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Pichardo-Rojas PS, Palacios-Cruz M, Calderón-Magdaleno LF, Coria-Medrano A, Flores-López SI, Garcia-Mijangos PC, Esquenazi Y. Evaluating Neurosurgical Care Perception Across Mexico: Insights from a Nationwide Survey. World Neurosurg 2024; 188:e41-e52. [PMID: 38735568 DOI: 10.1016/j.wneu.2024.05.001] [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: 01/09/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Most of the scientific and healthcare resources in Mexico are limited to the large major cities. However, many communities with complex socioeconomic and cultural backgrounds have limited access to neurosurgical care. A cross-sectional study aiming to evaluate the population's perception regarding neurosurgical care was conducted. METHODS A nationwide online survey, conducted starting February 2023, assessed public perception of neurosurgical care. Data analysis was performed based on sociodemographic characteristics such as age, socioeconomic status, religion, and education. Pearson's chi-square and odds ratio were employed for statistical comparisons of categorical variables. RESULTS A total of 508 participants consented to the survey. Younger participants and higher education levels correlated with greater perceived knowledge about neurosurgery (P = <0.001) and higher confidence in neurosurgical healthcare personnel (P = 0.021 and P = 0.022, respectively). Lower educational levels were prone to perceive neurosurgical care as less safe and effective (P = 0.002) and preferred to seek initial alternative/traditional treatments for neurosurgical issues (P = 0.012). A higher income level was associated with a preference for private healthcare over public services P = <0.001). Odds ratio analysis corroborated these findings. Healthcare personnel emerged as the most common source of information for neurosurgical diseases (71.4%). CONCLUSIONS Our findings suggest that sociodemographic factors such as age, education, and income correlate with the population's self-perceived knowledge, trust and beliefs about safety and effectiveness regarding neurosurgical care in Mexico. These findings can be instrumental for developing healthcare policies that address the needs of Mexico's patient population.
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Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.
| | | | | | - Adrian Coria-Medrano
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Shadia I Flores-López
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad en Ciencias de la Salud, Universidad Anáhuac México, Estado de México, Mexico
| | - Paulina C Garcia-Mijangos
- Facultad de Ciencias de la Salud, Universidad Autónoma de Baja California, Baja California, Mexico; Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Yoshua Esquenazi
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas
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Shakir M, Shariq SF, Irshad HA, Khowaja AH, Tahir I, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Governance Challenges to the Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2024:S1878-8750(24)01258-0. [PMID: 39038646 DOI: 10.1016/j.wneu.2024.07.118] [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: 04/01/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Low- and middle-income countries (LMICs) often struggle to provide adequate neurosurgical care due to poor governance and institutional efforts, making access to care difficult. Therefore, our review of literature aims to identify gaps in government, national, and institutional efforts to combat barriers to neurosurgical care of brain tumors in LMICs, to inform future policy and action planning. METHODS A comprehensive literature search was conducted using PubMed, Scopus, Google Scholar, and CINAHL without language restrictions from inception to October 20, 2022. After screening and data extraction, a thematic analysis based on the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) systematically identified and classified notable themes, which were then quantified and presented as percentages. RESULTS A total of 12 studies were included in the final analysis. The review highlighted some of the barriers to providing surgical care of brain tumors in LMICs, including political instability (14%), inadequate national budget for health care (43%), poor government support (14%), lack of support of hospital management (14%), and no coverage under national insurance plans (14%). Strategies that can be implemented to address the barriers include strengthening the local health system (17%), advocating for health ministry support (33%), developing national treatment guidelines (17%), making neurosurgery a part of the national surgical plan (17%), fostering collaborations across various levels of government (17%), changing national insurance policy to include neurosurgical care (17%), and advocating for more resources and changes in global care (33%). CONCLUSIONS Effective governance plays a critical role in addressing challenges as it shapes the availability of resources and policies that affect the quality of care provided. Our study outlines key challenges and strategies reported within literature in an attempt to drive government attention and thereby policy to support the neurosurgical care of brain tumors, particularly in the developing world.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department Aga Khan University Hospital, Karachi, Pakistan; Centre of Oncological Research in Surgery (COORS), Juma Research Laboratories, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Centre of Oncological Research in Surgery (COORS), Juma Research Laboratories, Aga Khan University, Karachi, Pakistan.
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Shakir M, Shariq SF, Irshad HA, Khowaja AH, Tahir I, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Barriers to Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review of the Service Delivery Challenges. World Neurosurg 2024; 187:211-222.e3. [PMID: 38740084 DOI: 10.1016/j.wneu.2024.05.044] [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: 04/02/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Brain tumors pose a major challenge in low- and middle-income countries (LMICs) due to limited resources and high costs, resulting in hampered service delivery of neurosurgical care and significant disparities in patient outcomes compared to high-income nations. Therefore, our systematic review aims to identify barriers to service delivery in providing adequate surgical care for the management of brain tumors in LMICs. METHODS We searched Scopus, PubMed, Google Scholar, and CINAHL, from inception to October 20, 2022. The data from the eligible studies were extracted and analyzed qualitatively. RESULTS The final analysis included 35 articles, which highlighted significant challenges in providing adequate surgical care for brain tumors in LMICs. Among the cited studies, 10% reported lack of multidisciplinary team structures, 61% noted delayed patient presentation, 16% highlighted delays in neuroimaging, 10% reported delays in scheduling surgery, lack of training for specialized surgery (3%), lack of intra-operative facilities (19%), power supply interruption (6%), and lack of advanced diagnostic and specialized surgery facilities (19%). Strategies for addressing these challenges include cross-border collaboration (7%), public education, and awareness (13%), establishing multidisciplinary teams (20%), utilizing alternative surgical techniques (13%), 7% intraoperative ultrasound, 13% intraoperative cytology smear), and establishing satellite hospitals for low-risk care (7%), standard operating procedure and infection control (13%). CONCLUSION Targeted interventions considering economic constraints are essential to improve the availability, affordability, and quality of neuro-oncologic services in developing countries. International collaborations and building capacity are vital for improving patient outcomes and service delivery, as well as forming multidisciplinary teams and utilizing resource-saving, innovative methods.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Shakir M, Khowaja AH, Shariq SF, Irshad HA, Tahir I, Rae AI, Hamzah R, Gupta S, Park KB, Enam SA. Workforce Challenges for the Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Scoping Review. World Neurosurg 2024:S1878-8750(24)01057-X. [PMID: 38925244 DOI: 10.1016/j.wneu.2024.06.098] [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: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Limited neurosurgical workforces remain one of the critical problems experienced in low resource settings. Therefore, our study aims to explore and summarize the key challenges to neurosurgical care of brain tumors in terms of workforce in LMICs. A comprehensive literature search was conducted using Scopus, PubMed, CINAHL, and Google Scholar from inception to October 20, 2022. All extracted data were screened independently by 2 reviewers and thematically analyzed. We found and screened 3764 articles, of which 33 studies were included in our final analysis as per our inclusion criteria. Among the studies included, 33% highlighted the limited number of neurosurgeons, 39% emphasized the absence of specialized surgical teams, 7% pointed out a shortage of nursing staff, and 4% noted suboptimal anesthesia teams. The study uncovered the need for improved training programs in neuro-oncology (32%) and neuro-anesthesia (3%), as well as improved collaboration (32%), and multidisciplinary team structures (15%), are essential for tackling these workforce challenges and improving patient outcomes. It is crucial to implement targeted interventions and policy changes to address the barriers to the workforce in providing effective neurosurgical care to patients with brain tumors in developing countries. This might entail capacity building and training programs for healthcare professionals. Policymakers should consider allocating resources and funding for workforce development and making neurosurgical care a priority in healthcare plans.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | | | | | | | - Izza Tahir
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Ali I Rae
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Radzi Hamzah
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Díaz-Coronado R, Villar RC, Cappellano AM. Pediatric neuro-oncology in Latin America and the Caribbean: a gap to be filled. Front Oncol 2024; 14:1354826. [PMID: 38571497 PMCID: PMC10989070 DOI: 10.3389/fonc.2024.1354826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Rosdali Díaz-Coronado
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
- Post Graduated Medicine School, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosangela Correa Villar
- Radiation Oncology Department, Centro Infantile Boldrini, Sao Paolo, Brazil
- Medicine School, University of São Paulo, São Paulo, Brazil
| | - Andrea M. Cappellano
- Pediatric Oncology Department, Pediatric Oncology Institute-GRAACC (IOP-GRAACC)/Federal University of São Paulo, São Paulo, Brazil
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Ramirez O, Piedrahita V, Ardila J, Pardo C, Cabrera-Bernal E, Lopera J, Suarez A, Portilla CA, Narváez C, Rodriguez P, Castro X, Castro Á, Estupinan-Perico DI, Valencia D, Álvarez MDR, Fox JE, Bravo LE, Aristizabal P. Primary central nervous system tumors survival in children in ten Colombian cities: a VIGICANCER report. Front Oncol 2024; 13:1326788. [PMID: 38505512 PMCID: PMC10949889 DOI: 10.3389/fonc.2023.1326788] [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: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 03/21/2024] Open
Abstract
Purpose Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. Methods We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. Results During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. Conclusion We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.
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Affiliation(s)
- Oscar Ramirez
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Clínica Imbanaco – Grupo Quirón Salud, Cali, Colombia
- Registro Poblacional de Cáncer de Cali – Departamento de Patología, Universidad del Valle, Cali, Colombia
| | - Vivian Piedrahita
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Clínica Imbanaco – Grupo Quirón Salud, Cali, Colombia
- Escuela de Enfermería, Universidad del Valle, Cali, Colombia
| | - Jesus Ardila
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Clínica Imbanaco – Grupo Quirón Salud, Cali, Colombia
| | - Carlos Pardo
- Unidad de Oncología y Hematología Pediátrica, Hospital de la Misericordia (HOMI) Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
- Grupo de Oncología y Hematología Pediátrica Universidad Nacional de Colombia, Bogotá, Colombia
| | - Edgar Cabrera-Bernal
- Unidad de Oncología y Hematología Pediátrica, Hospital de la Misericordia (HOMI) Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia
- Grupo de Oncología y Hematología Pediátrica Universidad Nacional de Colombia, Bogotá, Colombia
| | - John Lopera
- Unidad de Oncología y Hematología Pediátrica, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Amaranto Suarez
- Unidad de Oncología y Hematología Pediátrica, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Carlos Andrés Portilla
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Clínica Imbanaco – Grupo Quirón Salud, Cali, Colombia
- Departamento de Pediatría, Universidad del Valle, Cali, Colombia
| | - Carlos Narváez
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Clínica Imbanaco – Grupo Quirón Salud, Cali, Colombia
- Departamento de Pediatría, Universidad del Valle, Cali, Colombia
| | - Pamela Rodriguez
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Fundación Valle del Lili, Cali, Colombia
| | - Ximena Castro
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Fundación Valle del Lili, Cali, Colombia
| | - Ángel Castro
- Departamento de Pediatría, Universidad de Cartagena, Unidad de Oncología y Hematología Pediátrica, Clínica Blas de Lezo, Cartagena, Colombia
| | | | - Diana Valencia
- Unidad de Oncología y Hematología Pediátrica: Instituto Médico de Alta Tecnología (IMAT) Oncomédica, Montería, Colombia
| | - María del Rosario Álvarez
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Unidad de Oncología y Hematología Pediátrica, Hospital Infantil Los Ángeles, Pasto, Colombia
| | - Javier Enrique Fox
- Unidad de Oncología y Hematología Pediátrica, Fundación San Vicente de Paul, Medellín, Colombia
| | - Luis Eduardo Bravo
- Unidad de Investigación, Fundación Pediatras Oncólogos y Hematólogos (POHEMA), Cali, Colombia
- Registro Poblacional de Cáncer de Cali – Departamento de Patología, Universidad del Valle, Cali, Colombia
| | - Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA, United States
- Population Sciences, Disparities and Community Engagement, Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
- Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California, San Diego, San Diego, CA, United States
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Aristizabal P, Rivera-Gomez R, Chang A, Ornelas M, Ramirez M, Tamayo G, Martinez A, Ribeiro RC, Roberts W. Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models. JCO Glob Oncol 2023; 9:e2300123. [PMID: 37269343 PMCID: PMC10497272 DOI: 10.1200/go.23.00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/05/2023] Open
Abstract
PURPOSE Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence. METHODS In 2013, through a partnership between North-American and Mexican institutions, we used the WHO Framework for Action, a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators. RESULTS Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% (P = .023), 73% to 100% (P < .001), and 48% to 55% (P = .031), respectively. All sustainability indicators improved between 2013 and 2017. CONCLUSION Using the health systems strengthening WHO Framework for Action model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.
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Affiliation(s)
- Paula Aristizabal
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
- University of California San Diego Altman Clinical and Translational Research Institute, Dissemination and Implementation Science Center, La Jolla, CA
| | - Rebeca Rivera-Gomez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Andrew Chang
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Mario Ornelas
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Maribel Ramirez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Gabriela Tamayo
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Angelica Martinez
- Hospital General de Tijuana, Universidad Autónoma de Baja California, Tijuana, Mexico
| | - Raul C. Ribeiro
- Department of Oncology, Leukemia/Lymphoma Division, and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - William Roberts
- Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA
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Aristizabal P, Thornburg CD, Young J. At the border: A call to action for health equity for children with leukemia. Cancer 2023; 129:1159-1161. [PMID: 36805948 PMCID: PMC10416232 DOI: 10.1002/cncr.34629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We invite public health policy makers to be cognizant of the importance of where persons reside and consider focusing efforts to improve cancer outcomes in rural areas with concentrated poverty. We call for the attention of public health leaders and healthcare providers in both the US and Mexico to mitigate the health disparities suffered by immigrants, a population that plays a vital role for the economies and social fabric of these two countries.
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Affiliation(s)
- Paula Aristizabal
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA, USA
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, La Jolla, CA, USA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
- University of California San Diego Clinical and Translational Research Institute, Dissemination and Implementation Science Center, La Jolla, CA, USA
| | - Courtney D. Thornburg
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA, USA
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, La Jolla, CA, USA
| | - Janine Young
- University of California San Diego, Department of Pediatrics, Division of Academic General Pediatrics, La Jolla, CA, USA
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9
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Castellanos MI, Oluyomi AO, Chambers TM, Gramatges MM, Winestone LE, Lupo PJ, Scheurer ME. Ethnic disparities in childhood leukemia survival by border residence: A Texas population-based analysis. Cancer 2023; 129:1276-1286. [PMID: 36805949 DOI: 10.1002/cncr.34636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND The US-Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas-Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. METHODS The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan-Meier methods. RESULTS During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5-year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. CONCLUSIONS Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs.
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Affiliation(s)
- Maria I Castellanos
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Abiodun O Oluyomi
- Department of Medicine, Epidemiology, and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany M Chambers
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Maria M Gramatges
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Lena E Winestone
- Division of Allergy, Immunology, and Blood and Marrow Transplant, University of California-San Francisco Benioff Children's Hospitals, San Francisco, California, USA
| | - Philip J Lupo
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Hamid SA, Zia N, Maqsood S, Rafiq N, Fatima M, Syed Y, Tabori U, Bartels U, Hawkins C, Huang A, Ramsawami V, Mushtaq N, Bouffet E. Impact of dedicated pediatric neuro-oncological services in a developing country: A single-institution, Pakistani experience. Pediatr Blood Cancer 2022; 69:e29887. [PMID: 35856658 DOI: 10.1002/pbc.29887] [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: 02/23/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Brain tumors are the most common solid neoplasms and the second most common malignancy in the pediatric age group. Due to the complexity of their management, pediatric central nervous system (CNS) tumors are not a priority in low- and middle-income countries (LMICs). METHODS In an attempt to improve the survival rate and overall care, we introduced a dedicated pediatric neuro-oncology service in our institute and evaluated its impact by dividing the pre- and post-era into two cohorts and comparing them: 1998-2013 (16 years: cohort A) and 2014-2019 (6 years: cohort B, after the start of dedicated neuro-oncology services). RESULTS We observed that after the implementation of a proper neuro-oncology service, the proportion of patients treated with curative intent increased, and survival improved in cohort B. The patient volume also increased from 15.5 per year in cohort A to 44.8 per year in cohort B. The percentage of children given radiation therapy also increased significantly, while the proportion of children treated with chemotherapy remained stable. CONCLUSION A dedicated multidisciplinary team trained and knowledgeable in the specialty of pediatric neuro-oncology can enhance and improve outcomes, and supportive care and help can provide good quality of life to children and their families with brain neoplasms.
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Affiliation(s)
- Syed Ahmer Hamid
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Nida Zia
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Sidra Maqsood
- Indus Hospital Research Centre, Indus Hospital & Health Network, Karachi, Pakistan
| | - Naila Rafiq
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Mushkbar Fatima
- Indus Hospital Research Centre, Indus Hospital & Health Network, Karachi, Pakistan
| | - Yumna Syed
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi, Pakistan
| | - Uri Tabori
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vijay Ramsawami
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Naureen Mushtaq
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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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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12
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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