Survival in Childhood Acute Lymphocytic Leukemia: Effect of Protocol and Place of Treatment

Abstract

The objective of this study was to determine the effect of place and type of initial treatment on survival from acute lymphocytic leukemia (ALL). Every one of the 327 children under 15 years of age diagnosed with ALL from 1970 to 1975 in a 31-county area designated the Greater Delaware Valley, were studied. Treatment according to protocol was associated with improved survival, yielding a 4 year survival of 60% vs 19% for nonprotocol treated patients (p less than 0.001). There was also a significantly improved survival rate among patients treated in a cancer center, especially for those with a low white blood count (WBC) at diagnosis. The prognostic importance of WBC, age, and sex was confirmed.

Canadian adolescents and young adults with cancer: opportunity to improve coordination and level of care

“…32,33 Clinical trials For some malignant diseases, participation in a clinical trial is often associated with better survival among children under the age of 15 years. 34 Participation in such trials by adolescents and young adult cancer patients is low. 35 Participation in a trial under the care of an oncology specialist likely confers a stricter discipline to the treatment protocol by both physician and patient, as well as better adherence to drug dosages and schedules.…”

“…Second, the rapidly growing and aggressive nature of some of the curable cancers in adolescents and young adults, such as testis cancer and non-Hodgkin lymphoma, necessitates prompt referral to specialist care to take advantage of comprehensive treatment and access to cooperative group clinical trials. 34 Progress is also needed in the development of therapeutic and monitoring guidelines for adolescents and young adults. 35 Third, care provided in same-age peer settings allows patients to observe others with whom they can relate and to address areas of concern such as coping with uncertainty, dependency versus autonomy, social exclusion, separation processes, body image, intimacy, sexuality and fertility, and career plans.…”

Improving Care for Children With Cancer in Low- and Middle-Income Countries-A SIOP PODC Initiative

“…[37,38] Using HIC protocols in LMIC without adaptation can lead to unacceptably high rates of treatment toxicity, with attendant excess mortality and abandonment and hence need modification.…”

Standards for Pediatric Cancer Centers

“…[5][6][7][8][9] After diagnosis has been established and the treatment plan has been determined by the pediatric cancer center, certain aspects of care that are not investigational may be continued in the office of a primary care pediatrician for selected children when mandated by distance from the cancer center or other individual specific circumstances. In some circumstances, communication via telemedicine may be beneficial.…”