Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi–Italian experience

Abstract

Background Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). Methods We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele‐education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. Findings A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. Interpretation The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.

Pediatric Hematology and Oncology Center Integrated by Telemedicine: Experience, Challenges and First Results of a Cross Border Network

“…The authors of this review concluded that more research is needed to determine the efficacy of implementing the more widespread use of telemedicine for hematological conditions. We believe that the results presented in this manuscript add some more arguments speaking in favor of the utility of telemedicine in the field of pediatric oncology and hematology [13][14][15].…”

Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S

“…Al-Jadiry et al. reported significant improvements in diagnoses and management of pediatric cancer in Iraq through a partnership with Sapienza University of Rome, which included teleconsultations and pathology reviews ( 13 ). Similarly, Qaddoumi and Bouffet found that e-mail exchanges enhanced a neuro-oncology twinning program between Jordan and Canada, facilitating communication and collaboration ( 14 ).…”

A regional virtual case discussion forum in pediatric oncology: Experience of the Pediatric Oncology East and Mediterranean Group

“…Similar efforts within lower middle-income countries (LMICs) are often limited to twinning initiatives between one LMIC center and an HIC center, that typically utilize videoconferencing with a focus on specific subspecialty case discussions. [6][7][8][9][10][11][12] Such initiatives have been successful in developing local expertise, but their reach is limited to the institution participating in the twinning, which is usually a reference center that has reasonable resources.…”

“…Videoconferencing among regional oncology networks has been mostly reported within high‐income countries (HICs), 4,5 and is associated with multiple benefits, including enhanced care coordination, optimization of treatment plans, and education of practitioners. Similar efforts within lower middle‐income countries (LMICs) are often limited to twinning initiatives between one LMIC center and an HIC center, that typically utilize videoconferencing with a focus on specific subspecialty case discussions 6–12 . Such initiatives have been successful in developing local expertise, but their reach is limited to the institution participating in the twinning, which is usually a reference center that has reasonable resources.…”