer in Rural North India. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractOne of India's biggest challenges is to improve its global standing by increasing healthcare access and outcomes for children with cancer, with inferior overall survivorship compared with its Western counterparts. In conjunction with the government's efforts, private enterprise is crucial in delivering optimal cancer care consistently to its vast and diverse pediatric population, despite existing limitations. This article describes the successful implementation of a value-based, collaborative clinical and research framework by a philanthropic foundation in a rural Northern Indian city to establish and run a local childhood cancer service. It is proof of concept that substantial change could be brought about at grass roots level through resourceful partnerships and reduce prevailing imbalance in pediatric oncology service provision.
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Affiliation(s)
- Sumanth Nagabushan
- Department of Oncology and Bone Marrow Transplant, Perth Children's Hospital, Nedlands, Western Australia
| | - Prashanth J. Rao
- University of New South Wales, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Roopa Ganta
- Department of Head and Neck Oncology, Hanuman Prasad Poddar Cancer Hospital, ChildCan Cancer Foundation, Gorakhpur, Uttar Pradesh, India
| | - Shailja Chaturvedi
- Penrith Psychiatry Clinic, Sydney, New South Wales, Australia
- ChildCan Cancer Foundation, Gorakhpur, Uttar Pradesh, India
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5
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Major A, Palese M, Ermis E, James A, Villarroel M, Klussmann FA, Hessissen L, Geel J, Khan MS, Dalvi R, Sullivan M, Kearns P, Frazier AL, Pritchard-Jones K, Nakagawara A, Rodriguez-Galindo C, Volchenboum SL. Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage. JCO Glob Oncol 2022; 8:e2100266. [PMID: 35157510 PMCID: PMC8853619 DOI: 10.1200/go.21.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer. Local stakeholder engagement is necessary to collaborate with global pediatric cancer trial groups.![]()
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Affiliation(s)
- Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Monica Palese
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Ebru Ermis
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Anthony James
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Milena Villarroel
- Grupo de América Latina de Oncología Pediátrica (GALOP), Hospital Luis Calvo Mackenna, National Pediatric Cancer Program (PINDA), Santiago, Chile
| | - Federico Antillon Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Laila Hessissen
- Pediatric Hematology and Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Saudi Arabia
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
| | | | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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6
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Monsereenusorn C, Suwannaying K, Techavichit P, Sathitsamitphong L, Komvilaisak P, Rujkijyanont P, Seksarn P, Charoenkwan P, Pakakasama S. Clinical outcomes and screening for organ involvement in pediatric Langerhans cell histiocytosis in Thailand: multicenter study on behalf of the Thai Pediatric Oncology Group. Int J Hematol 2022; 115:563-574. [DOI: 10.1007/s12185-022-03293-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
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7
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Nguyen MC, Nguyen V, Le H, Nguyen DV, Nguyen ML, Hermiston ML, Bui CB, Loh AHP. Subcutaneous panniculitis-like T-cell lymphomas with homozygous inheritance of HAVCR2 mutations in Vietnamese pedigrees. Pediatr Blood Cancer 2021; 68:e29292. [PMID: 34398505 DOI: 10.1002/pbc.29292] [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: 05/31/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Vy Nguyen
- DNA Medical Technology, Ho Chi Minh City, Vietnam
| | - Hoa Le
- Children Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Mai-Lan Nguyen
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Michelle L Hermiston
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,Southeast Asia Pediatric Hematology Oncology (SEAPHO), University of California San Francisco, San Francisco, California, USA
| | - Chi-Bao Bui
- City Children's Hospital, Ho Chi Minh City, Vietnam.,School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
| | - Amos Hong Pheng Loh
- VIVA KKH Paediatric Brain and Solid Tumour Programme, KK Womens' and Children's Hospital, Singapore.,SingHealth Duke NUS Global Health Institute, Duke NUS Medical School, Singapore
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8
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Olkhov-Mitsel E, Lu FI, Gagliardi A, Plotkin A. Gynecologic pathology services in low- and middle-income countries. Int J Gynecol Cancer 2021; 32:918-923. [PMID: 34815269 DOI: 10.1136/ijgc-2021-003103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The International Gynecologic Cancer Society (IGCS) offers multidisciplinary conferences to underserved communities. Mentor pathologists have become an integral part of these tumor boards, as pathology services in low-to-middle-income countries are often inadequate and disjointed. The IGCS Pathology Working Group conducted a survey to assess barriers to quality pathology services in low-to-middle-income countries and identified potential solutions. METHODS A 69-question cross-sectional survey assessing different aspects of pathology services was sent to 15 IGCS Extension for Community Healthcare Outcomes (ECHO) training sites in Africa, Asia, Central America, and the Caribbean. Local gynecologic oncologists distributed the survey to their pathology departments for review. The responses were tabulated in Microsoft Excel. RESULTS Responses were received from nine training sites: five sites in Africa, two in Asia, one in Central America, and one in the Caribbean. There were no pathologists with subspecialty training in gynecologic pathology. Most (7/9, 78%) surveyed sites indicated that they have limited access to online education and knowledge transfer resources. Of the eight sites that responded to the questions, 50% had an electronic medical system and 75% had a cancer registry. Synoptic reporting was used in 75% of the sites and paper-based reporting was predominant (75%). Most (6/7, 86%) laboratories performed limited immunohistochemical stains on site. None of the sites had access to molecular testing. CONCLUSIONS Initial goals for collaboration with local pathologists to improve diagnostic pathology in low- and middle-income countries could be defining minimal gross, microscopic, and reporting pathology requirements, as well as wisely designed educational programs intended to mentor local leaders in pathology. Larger studies are warranted to confirm these observations.
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Affiliation(s)
- Ekaternia Olkhov-Mitsel
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Fang-I Lu
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anna Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna Plotkin
- Division of Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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9
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Ghalibafian M, Masoudifar M, Mohammadi E, Girinsky T, Oberlin O, Bouffet E. Establishing a pediatric radiation oncology department in a low- and middle-income country: Major challenge in implementing the Global Initiative for Childhood Cancer. Pediatr Blood Cancer 2021; 68:e29233. [PMID: 34357689 DOI: 10.1002/pbc.29233] [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: 02/13/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Mithra Ghalibafian
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Maryam Masoudifar
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Ehsan Mohammadi
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Odile Oberlin
- Department of Pediatrics, Gustave Roussy, Villejuif, France
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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10
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Roebuck DJ, McLaren CA. Pediatric interventional radiology - does it add value? Pediatr Radiol 2021; 51:570-573. [PMID: 33743040 DOI: 10.1007/s00247-020-04935-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 01/29/2023]
Abstract
Although attempts have been made to show that pediatric interventional radiology adds value in children's hospitals, none has been particularly persuasive. An analysis of individual procedures would seem to be the most scientific approach, but there are numerous problems, including the effects that different health care systems have on clinical practice and the difficulty of generalizing the results of a single-center study to other hospitals, even within the same type of health care system. It is unsurprising that there are no published randomized controlled trials comparing both the costs and outcomes of specific pediatric interventional radiology procedures with surgical alternatives, and in fact these may not be feasible. There is only anecdotal evidence of the value of pediatric interventional radiology in multidisciplinary teams in children's hospitals. Currently, the best justification may be the counterfactual: demonstrating what can go wrong if pediatric interventional radiology expertise is not available.
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Affiliation(s)
- Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia. .,Division of Paediatrics, Medical School, University of Western Australia, Crawley, Australia.
| | - Clare A McLaren
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia.,School of Molecular and Life Sciences, Curtin University, Bentley, Australia
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