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Rujkijyanont P, Inaba H. Diagnostic and treatment strategies for pediatric acute lymphoblastic leukemia in low- and middle-income countries. Leukemia 2024; 38:1649-1662. [PMID: 38762553 DOI: 10.1038/s41375-024-02277-9] [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: 03/13/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
The survival rate of children and adolescents with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, has improved significantly in high-income countries (HICs), serving as an excellent example of how humans can overcome catastrophic diseases. However, the outcomes in children with ALL in low- and middle-income countries (LMICs), where approximately 80% of the global population live, are suboptimal because of limited access to diagnostic procedures, chemotherapeutic agents, supportive care, and financial assistance. Although the implementation of therapeutic strategies in resource-limited countries could theoretically follow the same path of improvement as modeled in HICs, intensification of chemotherapy may simply result in increased toxicities. With the advent of genetic diagnosis, molecular targeted therapy, and immunotherapy, the management of ALL is changing dramatically in HICs. Multidisciplinary collaborations between institutions in LMICs and HICs will provide access to strategies that are suitable for institutions in LMICs, enabling them to minimize toxicities while improving outcomes. This article summarizes important aspects of the diagnosis and treatment of pediatric ALL that were mostly developed in HICs but that can be realistically implemented by institutions in countries with limited resources through resource-adapted multidisciplinary collaborations.
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Affiliation(s)
- Piya Rujkijyanont
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Hiroto Inaba
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
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2
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Deribe L, Girma E, Lindström NB, Gidey A, Teferra S, Addissie A. Family-centered care for child cancer treatment in Ethiopia-A qualitative descriptive study. J Pediatr Nurs 2024:S0882-5963(24)00292-6. [PMID: 39085006 DOI: 10.1016/j.pedn.2024.07.030] [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: 03/16/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Families are the primary source of support and strength in the care process of children with cancer. Family-centered care (FCC) is a healthcare delivery approach that considers parents as both partners and care recipients, characterized by providing care based on dignity and respect, information sharing, participation, and collaboration or partnership. AIM This study aimed to describe the delivery of care based on the family-centered care approach at the Tikur Anbessa Specialized Hospital pediatric cancer unit. METHOD An exploratory, descriptive qualitative study was conducted from March 2023 to August 2023. Eighteen participants (thirteen parents and five health care providers) were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and translated into English. The translated transcripts were used for inductive, data-driven thematic analysis. ATLAS.ti 9 software was used to assist the analysis process. RESULT Two themes have emerged during the analysis. These are (1) Information sharing, and (2) Enabling and partnership. Under the information sharing theme, we described parents' understanding of child cancer, parents' information-related expectations, the process of obtaining information, adequacy of information received, and factors inhibiting information sharing. Under the enabling and partnership theme, we presented family participation in childcare, discussion among parents, parents' communication with healthcare providers and psychosocial support. CONCLUSION Suboptimal implementation of family-centered care practice was identified at the pediatric oncology unit. PRACTICE IMPLICATIONS The findings from this study indicate the need to strengthen the provision of child cancer-related information, improve communication, and strengthen family participation in childcare.
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Affiliation(s)
- Leul Deribe
- School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Eshetu Girma
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Abdulkadir Gidey
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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3
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Irshad HA, Shariq SF, Khan MAA, Shaikh T, Kakar WG, Shakir M, Hankinson TC, Enam SA. Delay in the Diagnosis of Pediatric Brain Tumors in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01274. [PMID: 38984834 DOI: 10.1227/neu.0000000000003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Vague symptoms and a lack of pathognomonic features hinder the timely diagnosis of pediatric brain tumors (PBTs). However, patients in low- and middle-income countries (LMICs) must also bear the brunt of a multitude of additional factors contributing to diagnostic delays and subsequently affecting survival. Therefore, this study aims to assess these factors and quantify the durations associated with diagnostic delays for PBTs in LMICs. METHODS A systematic review of extant literature regarding children from LMICs diagnosed with brain tumors was conducted. Articles published before June 2023 were identified using PubMed, Google Scholar, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. A meta-analysis was conducted using a random-effects model through R Statistical Software. Quality was assessed using the Newcastle Ottawa Scale. RESULTS A total of 40 studies including 2483 patients with PBT from 21 LMICs were identified. Overall, nonspecific symptoms (62.5%) and socioeconomic status (45.0%) were the most frequently reported factors contributing to diagnostic delays. Potential sources of patient-associated delay included lack of parental awareness (45.0%) and financial constraints (42.5%). Factors contributing to health care system delays included misdiagnoses (42.5%) and improper referrals (32.5%). A pooled mean prediagnostic symptomatic interval was calculated to be 230.77 days (127.58-333.96), the patient-associated delay was 146.02 days (16.47-275.57), and the health care system delay was 225.05 days (-64.79 to 514.89). CONCLUSION A multitude of factors contribute to diagnostic delays in LMICs. The disproportionate effect of these factors is demonstrated by the long interval between symptom onset and the definitive diagnosis of PBTs in LMICs, when compared with high-income countries. While evidence-based policy recommendations may improve the pace of diagnosis, policy makers will need to be cognizant of the unique challenges patients and health care systems face in LMICs.
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Affiliation(s)
| | | | | | - Taha Shaikh
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Todd C Hankinson
- Department of Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Petricca K, Carson L, Kambugu J, Denburg A. Strengthening access to cancer medicines for children in East Africa: policy options to enhance medicine procurement, forecasting, and regulations. Glob Health Res Policy 2024; 9:24. [PMID: 38951949 PMCID: PMC11218261 DOI: 10.1186/s41256-024-00365-y] [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] [Received: 05/30/2023] [Accepted: 06/13/2024] [Indexed: 07/03/2024] Open
Abstract
Gaps in access to quality essential medicines remain a major impediment to the effective care of children with cancer in low-and middle-income countries (LMICs). The World Health Organization reports that less than 30% of LMICs have consistent availability of childhood cancer medicines, compared to over 95% in high-income countries. Information provided within this policy brief is drawn from a review of the literature and a mixed-methods study published in the Lancet Oncology that analyzed determinants of cancer medicine access for children in Kenya, Tanzania, Uganda, and Rwanda. Three key policy options are presented to guide strategic policy direction and critical health system planning for strengthening access to cancer medicines for children: pooled procurement, evidence-based forecasting, and regional harmonization of regulatory processes. Enhancing regional pooled procurement to address fragmented markets and improve medicine supply, investing in health information systems for improved forecasting and planning of childhood cancer medicine needs, and promoting regulatory harmonization to streamline medicine approval and quality assurance across East Africa are recommended. This policy brief is intended for policymakers, clinicians, and health-system planners involved in the procurement, supply chain management, policy and financing of childhood cancer medicines.
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Affiliation(s)
- Kadia Petricca
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Laura Carson
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joyce Kambugu
- Department of Paediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Avram Denburg
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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Duffy C, Hunger SP, Bhakta N, Denburg AE, Antillon F, Barr RD. Curing pediatric cancer: A global view. Examples from acute lymphoblastic leukemia. Cancer 2024; 130:2247-2252. [PMID: 38552145 DOI: 10.1002/cncr.35290] [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] [Indexed: 06/09/2024]
Abstract
There is a substantial difference in observed survival among children with acute lymphoblastic leukemia in high‐income countries versus those in low‐ and middle‐income countries. This gap can be reduced considerably by multilevel investing in health systems and services with innovative frameworks such as implementation science.
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Affiliation(s)
- Caitlyn Duffy
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephen P Hunger
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nickhill Bhakta
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and Francisco Marroquín University, Guatemala City, Guatemala
| | - Ronald D Barr
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
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Stokkevåg CH, Journy N, Vogelius IR, Howell RM, Hodgson D, Bentzen SM. Radiation Therapy Technology Advances and Mitigation of Subsequent Neoplasms in Childhood Cancer Survivors. Int J Radiat Oncol Biol Phys 2024; 119:681-696. [PMID: 38430101 DOI: 10.1016/j.ijrobp.2024.01.206] [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: 09/20/2023] [Revised: 12/17/2023] [Accepted: 01/13/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE In this Pediatric Normal Tissue Effects in the Clinic (PENTEC) vision paper, challenges and opportunities in the assessment of subsequent neoplasms (SNs) from radiation therapy (RT) are presented and discussed in the context of technology advancement. METHODS AND MATERIALS The paper discusses the current knowledge of SN risks associated with historic, contemporary, and future RT technologies. Opportunities for research and SN mitigation strategies in pediatric patients with cancer are reviewed. RESULTS Present experience with radiation carcinogenesis is from populations exposed during widely different scenarios. Knowledge gaps exist within clinical cohorts and follow-up; dose-response and volume effects; dose-rate and fractionation effects; radiation quality and proton/particle therapy; age considerations; susceptibility of specific tissues; and risks related to genetic predisposition. The biological mechanisms associated with local and patient-level risks are largely unknown. CONCLUSIONS Future cancer care is expected to involve several available RT technologies, necessitating evidence and strategies to assess the performance of competing treatments. It is essential to maximize the utilization of existing follow-up while planning for prospective data collection, including standardized registration of individual treatment information with linkage across patient databases.
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Affiliation(s)
- Camilla H Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Bergen, Norway.
| | - Neige Journy
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | - Ivan R Vogelius
- Department of Clinical Oncology, Centre for Cancer and Organ Diseases and University of Copenhagen, Copenhagen, Denmark
| | - Rebecca M Howell
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
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Prabhu NS, Maiya GA, Bhat K V. Implementation of physical rehabilitation programs for children with cancer across low- and middle-income countries: A need of the hour perspective. Pediatr Blood Cancer 2024; 71:e30876. [PMID: 38243768 DOI: 10.1002/pbc.30876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Nivedita S Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - G Arun Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Bhat K
- Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Force LM, Hlatywayo L, Salek M, Bhakta M, Bonilla M, Kaye EC, Rodriguez-Galindo C, Baker JN, Bhakta N, Chitsike I. Understanding treatment recommendations at diagnosis of advanced cancer in pediatric oncology: The need to explore decision-making challenges globally. Pediatr Blood Cancer 2024; 71:e30854. [PMID: 38233986 PMCID: PMC10922856 DOI: 10.1002/pbc.30854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Lisa M. Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Loyce Hlatywayo
- Parirenyatwa Hospital and University of Zimbabwe, Harare, Zimbabwe
| | - Marta Salek
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Manoo Bhakta
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Miguel Bonilla
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Erica C. Kaye
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Division of Quality of Life and Palliative Care, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Inam Chitsike
- Parirenyatwa Hospital and University of Zimbabwe, Harare, Zimbabwe
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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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McNeil MJ, Garcia Quintero X, Gonzalez M, Zheng Y, Ugaz Olivares C, Morales R, Boldrini E, Rebollo de Campos D, Ferreira D, Coopasamy K, Caneba J, Padernilla ML, Friedrichsdorf S, Baker JN, Friedrich P. Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries. Cancers (Basel) 2024; 16:1025. [PMID: 38473383 DOI: 10.3390/cancers16051025] [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: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
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Affiliation(s)
- Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Miriam Gonzalez
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yawen Zheng
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Roxana Morales
- Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Daiane Ferreira
- Hospital de Câncer Infantojuvenil de Barretos, Barretos 14784-400, Brazil
| | | | - Joliza Caneba
- Philippines General Hospital, Manila 1000, Philippines
| | | | - Stefan Friedrichsdorf
- Division of Pediatric Pain, Palliative Care & Integrative Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA 94305, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Carson L, Petricca K, Denburg A. The promise of POSIT: Real-world application of the Paediatric Oncology System Integration Tool. J Cancer Policy 2024; 39:100454. [PMID: 37989453 DOI: 10.1016/j.jcpo.2023.100454] [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: 08/15/2023] [Revised: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Childhood cancer presents significant acute and long-term challenges for patients,families, communities, and health systems. Although meaningful strides have been made in research and treatment, severe outcome disparities prevail between low- and middle-income countries (LMICs) and high-income countries (HICs), with childhood cancer survival rates lower than 20% in LMICs, as compared with over 80% across many HICs. In recent years, greater emphasis has been placed on health system strengthening as a means to develop domestic policy and capacity for sustainable improvements in childhood cancer outcomes in LMICs. In pursuit of a systems approach to childhood cancer in LMICs, our research team developed the Paediatric Oncology System Integration Tool (POSIT)-the first comprehensive framework for the design and evaluation of childhood cancer systems. Since its development, POSIT has been applied in an exploration of key determinants of access to essential childhood cancer medicines across two separate multi-site studies. In this commentary, we explore the value of the POSIT framework and toolkit as a constructive systems-level guide for examining interactions between childhood cancer-specific programs and encompassing health system. socio-political, and economic contexts.
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Affiliation(s)
- Laura Carson
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kadia Petricca
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Avram Denburg
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
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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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Grassi J, Pessanha RM, Grippa WR, Dell’Antonio LS, Dell’Antonio CSDS, Faure L, Clavel J, Lopes-Júnior LC. Temporal Trends in the Completeness of Epidemiological Variables in a Hospital-Based Cancer Registry of a Pediatric Oncology Center in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:200. [PMID: 38397690 PMCID: PMC10888061 DOI: 10.3390/ijerph21020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/27/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
This ecological time series study aimed to examine the temporal trends in the completeness of epidemiological variables from a hospital-based cancer registry (HbCR) of a reference center for pediatric oncology in Brazil from 2010 to 2016. Completeness categories were based on the percentage of missing data, with the categories excellent (<5%), good (5-10%), regular (11-20%), poor (21-50%), and very poor (>50%). Descriptive and bivariate analyses were performed using R.4.1.0; a Mann-Kendall trend test was performed to examine the temporal trends. Variables with the highest incompleteness included race/color (17.24% in 2016), level of education (51.40% in 2015), TNM (56.88% in 2012), disease status at the end of the first treatment (12.09% in 2013), cancer family history (79.12% in 2013), history of alcoholic consumption (39.25% in 2015), history of tobacco consumption (38.32% in 2015), and type of admission clinic (10.28% in 2015). Nevertheless, most variables achieved 100% completeness and were classified as excellent across the time series. A significant trend was observed for race/color, TNM, and history of tobacco consumption. While most variables maintained excellent completeness, the increasing incompleteness trend in race/color and decreasing trend in TNM underscore the importance of reliable and complete HbCRs for personalized cancer care, for planning public policies, and for conducting research on cancer control.
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Affiliation(s)
- Jonathan Grassi
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Raphael Manhães Pessanha
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Wesley Rocha Grippa
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
| | - Larissa Soares Dell’Antonio
- Espírito Santo State Health Department, Special Center for Epidemiological Surveillance, Vitoria 29047-105, ES, Brazil; (L.S.D.); (C.S.d.S.D.)
| | | | - Laure Faure
- Centre de Recherche en Epidémiologie et Statistiques (CRESS), Institut National de la Santé et de la Recherche Médicale—INSERM, Université Paris-Cité, 75013 Paris, France; (L.F.); (J.C.)
| | - Jacqueline Clavel
- Centre de Recherche en Epidémiologie et Statistiques (CRESS), Institut National de la Santé et de la Recherche Médicale—INSERM, Université Paris-Cité, 75013 Paris, France; (L.F.); (J.C.)
| | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health, Universidade Federal do Espírito Santo (Ufes), Vitoria 29047-105, ES, Brazil; (J.G.); (R.M.P.); (W.R.G.)
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14
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Cuervo-Suarez MI, Cleves D, Duque-Nieto N, Claros-Hulbert A, Molina-Gómez K, Bolaños-Lopez JE, Tello-Cajiao ME, Baker JN, McNeil MJ, García-Quintero X. Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes. BMC Palliat Care 2024; 23:31. [PMID: 38302931 PMCID: PMC10836057 DOI: 10.1186/s12904-024-01354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND In 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia and an overall survival rate of approximately 55%. The aim of this study is to compare outcomes in children with cancer in the hospital setting during the last 72 h of life who received concurrent Pediatric Palliative Care (PPC) versus oncology care alone. METHODS An observational descriptive study was conducted between January 2013 and June 2022 in a center for pediatric patients with oncological diagnoses. In 2017, the PPC team was created. Patients between 28 days and 17 years of age who were hospitalized at least 72 h before death were included. A retrospective review of the medical records of patients in the last 72 h of life was performed. Two cohorts were established: oncology-alone group received exclusive management by oncology, and oncology and PPC received concurrent oncology and PPC management since the diagnosis. RESULTS We evaluated 257 medical records of deceased pediatric patients with cancer diagnoses. For the first cohort (2013-2017), 136 patients were included; for the second cohort (2018 and 2022), 121 patients were evaluated. The most frequent diagnosis was leukemia [47.1% (n = 121)]. No significant difference was found in either group between dyspnea, pain, and seizures. Dyspnea was the most frequent symptom in both groups. Agitation and anxiety were reported more frequently in children from the oncology-alone group (22.1% and 13.2%, respectively). The oncology and PPC group received more psychology and social work consultation (94.2% and 70.2% vs. 84.6 and 54.4% in the oncology alone group) and had a higher percentage of advance care planning (79.3% vs. 62.5% in the oncology alone group). CONCLUSIONS This retrospective study highlights that PPC at the end of life (EoL) offers a holistic approach to the physical and psychosocial symptoms experienced by children with cancer; these patients received more comfort through symptom management and less aggressive treatment at the EoL. The availability of a PPC team may contribute to improvements in the quality of end-of-life care. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- María Isabel Cuervo-Suarez
- Palliative Care Department, Fundación Valle del Lili, Avenida Simón Bolívar. Cra. 98 No.18-49, Cali, 760032, Colombia.
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760031, Colombia.
| | - Daniela Cleves
- Department of Global Pediatric Medicine, St. Jude Children's Hospital, Memphis, TN, 38105, USA
| | - Natalia Duque-Nieto
- Department of Pain and Palliative Care, Grupo Keralty, Clinica Sebastian de Belalcazar, Cali, 760044, Colombia
| | | | - Karen Molina-Gómez
- Palliative Care Department, Fundación Valle del Lili, Avenida Simón Bolívar. Cra. 98 No.18-49, Cali, 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, 760031, Colombia
| | | | | | - Justin N Baker
- Division Chief, Quality of Life and Pediatric Palliative, Stanford University School of Medicine, Alto, CA, 94304, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine, St. Jude Children's Hospital, Memphis, TN, 38105, USA
| | - Ximena García-Quintero
- Department of Global Pediatric Medicine, St. Jude Children's Hospital, Memphis, TN, 38105, USA
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15
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Israels T, Arora RS, Sung L. The value of reporting on end-of-treatment outcome of patients in low-income settings. Pediatr Blood Cancer 2023; 70:e30686. [PMID: 37728943 DOI: 10.1002/pbc.30686] [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: 07/10/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Trijn Israels
- Collaborative African Network for Childhood Cancer Care and Research (CANCaRe Africa), Blantyre, Malawi
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Lillian Sung
- Sick Children's Hospital, Toronto, Ontario, Canada
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16
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Owusu WE, Burger JR, Lubbe MS, Joubert R, Cockeran M. Incidence patterns of childhood cancer in two tertiary hospitals in Ghana from 2015 to 2019: A retrospective observational study. Cancer Epidemiol 2023; 87:102470. [PMID: 37832243 DOI: 10.1016/j.canep.2023.102470] [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: 09/15/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Accurate epidemiological data are vital in estimating the burden of disease in a country. Little is known about the incidence of childhood cancer in Ghana. This study describes the incidence patterns of cancer in children below 14 years and 11 months from 2015 to 2019 at the only two main pediatric cancer referral centers in Ghana: Korle Bu Teaching Hospital (KBTH) and Komfo Anokye Teaching Hospital (KATH). METHOD Data on the incidence of cancer in children below 14 years and 11 months were collected retrospectively between 1st January 2015 and 31st December 2019 from patients' medical folders at KBTH and the cancer registry at the pediatric units of KATH. Descriptive statistics were used to describe the data. Incident rates expressed as age-specific rates (ASRs) per 100,000 person-years using population estimates for age groups and sex in each year, were determined by age groups (0-4, 5-9, 10-14 years and 11 months), sex, region of residence and cancer types based on the International Childhood Cancer Classification, third edition. RESULTS The total ASR per 100,000 person-years from 2015 to 2019 was 9.36 based on 1073 cases observed. The ASR increased from 1.6 per 100,000 person-years in 2015-2.41 in 2017, thereafter decreasing to 1.45 in 2019. The ASR was higher in male children (2.10 per 100,000 person-years), children between 0 and 4 years (0.27 per 100,000 person-years), and children living in the Greater Accra region (4.17 per 100,000 person-years). The most prevalent cancers were lymphomas (2.17 per 100,000 person-years) and leukemia (1.88 per 100,000 person-years). CONCLUSION The study provides baseline information on the incidence patterns of childhood cancer from 2015 to 2019, addressing a critical gap in childhood cancer epidemiology in Ghana.
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Affiliation(s)
- Winifred E Owusu
- Medicine Usage in South Africa, North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa, North-West University, Faculty of Health Sciences, Potchefstroom, South Africa.
| | - Martha S Lubbe
- Medicine Usage in South Africa, North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
| | - Rianda Joubert
- Medicine Usage in South Africa, North-West University, Faculty of Health Sciences, Potchefstroom, South Africa
| | - Marike Cockeran
- Statistical Consultation Services, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
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17
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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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18
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Lu VM, Elarjani T, Niazi TN. Global, Regional, and National Incidence and Mortality Trends in Pediatric Central Nervous System Tumors over the Past 2 Decades. World Neurosurg 2023; 179:e568-e574. [PMID: 37683927 DOI: 10.1016/j.wneu.2023.09.003] [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: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Pediatric tumors of the brain and central nervous system (CNS) are a worldwide issue with variances in epidemiology. How exactly incidence and mortality rates have changed over time has not been summarized. Correspondingly, the aim of this study was to quantitively define the global, regional, and national epidemiological trends of these tumors. METHODS A retrospective review of data from the Global Burden of Disease Study 2019 Database was performed incorporating data from 1999 to 2019. Global, regional, and national outcomes for pediatric CNS tumors were collected for incidence and mortality at a worldwide level, as well as across 7 continental regions, and then 204 countries and territories. RESULTS Globally, the latest incidence of pediatric CNS tumors was 47,600 (uncertainty interval, 36,500-55,200) at a rate of 1.8 (1.4-2.2) per 100,000, with 23,500 (18,000-27,500) deaths due to these tumors at a rate of 0.9 (0.7-1.1) per 100,000 population. Both rates per 100,000 have decreased over the past 2 decades. With respect to regions, East Asia and Pacific had the highest incidence and mortality cases overall, but in terms of rate per 100,000, North America and Latin America and Caribbean had the highest values, respectively. There were 3/7 (43%) and 6/7 (86%) regions with decreasing incidence and mortality rates per 100,000 over the past 2 decades. China, India, and Pakistan were the 3 countries with both the highest incidence and mortality cases overall; however, San Marino, Denmark, and Norway had the highest incidence rates per 100,000, and Albania, Armenia, and Haiti had the highest mortality rates per 100,000. In the past 2 decades, 79/204 (39%) and 120/204 (59%) countries observed decreasing incidence and mortality rates per 100,000, respectively. CONCLUSIONS Pediatric CNS tumors remains a worldwide issue, with there being multiple regions and countries worldwide that continue to experience uptrending incidence and mortality rates per 100,000. For both incidence and mortality, there is a clear discordance between regions and countries that report the highest number of cases versus the highest rate of cases per 100,000. Future research efforts are needed to identify positive intervention measures that respect the epidemiology of these tumors at global, regional, and national levels.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA.
| | - Turki Elarjani
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Toba N Niazi
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, Florida, USA
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19
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Hoover A, Thielen BK, Ebens CL. Fever and neutropenia in pediatric oncology and stem cell transplant patients: an editorial commentary on updated international clinical practice guidelines. Transl Pediatr 2023; 12:1908-1912. [PMID: 37969121 PMCID: PMC10644023 DOI: 10.21037/tp-23-368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Alex Hoover
- Division of Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Beth K. Thielen
- Division of Infectious Diseases, Department of Pediatrics, Global Pediatrics Program, Minneapolis, MN, USA
| | - Christen L. Ebens
- Division of Blood and Marrow Transplant & Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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20
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Majamanda MD, Chisoni F, Selemani A, Kearns I, Maree J. Paediatric oncology nursing education and training programmes: a scoping review protocol. BMJ Open 2023; 13:e070694. [PMID: 37813530 PMCID: PMC10565288 DOI: 10.1136/bmjopen-2022-070694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment. METHODS The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary. ETHICS AND DISSEMINATION This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/X3Q4H.
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Affiliation(s)
- Maureen Daisy Majamanda
- Child Health Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Chisoni
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Apatsa Selemani
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
- Library, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Irene Kearns
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna Maree
- Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
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21
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Reece-Mills M, Bodkyn C, Baxter JAB, Allen U, Alexis C, Browne-Farmer C, Craig J, de Young S, Denburg A, Dindial K, Fleming-Carroll B, Gibson T, Gupta S, Knight-Madden J, Manley-Kucey M, Mclean-Salmon S, Ocho ON, Orrigio K, Read S, Sin Quee C, Smith B, Thame M, Wharfe G, Whitlock JA, Zlotkin S, Blanchette V. Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI). LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100592. [PMID: 37727865 PMCID: PMC10506063 DOI: 10.1016/j.lana.2023.100592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.
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Affiliation(s)
- Michelle Reece-Mills
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Curt Bodkyn
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Jo-Anna B. Baxter
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Upton Allen
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Cheryl Alexis
- Haematology/Oncology Department, Queen Elizabeth Hospital, Bridgetown, Barbados
| | | | - Jenna Craig
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephanie de Young
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kevon Dindial
- Department of Paediatrics, Eric Williams Medical Sciences Complex, San Juan, Trinidad and Tobago
| | - Bonnie Fleming-Carroll
- Learning Institute, Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tracey Gibson
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | - Oscar Noel Ocho
- Faculty of Medical Sciences, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
- PAHO/WHO Collaborating Centre for Nursing and Midwifery Development in the Caribbean, School of Nursing, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Kadine Orrigio
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Stanley Read
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
| | - Corrine Sin Quee
- School of Clinical Medicine and Research, The University of the West Indies, Nassau, The Bahamas
| | - Brian Smith
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Minerva Thame
- Faculty of Medical Sciences, Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Gilian Wharfe
- Department of Haematology/Oncology, The University of the West Indies, Kingston, Jamaica
| | - James A. Whitlock
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Victor Blanchette
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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22
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Escobedo-Melendez G, Paniagua-Padilla J, Caniza MA. Outcomes of Care-bundle Implementation for Children With Cancer and Suspected Bloodstream Infection in a Pediatric Oncology Unit in a Resource-limited Setting. J Pediatr Hematol Oncol 2023; 45:e798-e809. [PMID: 37526415 PMCID: PMC10521769 DOI: 10.1097/mph.0000000000002719] [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: 07/13/2022] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
Bloodstream infections (BSIs) are a major cause of mortality among pediatric oncology patients in resource-limited settings. Effective, innovative strategies are needed to improve care and survival. In a pediatric oncology unit in Mexico, we retrospectively analyzed the risk factors for mortality related to BSI and the results of using a care-bundle intervention. The care-bundle consisted of a swift clinical evaluation, initial fluid-resuscitation support, obtaining blood cultures, and administration of effective empirical antibiotic therapy for suspected BSI. The outcomes of patients who received the care-bundle during a 12-month period were compared with those of patients treated with standard care during the 12 months preceding its implementation. The primary outcomes were BSI diagnosis, choice of antibiotics, and mortality. Of the 261 suspected BSIs treated with standard care, 33 (12.6%) infections were confirmed, and of the 308 treated with the care-bundle, 67 (21.7%) BSIs were confirmed. Thus, after implementation of the care-bundle, significantly more BSIs were diagnosed ( P =0.004), and BSI-related mortality was significantly reduced by 22.2% ( P = 0.035). Surgical resection and mechanical ventilation support were independently associated with BSI-related mortality, and receiving effective initial empirical antibiotic therapy was protective against mortality (odds ratio, 0.013; 95% CI: 0.002-0.105; P =0.001), which comprising cefepime plus amikacin or meropenem in 44 (80.0%) of the cases alive. Consistent use of a care-bundle with initial fluid resuscitation, obtaining a blood culture, and administering effective antibiotics to children with cancer and suspected BSI can decrease mortality.
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Affiliation(s)
- Griselda Escobedo-Melendez
- Institute for Research in Childhood and Adolescence Cancer, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Jenny Paniagua-Padilla
- Institute for Research in Childhood and Adolescence Cancer, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Miguela A. Caniza
- Departments of Global Pediatric Medicine and Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
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23
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Vásquez L, Fuentes-Alabí S, Loggetto P, Benitez-Majano S, Metzger ML, Jarquin-Pardo M, Echeandia-Abud N, Gupta S, Denburg A, Friedrich P, Ortiz R, Lam C, Luciani S, Ilbawi A, Rodríguez-Galindo C, Maza M. Advances in the Global Initiative for Childhood Cancer: implementation in Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e128. [PMID: 37750056 PMCID: PMC10516329 DOI: 10.26633/rpsp.2023.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023] Open
Abstract
This report describes the status of childhood cancer control initiatives in Latin America and the Caribbean (LAC). Progress between 2017 and 2023 is measured using the outcome indicators from the Pan American Health Organization (PAHO) childhood cancer logic model aligned with the World Health Organization Global Initiative for Childhood Cancer (GICC). This report also describes the advances, barriers, and facilitators for the implementation of the GICC at the Regional level. Methods used in this report encompassed a comprehensive approach, incorporating a literature review, interviews, surveys, and a Delphi study developed by the technical team of the PAHO Non-Communicable Diseases and Mental Health Department and by the GICC LAC working group. Since 2017, there has been a substantial increase in the number of countries that have included childhood cancer in their national regulations. Currently, 21 LAC countries are involved in the GICC implementation, activities, and dialogues. However, the objectives for 2030 will only be achieved if Member States overcome the barriers to accelerating the pace of initiative implementation. There is an urgent need to increase the efforts in childhood cancer control in LAC, especially regarding the prioritization of timely detection, essential diagnostics, access to cancer treatment, palliative care, and close follow-up of children and adolescents with cancer.
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Affiliation(s)
- Liliana Vásquez
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Soad Fuentes-Alabí
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Patricia Loggetto
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Sara Benitez-Majano
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Monika L. Metzger
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Marta Jarquin-Pardo
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Naomi Echeandia-Abud
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Sumit Gupta
- Division of Hematology–OncologyThe Hospital for Sick ChildrenTorontoCanadaDivision of Hematology–Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Avram Denburg
- Division of Hematology–OncologyThe Hospital for Sick ChildrenTorontoCanadaDivision of Hematology–Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Paola Friedrich
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Roberta Ortiz
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury PreventionWorld Health OrganizationGenevaSwitzerlandDepartment for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
| | - Catherine Lam
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Silvana Luciani
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Andre Ilbawi
- Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury PreventionWorld Health OrganizationGenevaSwitzerlandDepartment for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland.
| | - Carlos Rodríguez-Galindo
- Department of Global Pediatric MedicineWorld Health Organization–Collaborating Center for Childhood CancerSt. Jude Children’s Research HospitalMemphisUnited States of AmericaDepartment of Global Pediatric Medicine, World Health Organization–Collaborating Center for Childhood Cancer, St. Jude Children’s Research Hospital, Memphis, United States of America.
| | - Mauricio Maza
- Unit of Noncommunicable DiseasesDepartment of Noncommunicable Diseases and Mental HealthPan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaUnit of Noncommunicable Diseases, Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America.
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24
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Farrag A, Ghazaly MH, Mohammed K, Volland R, Hero B, Berthold F. Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country. BMC Pediatr 2023; 23:443. [PMID: 37670249 PMCID: PMC10478379 DOI: 10.1186/s12887-023-04214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC). METHODS A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors. RESULTS The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma. CONCLUSIONS Outcome differences were associated with different causes of death and other less prominent factors.
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Affiliation(s)
- Ahmed Farrag
- Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
| | | | - Khaled Mohammed
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Volland
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Statistics, University Hospital of Cologne, Cologne, Germany
| | - Barbara Hero
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
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25
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Gopal S. The case for prioritizing malignant hematology services in low- and middle-income countries. Semin Hematol 2023; 60:189-191. [PMID: 37723025 PMCID: PMC10840687 DOI: 10.1053/j.seminhematol.2023.08.005] [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] [Received: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
A clear case for can be made for prioritizing malignant hematology services in low- and middle-income countries based on large public health burden, convincing demonstrations of cure and control, innovation opportunities with likely worldwide implications, and sizable returns on investment for health systems and societies. We must now ensure that need and opportunity are matched by commensurate levels of investment and attention.
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Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD.
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26
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Salek M, Silverstein A, Tilly A, Gassant PY, Gunasekera S, Hordofa DF, Hesson D, Duffy C, Malik N, McNeil M, Force LM, Bhakta N, Rodin D, Kaye EC. Factors influencing treatment decision-making for cancer patients in low- and middle-income countries: A scoping review. Cancer Med 2023; 12:18133-18152. [PMID: 37526041 PMCID: PMC10524036 DOI: 10.1002/cam4.6375] [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] [Received: 03/23/2023] [Revised: 07/01/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE In this scoping review, we evaluated existing literature related to factors influencing treatment decision-making for patients diagnosed with cancer in low- and middle-income countries, noting factors that influence decisions to pursue treatment with curative versus non-curative intent. We identified an existing framework for adult cancer developed in a high-income country (HIC) context and described similar and novel factors relevant to low-and middle-income country settings. METHODS We used scoping review methodology to identify and synthesize existing literature on factors influencing decision-making for pediatric and adult cancer in these settings. Articles were identified through an advanced Boolean search across six databases, inclusive of all article types from inception through July 2022. RESULTS Seventy-nine articles were identified from 22 countries across six regions, primarily reporting the experiences of lower-middle and upper-middle-income countries. Included articles largely represented original research (54%), adult cancer populations (61%), and studied patients as the targeted population (51%). More than a quarter of articles focused exclusively on breast cancer (28%). Approximately 30% described factors that influenced decisions to choose between therapies with curative versus non-curative intent. Of 56 reported factors, 22 novel factors were identified. Socioeconomic status, reimbursement policies/cost of treatment, and treatment and supportive care were the most commonly described factors. CONCLUSIONS This scoping review expanded upon previously described factors that influence cancer treatment decision-making in HICs, broadening knowledge to include perspectives of low- and middle-income countries. While global commonalities exist, certain variables influence treatment choices differently or uniquely in different settings. Treatment regimens should further be tailored to local environments with consideration of contextual factors and accessible resources that often impact decision-making.
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Affiliation(s)
- Marta Salek
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Allison Silverstein
- Department of PediatricsUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Alyssa Tilly
- Division of General Medicine and Clinical EpidemiologyUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | | | - Sanjeeva Gunasekera
- Department of Paediatric OncologyNational Cancer InstituteMaharagamaSri Lanka
| | - Diriba Fufa Hordofa
- Department of Pediatrics and Child HealthJimma University Medical CenterJimmaEthiopia
| | - Donna Hesson
- Welch Medical LibraryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Caitlyn Duffy
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nauman Malik
- Department of Radiation OncologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Michael McNeil
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lisa M. Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Danielle Rodin
- Department of Radiation, OncologyUniversity of TorontoTorontoOntarioCanada
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
- Canada Global Cancer ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Erica C. Kaye
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
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27
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Ehrlich BS, McNeil MJ, Pham LTD, Chen Y, Rivera J, Acuna C, Sniderman L, Sakaan FM, Aceituno AM, Villegas CA, Force LM, Bolous NS, Wiphatphumiprates PP, Slone JS, Carrillo AK, Gillipelli SR, Duffy C, Arias AV, Devidas M, Rodriguez-Galindo C, Mukkada S, Agulnik A. Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Oncol 2023; 24:967-977. [PMID: 37517410 PMCID: PMC10812862 DOI: 10.1016/s1470-2045(23)00318-2] [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: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality. METHODS For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849). FINDINGS Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16). INTERPRETATION Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival. FUNDING American Lebanese Syrian Associated Charities and National Cancer Institute.
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Affiliation(s)
- Bella S Ehrlich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Linh T D Pham
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jocelyn Rivera
- Department of Pediatric Emergency Medicine, Hospital Infantil Teletón de Oncología, Querétaro, México
| | - Carlos Acuna
- Department of Pediatric Intensive Care, Dr Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - Liz Sniderman
- Northern Alberta Children's Cancer Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Firas M Sakaan
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Alejandra Mendez Aceituno
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Pediatric Intensive Care Unit, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Cesar A Villegas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Washington, Seattle, WA, USA
| | - Nancy S Bolous
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jeremy S Slone
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela K Carrillo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Caitlyn Duffy
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Anita V Arias
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Sheena Mukkada
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
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28
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Agulnik A, Muniz-Talavera H, Pham LTD, Chen Y, Carrillo AK, Cárdenas-Aguirre A, Gonzalez Ruiz A, Garza M, Conde Morelos Zaragoza TM, Soberanis Vasquez DJ, Méndez-Aceituno A, Acuña-Aguirre C, Alfonso-Carreras Y, Alvarez Arellano SY, Andrade Sarmiento LA, Batista R, Blasco Arriaga EE, Calderon P, Chavez Rios M, Costa ME, Díaz-Coronado R, Fing Soto EA, Gómez García WC, Herrera Almanza M, Juarez Tobías MS, León López EM, López Facundo NA, Martinez Soria RA, Miller K, Miralda Méndez ST, Mora Robles LN, Negroe Ocampo NDC, Noriega Acuña B, Osuna Garcia A, Pérez Alvarado CM, Pérez Fermin CK, Pineda Urquilla EE, Portilla Figueroa CA, Ríos Lopez LE, Rivera Mijares J, Soto Chávez V, Suarez Soto JI, Teixeira Costa J, Tejocote Romero I, Villanueva Hoyos EE, Villegas Pacheco M, Devidas M, Rodriguez-Galindo C. Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study. Lancet Oncol 2023; 24:978-988. [PMID: 37433316 PMCID: PMC10727097 DOI: 10.1016/s1470-2045(23)00285-1] [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: 03/10/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. METHODS Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. FINDINGS Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9-13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10-13) before PEWS implementation and 18 months (16-18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69-0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22-1·43]; p<0·0001), being a teaching hospital (1·18 [1·09-1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21-1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92-0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68-1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97-1·12]; p=0·29). INTERPRETATION PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. FUNDING American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. TRANSLATIONS For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | - Linh T D Pham
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Marcela Garza
- St Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenia Miller
- Hospital del Niño "Jose Renan Esquivel", Panama, Panama
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Iván Suarez Soto
- Hospital del Niño. Sistema integral para el Desarrollo de la Familia (DIF), Pachuca, Mexico
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29
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Langat S, Njuguna F, Olbara G, Martijn H, Sieben C, Haverkort M, Njenga D, Vik TA, Kaspers G, Mostert S. Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya. Support Care Cancer 2023; 31:467. [PMID: 37452971 PMCID: PMC10349750 DOI: 10.1007/s00520-023-07913-1] [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: 10/04/2022] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Few governments in low and middle-income countries (LMIC) have responded favourably to the international plea for Universal Health Coverage. Childhood cancer survival in LMIC is often below 20%. Limited health-insurance coverage may contribute to this poor survival. Our study explores the influence of health-insurance status on childhood cancer treatment outcomes in a Kenyan academic hospital. METHODS This was a retrospective medical records review of all children diagnosed with cancer at Moi Teaching and Referral Hospital between 2010 and 2016. Socio-demographic and clinical data was collected using a structured data collection form. Fisher's exact test, chi-squared test, Kaplan-Meier method, log-rank test and Cox proportional hazard model were used to evaluate relationships between treatment outcomes and patient characteristics. Study was approved by Institutional Research Ethics Committee. FINDINGS From 2010-2016, 879 children were newly diagnosed with cancer. Among 763 patients whose records were available, 28% abandoned treatment, 23% died and 17% had progressive/relapsed disease resulting in 32% event-free survival. In total 280 patients (37%) had health-insurance at diagnosis. After active enrolment during treatment, total health-insurance registration level reached 579 patients (76%). Treatment outcomes differed by health-insurance status (P < 0.001). The most likely treatment outcome in uninsured patients was death (49%), whereas in those with health-insurance at diagnosis and those who enrolled during treatment it was event-free survival (36% and 41% respectively). Overall survival (P < 0.001) and event-free survival (P < 0.001) were higher for insured versus uninsured patients. The hazard-ratio for treatment failure was 0.30 (95% CI:0.22-0.39; P < 0.001) for patients insured at diagnosis and 0.32 (95% CI:0.24-0.41; P < 0.001) for patients insured during treatment in relation to those without insurance. INTERPRETATION Our study highlights the need for Universal Health Coverage in LMIC. Children without health-insurance had significantly lower survival. Childhood cancer treatment outcomes can be ameliorated by strategies that improve health-insurance access.
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Affiliation(s)
- Sandra Langat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Hugo Martijn
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Cenne Sieben
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Moniek Haverkort
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dennis Njenga
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Terry A Vik
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
- Department of Pediatrics, Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Costa ARS, Costa JT, Breviglieri CNM, Melgares LMP, Godinho PR, Metzger ML. Children and adolescents with non-Hodgkin lymphoma in Brazil: A national survey identifies the challenges encountered and documents the diversity of care. Hematol Transfus Cell Ther 2023; 45 Suppl 2:S36-S42. [PMID: 34980571 PMCID: PMC10433315 DOI: 10.1016/j.htct.2021.11.013] [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: 07/15/2021] [Revised: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Brazil has many inequities in the healthcare provided nationwide. Therefore, in order to access challenges in treatment, available resources and current practices, to identify barriers in delivering a good quality of care among Brazilian centers treating children and adolescents with Non-Hodgkin Lymphoma (NHL) and to generate a future prospective guideline, a customized online survey was distributed to pediatric hematologists and oncologists across the country. RESULTS A total of 97 surveys were completed (35% response rate), from 47 cities in all Brazilian regions and 79 units of care, with a median of 1 answer by the center (range 1 - 5). Most respondents work at an institution supported exclusively by public/philanthropic resources (58%), with an average of 5 to 9 new cases/year (49%), and 41% have 4 to 6 oncologists/centers. Additionally, 22% have no easy access to the intensive care unit, 26% have no access to Rasburicase, 28% have no access to Rituximabe as front-line therapy and 41% have unreliable methotrexate monitoring levels. Those differences cannot be explained thoroughly by regional wealth variances, nor by the financing model. Regarding the pathology service, 70% consider having reasonable quality assistance, but the timeframe to deliver diagnosis is satisfactory to 46%. There is no uniform management of care, with the current guideline from the Sociedade Brasileira de Oncologia Pediátrica being adopted by 54 to 59%, depending on the NHL subtype. CONCLUSION This study provides insights into the heterogeneity of care among Brazilian centers. Recognizing those diversities will support the design of effective strategies and collaboration nationwide.
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Affiliation(s)
- Ana Rosa S Costa
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n, CEP 18618687, Botucatu, SP, Brazil.
| | | | - Carla Nolasco Monteiro Breviglieri
- Hospital Samaritano Higienópolis, São Paulo, SP, Brazil; Instituto do Tratamento do Câncer Infantil (ITACI), Hospital das Clínicas, Universidade de São Paulo, SP, Brazil
| | | | - Patrick R Godinho
- Fundação Pio-XII, Hospital de Amor da Amazônia, Porto Velho, RO, Brazil
| | - Monika L Metzger
- St Jude Children's Research Hospital, Memphis, TN, United States
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Mirutse MK, Palm MT, Tolla MT, Memirie ST, Kefyalew ES, Hailu D, Norheim OF. Cost of childhood cancer treatment in Ethiopia. PLoS One 2023; 18:e0286461. [PMID: 37267276 DOI: 10.1371/journal.pone.0286461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Despite the recent interest in expanding pediatric oncology units in Ethiopia, reflected in the National Childhood and Adolescent Cancer Control Plan (NCACCP), little is known about the cost of running a pediatric oncology unit and treating childhood cancers. METHODS We collected historical cost data and quantity of services provided for the pediatric oncology unit and all other departments in Tikur Anbessa Specialized Hospital (TASH) from 8 July 2018 to 7 July 2019, using a provider perspective and mixed (top-down and bottom-up) costing approaches. Direct costs (human resources, drugs, supplies, medical equipment) of the pediatric oncology unit, costs at other relevant clinical departments, and overhead cost share are summed up to estimate the total annual cost of running the unit. Further, unit costs were estimated at specific childhood cancer levels. RESULTS The estimated annual total cost of running a pediatric oncology unit was USD 776,060 (equivalent to USD 577 per treated child). The cost of running a pediatric oncology unit per treated child ranged from USD 469 to USD 1,085, on the scenario-based sensitivity analysis. Drugs and supplies, and human resources accounted for 33% and 27% of the total cost, respectively. Outpatient department and inpatient department shared 37% and 63% of the cost, respectively. For the pediatric oncology unit, the cost per OPD visit, cost per bed day, and cost per episode of hospital admission were USD 36.9, 39.9, and 373.3, respectively. The annual cost per treated child ranged from USD 322 to USD 1,313 for the specific childhood cancers. CONCLUSION Running a pediatric oncology unit in Ethiopia is likely to be affordable. Further analysis of cost effectiveness, equity, and financial risk protection impacts of investing in childhood cancer programs could better inform the prioritization of childhood cancer control interventions in the Ethiopia Essential Health Service Package.
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Affiliation(s)
- Mizan Kiros Mirutse
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | | | - Mieraf Taddesse Tolla
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Talleur AC, Pui CH, Karol SE. What is Next in Pediatric B-cell Precursor Acute Lymphoblastic Leukemia. LYMPHATICS 2023; 1:34-44. [PMID: 38269058 PMCID: PMC10804398 DOI: 10.3390/lymphatics1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Cure rates now exceed 90% in many contemporary trials for children with B-cell acute lymphoblastic leukemia (ALL). However, treatment remains suboptimal and therapy is toxic for all patients. New treatment options potentially offer the chance to reduce both treatment resistance and toxicity. Here, we review recent advances in ALL diagnostics, chemotherapy, and immunotherapy. In addition to describing recently published results, we also attempt to project the impact of these new developments into the future to imagine what B-ALL therapy may look like in the next few years.
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Affiliation(s)
- Aimee C Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Seth E Karol
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Barr RD. Re: "Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group" by Beauchemin et al: Caring for Adolescents and Young Adults with Cancer Worldwide. J Adolesc Young Adult Oncol 2023; 12:458. [PMID: 36961386 DOI: 10.1089/jayao.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Affiliation(s)
- Ronald D Barr
- Pediatrics and Medicine, McMaster University, Hamilton, Canada
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Heipertz AE, Pajtler KW, Pfaff E, Schramm K, Blattner-Johnson M, Milde T, Jones BC, Zuliani C, Hutter C, Lohi O, Kattamis A, Dachowska-Kalwak I, Nilsson A, Gerber NU, Langenberg KPS, Goemans B, Zwaan CM, Molenaar JJ, Jäger N, Dirksen U, Witt R, Pfister SM, Jones DTW, Kopp-Schneider A, Witt O, van Tilburg CM. Outcome of Children and Adolescents With Relapsed/Refractory/Progressive Malignancies Treated With Molecularly Informed Targeted Drugs in the Pediatric Precision Oncology Registry INFORM. JCO Precis Oncol 2023; 7:e2300015. [PMID: 37364231 DOI: 10.1200/po.23.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/15/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE INFORM is an international pediatric precision oncology registry, prospectively collecting molecular and clinical data of children with recurrent, progressive, or very high-risk malignancies. We have previously identified a subgroup of patients with improved outcomes on the basis of molecular profiling. The present analysis systematically investigates progression-free survival (PFS) and overall survival (OS) of patients receiving matching targeted treatment (MTT) with the most frequently applied drug classes and its correlation with underlying molecular alterations. METHODS A cohort of 519 patients with relapsed or refractory high-risk malignancies who had completed a follow-up of at least 2 years or shorter in the case of death or loss to follow-up was analyzed. Survival times were compared using the log-rank test. RESULTS MTT with anaplastic lymphoma kinase (ALK), neurotrophic tyrosine receptor kinase (NTRK), and B-RAF kinase (BRAF) inhibitors showed significantly improved PFS (P = .012) and OS (P = .036) in comparison with conventional treatment or no treatment. However, analysis of the four most commonly applied MTT groups, mitogen-activated protein kinase (MEK- n = 19), cyclin-dependent kinase (CDK- n = 23), other kinase (n = 62), and mammalian-target of rapamycin (mTOR- n = 20) inhibitors, did not reveal differences in PFS or OS compared with conventional treatment or no treatment in patients with similar molecular pathway alterations. We did not observe differences in the type of pathway alterations (eg, copy number alterations, single-nucleotide variants, InDels, gene fusions) addressed by MTT. CONCLUSION Patients with respective molecular alterations benefit from treatment with ALK, NTRK, and BRAF inhibitors as previously described. No survival benefit was observed with MTT for mutations in the MEK, CDK, other kinase, or mTOR signaling pathways. The noninterventional character of a registry has to be taken into account when interpreting these data and underlines the need for innovative interventional biomarker-driven clinical trials in pediatric oncology.
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Affiliation(s)
- Anna-Elisa Heipertz
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Heidelberg Medical Faculty, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Pfaff
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kathrin Schramm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mirjam Blattner-Johnson
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Barbara C Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cecilia Zuliani
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Caroline Hutter
- Department of Pediatrics, St Anna Children's Hospital, Medical University of Vienna, and St Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Olli Lohi
- Tampere Center for Child Health Research and Tays Cancer Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Iwona Dachowska-Kalwak
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Nilsson
- Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, K6 Women's and Children's Health, K6 Paediatric Oncology and Paediatric Surgery, Stockholm, Sweden
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | | | - Bianca Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Ped Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Heidelberg Medical Faculty, University of Heidelberg, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uta Dirksen
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Heidelberg Medical Faculty, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- West German Cancer Center, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Ruth Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annette Kopp-Schneider
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Cornelis M van Tilburg
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
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Ganesan P, El Cheikh J, Isidori A, Kuo SH, Saleh M, Nair R. Editorial: The management of hematologic malignancies in lower-income countries. Front Oncol 2023; 13:1218718. [PMID: 37284195 PMCID: PMC10240044 DOI: 10.3389/fonc.2023.1218718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Prasanth Ganesan
- Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Jean El Cheikh
- Department of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alessandro Isidori
- Hematology and Stem Cell Transplant Center, Marche Norde Hospital, Pesaro, Italy
| | - Sung-Hsin Kuo
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mustafa Saleh
- Department of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reena Nair
- Clinical Haematology Oncology and Hematopoietic Cell Transplantation (HCT), Tata Medical Centre, Kolkata, India
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Graetz DE. The most vulnerable pediatric cancer patients. THE LANCET REGIONAL HEALTH - AMERICAS 2023; 21:100480. [PMID: 37008198 PMCID: PMC10064219 DOI: 10.1016/j.lana.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/28/2023]
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Graetz DE, Chen Y, Devidas M, Antillon-Klussmann F, Fu L, Quintero K, Fuentes-Alabi SL, Gassant PY, Kaye EC, Baker JN, Rodriguez Galindo C, Mack JW. Interdisciplinary care of pediatric oncology patients: A survey of clinicians in Central America and the Caribbean. Pediatr Blood Cancer 2023; 70:e30244. [PMID: 36788461 DOI: 10.1002/pbc.30244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/26/2022] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Quality cancer care depends on interdisciplinary communication. This study explored the communication practices of interdisciplinary clinicians, the types of healthcare services for which they engage in interdisciplinary collaboration, and the association between interdisciplinary care and perceived quality of care, as well as job satisfaction. METHODS We conducted a survey of interdisciplinary clinicians from cancer centers in Guatemala, Honduras, Panama, El Salvador, and Haiti. The survey included 68 items including previously validated tools and novel questions. RESULTS Total 174 interdisciplinary clinicians completed the survey: nurses (n = 60), medical subspecialists (n = 35), oncologists (n = 22), psychosocial providers (n = 20), surgeons (n = 12), pathologists (n = 9), radiologists (n = 9), and radiation oncologists (n = 5). Oncologists reported daily communication with nurses (95%) and other oncologists (91%). While 90% of nurses reported daily communication with other nurses, only 66% reported daily communication with oncologists, and more than 50% of nurses reported never talking to pathologists, radiologists, radiation oncologists, or surgeons. Most clinicians described interdisciplinary establishment of cancer treatment goals and prognosis (84%), patient preferences (81%), and determination of first treatment modality (80%). Clinicians who described more interdisciplinary collaboration had higher job satisfaction (p = .04) and perceived a higher level of overall quality of care (p = .004). CONCLUSIONS Clinicians in these limited resource settings describe strong interdisciplinary collaboration contributing to higher job satisfaction and perceived quality of care. However, nurses in these settings reported more limited interdisciplinary communication and care. Additional studies are necessary to further define clinical roles on interdisciplinary care teams and their associations with patient outcomes.
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Affiliation(s)
- Dylan E Graetz
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yichen Chen
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Ligia Fu
- Hospital Escuela de Tegucigalpa, Tegucigalpa, Honduras
| | - Karina Quintero
- Children's Hospital Dr Jose Renan Esquivel, Panama City, Panama
| | - Soad L Fuentes-Alabi
- Hospital Nacional de Niños Benjamin Bloom, Fundación Ayudame a Vivir, El Salvador City, El Salvador
| | | | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Jennifer W Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
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Roach JT, Baticulon RE, Campos DA, Andrews JM, Qaddoumi I, Boop FA, Moreira DC. The role of neurosurgery in advancing pediatric CNS tumor care worldwide. BRAIN & SPINE 2023; 3:101748. [PMID: 37383442 PMCID: PMC10293316 DOI: 10.1016/j.bas.2023.101748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction There is substantial inequity in survival outcomes for pediatric brain tumor patients residing in high-income countries (HICs) compared to low- and middle-income countries (LMICs). To address disparities in pediatric cancer survival, the World Health Organization (WHO) established the Global Initiative for Childhood Cancer (GICC) to expand quality care for children with cancer. Research question To provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children. Material and methods A narrative review of the current context of global pediatric neurosurgical capacity as it relates to neurooncology and other diseases relevant to children. Results In this article, we provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children. We highlight concerted advocacy and legislative efforts aimed at addressing unmet neurosurgical needs in children. Finally, we discuss the potential implications of advocacy efforts on treating pediatric CNS tumors and outline strategies to improve global outcomes for children with brain tumors worldwide in the context of the WHO GICC. Discussion and conclusion With both global pediatric oncology and neurosurgical initiatives converging on the treatment of pediatric brain tumors, significant strides toward decreasing the burden of pediatric neurosurgical diseases will hopefully be made.
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Affiliation(s)
- Jordan T. Roach
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Developmental Neurobiology, Division of Brain Tumor Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ronnie E. Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Jared M. Andrews
- Department of Developmental Neurobiology, Division of Brain Tumor Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick A. Boop
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel C. Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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Bai L, Zhan Y, Zhou Y, Zhang Y, Shi L, Gupta S, Denburg A, Guan X. Evidence of clinical benefit of WHO essential anticancer medicines for children, 2011-2021. EClinicalMedicine 2023; 59:101966. [PMID: 37125406 PMCID: PMC10130597 DOI: 10.1016/j.eclinm.2023.101966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Background Access to essential cancer medicines is a key determinant of childhood cancer survival. WHO published the Model List of Essential Medicine for Children (EMLc) and updated it every two years since 2007 to promote better access to medicines for children. This study aimed to assess whether the inclusion of essential anticancer medicines for respective indications for children was based on evidence of significant clinical benefit between 2011 and 2021. Methods We identified all anticancer medicine indications added to the WHO EMLc Section 8 since 2011 and extracted evidence of benefit documented in the corresponding technical reports. Evidence in children was defined as evidence that included participants under 12, and graded into five levels, according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. We analyzed whether each anticancer medicine indication was listed with documented OS benefit or improvements in surrogate measures based on the highest level of documented evidence in children. Findings A total of 115 anticancer medicine indications were added to the EMLc from 2011 to 2021, of which 101 (87.8%) had some clinical evidence in children and 4 (3.5%) were added without any clinical evidence. Among the 101 medicine indications, none were added with level-1 evidence in children, and 43 (42.6%), 11 (10.9%), 41 (40.6%), and 6 (5.9%) were listed with level-2, level-3, level-4, and level-5 evidence in children, respectively. Only eight (7.9%) medicine indications were reported to have OS benefit, another 12 (11.9%) were reported to have improvements on surrogate measures, and 81 (80.2%) were listed in the EMLc without documented improvements in either OS or surrogate measures. Interpretation Most anticancer medicine indications of the WHO EMLc were added based on limited evidence of statistically significant clinical benefit in children. Our results suggest that WHO should refine requirements for clinical benefit criteria and permissible forms, quality, and reporting of evidence of essential anticancer medicines for children, specify whether anticancer medicine indications have required evidence of clinical benefit in children, and provide further details in its technical reports that summarise the available evidence. Funding Not applicable.
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Affiliation(s)
- Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Yuqi Zhan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Department of Pharmacy, Peking University People's Hospital, Beijing, 100044, China
| | - Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
- Corresponding author. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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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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Bo L, Wang Y, Li Y, Wurpel JND, Huang Z, Chen ZS. The Battlefield of Chemotherapy in Pediatric Cancers. Cancers (Basel) 2023; 15:cancers15071963. [PMID: 37046624 PMCID: PMC10093214 DOI: 10.3390/cancers15071963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
The survival rate for pediatric cancers has remarkably improved in recent years. Conventional chemotherapy plays a crucial role in treating pediatric cancers, especially in low- and middle-income countries where access to advanced treatments may be limited. The Food and Drug Administration (FDA) approved chemotherapy drugs that can be used in children have expanded, but patients still face numerous side effects from the treatment. In addition, multidrug resistance (MDR) continues to pose a major challenge in improving the survival rates for a significant number of patients. This review focuses on the severe side effects of pediatric chemotherapy, including doxorubicin-induced cardiotoxicity (DIC) and vincristine-induced peripheral neuropathy (VIPN). We also delve into the mechanisms of MDR in chemotherapy to the improve survival and reduce the toxicity of treatment. Additionally, the review focuses on various drug transporters found in common types of pediatric tumors, which could offer different therapeutic options.
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Affiliation(s)
- Letao Bo
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Youyou Wang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Yidong Li
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - John N. D. Wurpel
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Zoufang Huang
- Ganzhou Key Laboratory of Hematology, Department of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China
- Correspondence: (Z.H.); (Z.-S.C.); Tel.: +86-138-797-27439 (Z.H.); +1-718-990-1432 (Z.-S.C.); Fax: +1-718-990-1877 (Z.-S.C.)
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
- Institute for Biotechnology, St. John’s University, Queens, NY 11439, USA
- Correspondence: (Z.H.); (Z.-S.C.); Tel.: +86-138-797-27439 (Z.H.); +1-718-990-1432 (Z.-S.C.); Fax: +1-718-990-1877 (Z.-S.C.)
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Kiros M, Memirie ST, Tolla MTT, Palm MT, Hailu D, Norheim OF. Cost-effectiveness of running a paediatric oncology unit in Ethiopia. BMJ Open 2023; 13:e068210. [PMID: 36918241 PMCID: PMC10016307 DOI: 10.1136/bmjopen-2022-068210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.
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Affiliation(s)
- Mizan Kiros
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Addis Center for Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Mieraf Taddesse Taddesse Tolla
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Michael Tekle Palm
- Department of Health Financing, Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Department of Pediatrics and Child Health, Pediatric Hematology/Oncology Unit, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Girardi F, Di Carlo V, Stiller C, Gatta G, Woods RR, Visser O, Lacour B, Tucker TC, Coleman MP, Allemani C. Global survival trends for brain tumors, by histology: Analysis of individual records for 67,776 children diagnosed in 61 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:593-606. [PMID: 36215122 PMCID: PMC10013647 DOI: 10.1093/neuonc/noac232] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Tumors of the central nervous system are among the leading causes of cancer-related death in children. Population-based cancer survival reflects the overall effectiveness of a health care system in managing cancer. Inequity in access to care world-wide may result in survival disparities. METHODS We considered children (0-14 years) diagnosed with a brain tumor during 2000-2014, regardless of tumor behavior. Data underwent a rigorous, three-phase quality control as part of CONCORD-3. We implemented a revised version of the International Classification of Childhood Cancer (third edition) to control for under-registration of non-malignant astrocytic tumors. We estimated net survival using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 67,776 children. We estimated survival for 12 histology groups, each based on relevant ICD-O-3 codes. Age-standardized 5-year net survival for low-grade astrocytoma ranged between 84% and 100% world-wide during 2000-2014. In most countries, 5-year survival was 90% or more during 2000-2004, 2005-2009, and 2010-2014. Global variation in survival for medulloblastoma was much wider, with age-standardized 5-year net survival between 47% and 86% for children diagnosed during 2010-2014. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors in children, by histology. We devised an enhanced version of ICCC-3 to account for differences in cancer registration practices world-wide. Our findings may have public health implications, because low-grade glioma is 1 of the 6 index childhood cancers included by WHO in the Global Initiative for Childhood Cancer.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Veronica Di Carlo
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Brigitte Lacour
- National Registry of Childhood Solid Tumors, Faculty of Medicine -Vandœuvre-lès-Nancy Cedex, France.,National Registry of Childhood Cancers, CRESS EQ7, UMR-S 1153, INSERM, Université de Paris, Paris, France
| | - Thomas C Tucker
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Sullivan CE, Weber LS, Lamas PV, Diaz DN, Lu Z, Zhao X, Salinas-Avila SJ, Ramos RJ, Belderson KM, Challinor J. Expanding APHON's Pediatric Chemotherapy/Biotherapy Provider and Instructor Program to Spanish-Speaking Countries: Pilot Series Development and Evaluation. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:119-132. [PMID: 36285475 PMCID: PMC10073235 DOI: 10.1177/27527530221121729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Background: To address the need for standardized, comprehensive chemotherapy/biotherapy education in Latin American and Caribbean (LAC) countries, the Association of Pediatric Hematology/Oncology Nurses (APHON) Pediatric Chemotherapy/Biotherapy Provider and Instructor program courses were culturally adapted, translated to Spanish, and piloted. The process of course adaptation and implementation are described. A Context, Input, Process, Product model outcomes evaluation determined: (a) differences in pass rates by test version and pilot location, (b) predictors of pass rates, (c) course appropriateness for nurses' education and practice levels, and (d) strategies for course improvements. Methods: The Spanish APHON Pediatric Chemotherapy/Biotherapy Provider program was piloted four times and the Instructor program twice with nurses from Mexico, Central America, the Caribbean, South America, and Spain. Statistical analysis identified factors associated with pass rates. Results: Of the 203 students in four Spanish APHON Provider program courses, data from 108 students (three pilots) were analyzed (one unplanned pilot excluded for missing data). Significant predictors of pass rates included: pediatric oncology frontline nurses (OR = 9.86; 95% CI [2.56, 65.23]; p = .004), nurses dedicated to an inpatient or outpatient unit (non-rotating) (OR = 6.79 [1.29, 51.98]; p = .033), and graduation from a 5-year nursing program (OR = 5.92; 95% CI [1.30, 33.15]; p = .028). Discussion: The Spanish APHON Pediatric Chemotherapy/Biotherapy program was determined appropriate for nurses' education and practice levels in LAC countries. Through the APHON Spanish language instructor network, pediatric oncology nurses in LAC countries have increased access to standardized, comprehensive chemotherapy/biotherapy education.
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Affiliation(s)
- Courtney E. Sullivan
- Global Nursing Project Coordinator; St. Jude Children’s Research Hospital; Memphis, Tennessee, USA
| | - Lorena Segovia Weber
- St Jude Global Nursing Contractor; Nurse Educator, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Paola Viveros Lamas
- St Jude Global Nursing Contractor; Nurse Educator, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - Dorian Navarro Diaz
- Nurse Educator; Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”; Universidad de Guadalajara, Jalisco, México
| | - Zhaohua Lu
- Biostatistician; St. Jude Children’s Research Hospital; Memphis, Tennessee, USA
| | - Xiwen Zhao
- Biostatistician; Yale Center for Analytical Sciences; Yale University; New Haven, Connecticut, USA
| | | | - Richard J. Ramos
- Pediatric Oncology Nurse; Lucile Packard Children’s Hospital at Stanford; Palo Alto, California, USA
| | - Kristin M. Belderson
- Manager Professional Development; Children’s Hospital Colorado; Aurora, Colorado, USA
| | - Julia Challinor
- Associate Adjunct Professor; University of California at San Francisco; San Francisco, California, USA
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Espinoza D, Blanco Lopez JG, Vasquez R, Fu L, Martínez R, Rodríguez H, Navarrete M, Howard SC, Friedrich P, Valsecchi MG, Conter V, Ceppi F. How should childhood acute lymphoblastic leukemia relapses in low-income and middle-income countries be managed: The AHOPCA-ALL study group experience. Cancer 2023; 129:771-779. [PMID: 36504077 DOI: 10.1002/cncr.34572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children with relapsed acute lymphoblastic leukemia (ALL) in low-income and middle-income countries rarely survive. The Pediatric Hematology-Oncology Association of Central America (AHOPCA) developed the AHOPCA-ALL REC 2014 protocol to improve outcomes in resource-constrained settings without access to stem cell transplantation. METHODS The AHOPCA-ALL REC 2014 protocol was based on a modified frontline induction phase 1A, a consolidation therapy with six modified R-blocks derived from the ALL-Berlin-Frankfurt-Munster REZ 2002 protocol and intermittent maintenance therapy. Children with B-lineage ALL were eligible after a late medullary relapse, an early or late combined relapse, or any extramedullary relapses. Those with T-lineage ALL were eligible after early and late extramedullary relapses, as were those with both B-lineage and T-lineage relapses occurring at least 3 months after therapy abandonment. RESULTS The study population included 190 patients with T-lineage (n = 3) and B-lineage (n = 187) ALL. Of those with B-lineage ALL, 25 patients had a very early extramedullary relapse, 40 had an early relapse (32 extramedullary and 8 combined), and 125 had a late relapse (34 extramedullary, 19 combined, and 72 medullary). The main cause of treatment failure was second relapse (52.1%). The 3-year event-free survival rate (± standard error) was 25.9% ± 3.5%, and the 3-year overall survival rate was 36.7% ± 3.8%. The 3-year event-free survival rate was 47.2% ± 4.7% for late relapses. The most frequently reported toxicity was grade 3 or 4 infection. Mortality during treatment occurred in 17 patients (8.9%), in most cases because of infectious complications. CONCLUSIONS Selected children with relapsed ALL in Central America can be cured with second-line regimens even without access to consolidation with stem cell transplantation. Children in low-income and middle-income countries who have lower risk relapses of ALL should be treated with curative intent.
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Affiliation(s)
- Darrell Espinoza
- Department of Pediatric Oncology, Hospital Manuel de Jesus Rivera La Mascota, Managua, Nicaragua
| | | | - Roberto Vasquez
- Division of Hematology and Oncology, Hospital Nacional de Ninos Benjamin Bloom, San Salvador, El Salvador
| | - Ligia Fu
- Pediatric Hematology and Oncology Unit, Hospital Escuela, Tegucigalpa, Honduras
| | - Roxana Martínez
- Hemato-Oncology Service, Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Hilze Rodríguez
- Hospital Del Nino Doctor Jose Renan Esquivel, Panama City, Panama
| | - Marta Navarrete
- Hospital Nacional de Ninos y Escuela de Medicina Universidad de Costa Rica, San Jose, Costa Rica
| | - Scott C Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Valentino Conter
- Pediatric Hemato-Oncology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, University Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Francesco Ceppi
- Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Arias AV, Sakaan FM, Puerto-Torres M, Al Zebin Z, Bhattacharyya P, Cardenas A, Gunasekera S, Kambugu J, Kirgizov K, Libes J, Martinez A, Matinyan NV, Mendez A, Middlekauff J, Nielsen KR, Pappas A, Ren H, Sharara-Chami R, Torres SF, McArthur J, Agulnik A. Development and pilot testing of PROACTIVE: A pediatric onco-critical care capacity and quality assessment tool for resource-limited settings. Cancer Med 2023; 12:6270-6282. [PMID: 36324249 PMCID: PMC10028058 DOI: 10.1002/cam4.5395] [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: 06/06/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nearly 90% children with cancer reside in low- and middle-income countries, which face multiple challenges delivering high-quality pediatric onco-critical care (POCC). We recently identified POCC quality and capacity indicators for PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), a tool that evaluates strengths and limitations in POCC services. This study describes pilot testing of PROACTIVE, development of center-specific reports, and identification of common POCC challenges. METHODS The original 119 consensus-derived PROACTIVE indicators were converted into 182 questions divided between 2 electronic surveys for intensivists and oncologists managing critically ill pediatric cancer patients. Alpha-testing was conducted to confirm face-validity with four pediatric intensivists. Eleven centers representing diverse geographic regions, income levels, and POCC services conducted beta-testing to evaluate usability, feasibility, and applicability of PROACTIVE. Centers' responses were scored and indicators with mean scores ≤75% in availability/performance were classified as common POCC challenges. RESULTS Alpha-testing ensured face-validity and beta-testing demonstrated feasibility and usability of PROACTIVE (October 2020-June 2021). Twenty-two surveys (response rate 99.4%) were used to develop center-specific reports. Adjustments to PROACTIVE were made based on focus group feedback and surveys, resulting in 200 questions. Aggregated data across centers identified common POCC challenges: (1) lack of pediatric intensivists, (2) absence of abstinence and withdrawal symptoms monitoring, (3) shortage of supportive care resources, and (4) limited POCC training for physicians and nurses. CONCLUSIONS PROACTIVE is a feasible and contextually appropriate tool to help clinicians and organizations identify challenges in POCC services across a wide range of resource-levels. Widespread use of PROACTIVE can help prioritize and develop tailored interventions to strengthen POCC services and outcomes globally.
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Affiliation(s)
- Anita V Arias
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Firas M Sakaan
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Zebin Al Zebin
- Pediatric Hematology and Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Adolfo Cardenas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sanjeeva Gunasekera
- Department of Pediatric Oncology, National Cancer Institute Sri Lanka, Maharagama, Sri Lanka
| | - Joyce Kambugu
- Department of Pediatric Oncology, Uganda Cancer Institute, Kampala, Uganda
| | | | - Jaime Libes
- Department of Pediatric Hematology and Oncology, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Angelica Martinez
- Pediatric Hemato-Oncology Unit, Hospital General de Tijuana, Tijuana, Baja California, Mexico
| | | | - Alejandra Mendez
- Pediatric Critical Care, Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala City, Guatemala
| | - Janet Middlekauff
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Katie R Nielsen
- Division of Pediatric Critical Care, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Andrew Pappas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Hong Ren
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai, China
| | - Rana Sharara-Chami
- Department of Pediatric and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Silvio F Torres
- Pediatric Intensive Care Unit, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Jennifer McArthur
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Asya Agulnik
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Suthapot P, Chiangjong W, Chaiyawat P, Choochuen P, Pruksakorn D, Sangkhathat S, Hongeng S, Anurathapan U, Chutipongtanate S. Genomics-Driven Precision Medicine in Pediatric Solid Tumors. Cancers (Basel) 2023; 15:cancers15051418. [PMID: 36900212 PMCID: PMC10000495 DOI: 10.3390/cancers15051418] [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: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Over the past decades, several study programs have conducted genetic testing in cancer patients to identify potential genetic targets for the development of precision therapeutic strategies. These biomarker-driven trials have demonstrated improved clinical outcomes and progression-free survival rates in various types of cancers, especially for adult malignancies. However, similar progress in pediatric cancers has been slow due to their distinguished mutation profiles compared to adults and the low frequency of recurrent genomic alterations. Recently, increased efforts to develop precision medicine for childhood malignancies have led to the identification of genomic alterations and transcriptomic profiles of pediatric patients which presents promising opportunities to study rare and difficult-to-access neoplasms. This review summarizes the current state of known and potential genetic markers for pediatric solid tumors and provides perspectives on precise therapeutic strategies that warrant further investigations.
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Affiliation(s)
- Praewa Suthapot
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wararat Chiangjong
- Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Parunya Chaiyawat
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pongsakorn Choochuen
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dumnoensun Pruksakorn
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Surasak Sangkhathat
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Suradej Hongeng
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Usanarat Anurathapan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (U.A.); or (S.C.)
| | - Somchai Chutipongtanate
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Correspondence: (U.A.); or (S.C.)
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Wireko AA, Patel H, Mehta A, Jiffry R, Adebusoye FT, Miteu GD. Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial. Int J Surg 2023; 109:235-238. [PMID: 37093068 PMCID: PMC10389311 DOI: 10.1097/js9.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 04/08/2023]
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49
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Ma CT, Chou HW, Lam TTN, Tung YT, Lai YW, Lee LK, Lee VWY, Yeung NCY, Leung AWK, Bhatia S, Li CK, Cheung YT. Provision of a personalized survivorship care plan and its impact on cancer-related health literacy among childhood cancer survivors in Hong Kong. Pediatr Blood Cancer 2023; 70:e30084. [PMID: 36383479 DOI: 10.1002/pbc.30084] [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: 08/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the short-term effectiveness of a personalized survivorship care plan (SCP) in improving cancer-related literacy among childhood cancer survivors, and to identify characteristics of survivors who demonstrated minimal gain from the intervention. METHODS We recruited survivors diagnosed with cancer at ≤18 years old and were >2 years post treatment. The intervention included a personalized SCP and 30-minute health risk counseling. The participants' knowledge of their cancer diagnosis and potential treatment-related late effects (LEs) was assessed at baseline, immediately post intervention, and 1-3 months post intervention. Generalized estimating equation was used to test for changes in the awareness scores, with interacting terms (time*factor) added to identify differences in the score trajectory across clinically relevant subgroups. RESULTS In total, 248 survivors completed the intervention (mean age: 19.4 [SD = 6.7] years; 54.1% male; 66.1% hematological malignancies), of whom 162 completed all assessments. There was significant increase in survivors' awareness of their cancer diagnoses (mean adjusted score: baseline 66.9, post intervention 86.3; p < .001) and potential LEs (baseline 30.9, post intervention 66.3; p < .001). The proportion of survivors who demonstrated awareness of their potential LEs increased from 9.7% to 54.3%. The interaction analysis showed that there was significantly less improvement in awareness among survivors of non-central nervous system (non-CNS) solid tumors (p = .032), lower socioeconomic status (p = .014), and parents of pediatric survivors (vs. adult survivors; p = .013). CONCLUSIONS The provision of a personalized SCP showed preliminary effectiveness in improving survivors' understanding of their treatment-related LEs. Health counseling with SCP should be reinforced in vulnerable subgroups. Future work includes evaluating its long-term impact on lifestyle and health outcomes.
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Affiliation(s)
- Chung-Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Wing Chou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Teddy Tai-Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan Tung Tung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat Wing Lai
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lai-Ka Lee
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Vivian Wing-Yan Lee
- Centre for Learning Enhancement and Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nelson Chun-Yiu Yeung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alex Wing-Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, The University of Alabama in Birmingham, Birmingham, Alabama, USA
| | - Chi Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China.,Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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50
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McNeil MJ, Ehrlich B, Wang H, Bustamante M, Dussel V, Friedrich P, Garcia Quintero X, Gillipelli SR, Gómez García W, Graetz D, Kaye EC, Metzger M, Sabato Danon CV, Devidas M, Baker JN, Agulnik A. Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America. JAMA Netw Open 2023; 6:e2251496. [PMID: 36656580 PMCID: PMC9857245 DOI: 10.1001/jamanetworkopen.2022.51496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Early integration of pediatric palliative care (PPC) for children with cancer is critical for the quality of life of both patient and family. To improve access to PPC in resource-limited settings, barriers to early integration must be understood. OBJECTIVES To evaluate the ideal vs actual timing of PPC integration for children with cancer and to uncover barriers to early integration identified by physicians in Latin America. DESIGN, SETTING, AND PARTICIPANTS The Assessing Doctors' Attitudes on Palliative Treatment (ADAPT) survey was distributed electronically from August 1, 2020, to January 31, 2021, to physicians who treat children with cancer in 17 countries in Latin America. MAIN OUTCOMES AND MEASURES The ADAPT survey queried for understanding of ideal vs actual timing of PPC for children with cancer and for identification of barriers to PPC integration. Descriptive statistics were used to summarize the data. For secondary analyses, a comparison of the associations of previous palliative care training with physician specialty was performed using the Pearson χ2 test or the Fisher exact test. The McNemar test was used to assess responses regarding the actual vs ideal timing of PPC consultation. Analysis of variance was used to compare mean values for perceived barriers by country income level. Answers to open-ended questions were analyzed qualitatively. RESULTS A total of 831 physicians (578 women [69.6%]; 275 physicians [33.1%] aged <35 years and 556 physicians [66.9%] aged ≥35 years) from 17 countries participated, with an overall response rate of 37.9% (831 of 2193) and a median country response rate of 51.4% (range, 22.2%-88.9%). Most respondents (572 [68.8%]) said that PPC should be involved from diagnosis, but only 117 (14.1%) stated that this occurred at their institution (P < .001). The most significantly ranked barriers to PPC were lack of home-based services (713 [85.8%]), personnel (654 [78.7%]), and knowledge about PPC (693 [83.4%]), along with physician (676 [81.3%]) and family (603 [72.6%]) discomfort about PPC involvement. In addition, these barriers were rated as more important in lower-middle income countries compared with upper-middle income countries and high-income countries. CONCLUSIONS AND RELEVANCE This study highlights the discrepancy between ideal and actual timing of PPC for children with cancer and barriers to early PPC integration in Latin America. Interventions addressing access to PPC resources, didactic training, and clinical education (with a particular focus on equitable access to basic resources and support) are critical to improve the timing and quality of PPC in the region.
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Affiliation(s)
- Michael J. McNeil
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Bella Ehrlich
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Brown University School of Medicine, Providence, Rhode Island
| | - Huiqi Wang
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Veronica Dussel
- Center for Research and Implementation in Palliative Care, Buenos Aires, Argentina
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ximena Garcia Quintero
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Fundación Valle de Lilli, Cali Colombia
| | - Srinithya R. Gillipelli
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Wendy Gómez García
- Dr Robert Reid Cabral Children’s Hospital, Santo Domingo, Dominican Republic
| | - Dylan Graetz
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Erica C. Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Monika Metzger
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
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