Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico

Abstract

BackgroundIn 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer.ProcedureA retrospective cohort study (2006–2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan–Meier survival curves and Cox proportional hazards regression modeling.ResultsThe study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3–3.9) and 2.4; 95% CI: 2.0–2.8) of death from disease when compared with those from the central region.ConclusionFPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival.

Retinoblastoma

“…18,20 In 2013, the Paediatric Oncology in Developing Countries Committee of the SIOP (International Society of Paediatric Oncology) published a consensus guideline for the management of retinoblastoma in countries with limited resources 21 with clear ideas that can shape resource development. The Mexican National Strategy 22 and the Brazilian SOBOPE (Brazilian Society of Paediatric Oncology) 23 guidelines are also applicable at a national level with governmental support for treatment.…”

“…24 Retinoblastoma-specific twinning programmes include partnerships between St. Jude’s Children’s Research Hospital (USA) and the Middle-East, 25 Central America 26 and Mexico, 22 and between the Institut Curie and a centre in Bamako, Mali. 27 The Central American Association of Paediatric Hematology Oncology (AHOPCA) created a cooperative group and implemented multicentre protocols for retinoblastoma treatment, 26,28,29 a major achievement, not yet paralleled in developed countries.…”

Geographical Distribution and Cluster Detection of Childhood Leukemia in the Metropolitan Area of Guadalajara, Mexico

“…It is expected that this disease will continue to increase because the population in these countries is younger and growing 3 . It is anticipated that by 2030, developing countries will account for 70% of all childhood cancers, and the cancer-related mortality rate will be 5/100,000 children 4 . A high incidence of ALL has been reported among the Hispanic pediatric population of the USA 5 .…”

Capacity-building initiative to improve clinical outcomes in pediatric acute lymphoblastic leukemia in the US-Mexico border region

“…4 This capacity-building initiative has mitigated disparities across the US-Mexico border, and a similar approach could be implemented in other LMICs. Future directions include regional initiatives to improve care at a larger scale.…”