Childhood cancer in Latin America: from detection to palliative care and survivorship

C, Paula Carolina Guzman; Cordoba, Maria Adelaida; Godoy, Natalia; Castaño, Alexandra; Ribeiro, Karina Braga; Moreno, Florencia; Vries, Esther de

doi:10.1016/j.canep.2020.101837

Cited by 25 publications

(28 citation statements)

References 64 publications

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“…Leukemia was the most expensive cancer in terms of total cost, but cancer of the brain or nervous system had the higher OOP spending. Consistent with findings from other settings, leukemia was the most frequent type of cancer and had the highest average total cost [18,39,47,48]. However, we found cancer of the brain or nervous system, and bone and articular cartilage cancer, had the highest average OOP costs, whereas evidence from the US showed non-Hodgkin's lymphoma was the most expensive category among children [16].…”

Section: Discussionsupporting

confidence: 87%

“…Whereas in some areas of Latin America, a lack of adequate hospital infrastructure and expertise means pediatric cancers are not effectively managed, in recent years, Chile has implemented comprehensive, meaningful changes to improve cancer care for children, in particular with the implementation of a population-based registry [29,39]. The "Plan Nacional de Cancer" (National Cancer Plan was launched in 2018 and marked an unprecedented relevance of cancer in the national health policy, not only considering it a health condition, but also taking into account its social and economic dimensions in the design of a plan of several actions for the period 2018-2028 [40,41].…”

Section: Discussionmentioning

confidence: 99%

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Medical Cost of Cancer Care for Privately Insured Children in Chile

Borrescio-Higa

Valdés

2021

IJERPH

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Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Medical Cost of Cancer Care for Privately Insured Children in Chile

Borrescio-Higa

Valdés

2021

IJERPH

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“…24 In contrast, leukemia remained the main cause of childhood cancer deaths in Latin American countries-likely as a consequence of delays in diagnosis and lack of access to advanced treatments, as well as treatment discontinuation. 3,8,25 Moreover, children with cancer from several Latin American countries must often be referred to universal health care systems in places far from their place of residence. 25 Childhood cancer mortality rates in countries from North America and Australasia are comparable or even more favorable to those registered in Western Europe, whereas most Latin American countries still showed rates higher than those of Central-Eastern European countries, the area with the highest rates in Europe.…”

Section: Discussionmentioning

confidence: 99%

“…3,8,25 Moreover, children with cancer from several Latin American countries must often be referred to universal health care systems in places far from their place of residence. 25 Childhood cancer mortality rates in countries from North America and Australasia are comparable or even more favorable to those registered in Western Europe, whereas most Latin American countries still showed rates higher than those of Central-Eastern European countries, the area with the highest rates in Europe. 12 The encouraging trends in childhood cancer mortality observed during the last decades in the countries included in this analysis are largely based on important advancements in effective therapies.…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, Canada, Japan, and Australia, death rates from neoplasms of the CNS were higher than those from leukemia, reflecting the lack of substantial improvements in the treatment of these malignancies, even in high‐income countries 24 . In contrast, leukemia remained the main cause of childhood cancer deaths in Latin American countries—likely as a consequence of delays in diagnosis and lack of access to advanced treatments, as well as treatment discontinuation 3,8,25 . Moreover, children with cancer from several Latin American countries must often be referred to universal health care systems in places far from their place of residence 25 …”

Section: Discussionmentioning

confidence: 99%

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Childhood cancer mortality trends in the Americas and Australasia: An update to 2017

Malvezzi

Santucci

Alicandro

et al. 2021

Cancer

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BACKGROUND: Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends. METHODS: Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries. RESULTS: Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia. CONCLUSIONS: Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide. Cancer 2021;0:1-12.

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Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

et al. 2023

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ImportanceEarly 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.ObjectivesTo 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 ParticipantsThe 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 MeasuresThe 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.ResultsA total of 831 physicians (578 women [69.6%]; 275 physicians [33.1%] aged &lt;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 &lt; .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 RelevanceThis 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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Childhood cancer in Latin America: from detection to palliative care and survivorship

Cited by 25 publications

References 64 publications

Medical Cost of Cancer Care for Privately Insured Children in Chile

Medical Cost of Cancer Care for Privately Insured Children in Chile

Childhood cancer mortality trends in the Americas and Australasia: An update to 2017

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

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