Catalyzing Childhood Cancer Care in Peru After One Year of the Global Initiative for Childhood Cancer

Vásquez, Liliana; Maradiegue, Essy; Rojas, Ninoska; Montoya, Jacqueline; Zapata, Arturo; Ugaz, Cecilia; Pascual, Claudia; Santillán, Carlos; Wachtel, Antonio; Celis, Edinho; Bernedo, Hernán; Rossi, Jonathan; Saldaña, Lily; Díaz, Rosdali; Morales, Roxana; Perez, Vivian; Metzger, Monika L.; Luciani, Silvana

doi:10.1200/go.20.00601

Cited by 8 publications

(11 citation statements)

References 5 publications

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“…This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally. Creation of new legislation, 21 increasing utilisation of technology, 22 and optimising the allocation of resources 12 are some of the commendable efforts that have mitigated the impact of the pandemic on patients with paediatric cancer. The benefits of these interventions could persist beyond the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

2022

BMJ Open

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ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001).ConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

2022

BMJ Open

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“…The implementation of the Global Initiative for Childhood Cancer in Peru since 2019 has allowed the development of strategies that promote coordinated multidisciplinary management of the pediatric neuro-oncology department and interventions that promote early detection and timely referral aiming to improve the survival of children and adolescents with cancer. It also focusses on the 6 neoplasms prioritized by the initiative, including brain tumors 33,34. The approval of the Childhood Cancer Law in Peru includes universal coverage of treatment until its finalization, which constitutes a significant advance for childhood cancer in the country 9…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru

Morales

Ponce

Briceño³

et al. 2022

Journal of Pediatric Hematology/Oncology

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Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients’ data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.

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“…Conducted in a face-to-face meeting in Panama April 2022, the workshop consolidated the six childhood cancer commissions congresses and are in the process of publication development. In addition, prioritization of health systems activities in Peru has been published by the local team (18), and this serves as a model for expanding work implementing GICC regionally. Ongoing work is underway with country teams to further document country-specific findings and next steps.…”

Section: C) Regional and National Workhopsmentioning

confidence: 99%

“…Using C5, SJCRH and PAHO continued to support the development and/or implementation of NCCPs that include pediatric cancer, expanding this support in 2021 to six additional countries (Bolivia, Brazil, Chile, Colombia Ecuador, and Paraguay) where local teams have mobilized advances for children with cancer (17). SJCRH and PAHO also jointly supported the first regional focus country workshop for GICC in Peru in 2019, engaging stakeholders to develop a situational analysis and collaborative prioritization for GICC implementation (18). This has enabled ongoing work led by local teams in more than 16 countries now engaged in the Initiative in the Americas (15,17).…”

mentioning

confidence: 99%

Partnering to implement the Global Initiative for Childhood Cancer in the Americas: prioritizing systems strengthening

Lam

Vásquez

Loggetto

et al. 2023

Revista Panamericana De Salud Pública

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Working with PAHO/WHO to prioritize childhood cancer in the context of systems strengthening is central to St. Jude Children's Research Hospital (SJCRH)’s role as WHO Collaborating Centre for Childhood Cancer. This manuscript focuses on how SJCRH and PAHO/WHO have partnered to apply C5 (Country Collaboration for Childhood Cancer Control) to define and implement priority actions regionally, strengthening Ministry programs for childhood cancer, while implementing the Global Initiative for Childhood Cancer since 2018. Using C5, a tool developed by SJCRH, PAHO/WHO and SJCRH co-hosted regional/national workshops engaging authorities, clinicians and other stakeholders across 10 countries to map health systems needs and prioritize strategic activities (spanning Central America, Dominican Republic, Haiti, Brazil and Uruguay). SJCRH provided English/Spanish/Portuguese C5 versions/templates for analysis/prioritization exercises, and worked with PAHO/WHO and country teams to implement C5, analyze findings, and develop outputs. In an eight-country regional workshop, countries defined priorities within national/regional initiatives and ranked their value and political will, incorporating country-specific surveys and stakeholder dialogues. Each country prioritized one strategic activity for 2022-2023, exchanged insights via storytelling, and disseminated and applied results to inform country-specific and regional action plans. National workshops analyses have been incorporated into cancer control planning activities and collaborative work regionally. Implementation success factors include engaging actors beyond the clinic, enabling flexibility, and focusing on co-design with stakeholders. Joint implementation of C5 catalyzed prioritization and accelerated strategic activities to improve policies, capacity, and quality of care for children in the Americas, supporting Ministries to integrate childhood cancer interventions as part of systems strengthening.

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Catalyzing Childhood Cancer Care in Peru After One Year of the Global Initiative for Childhood Cancer

Cited by 8 publications

References 5 publications

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Clinical Factors, Management, and Outcomes of Patients Under 18 Years Old With Central Nervous System Tumors: Single-center Experience in Peru

Partnering to implement the Global Initiative for Childhood Cancer in the Americas: prioritizing systems strengthening

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