Treating Children With Cancer Worldwide—Challenges and Interventions

Israëls, Trijn; Challinor, Julia; Howard, Scott C.; Arora, Ramandeep Harman

doi:10.1542/peds.2015-0300

Cited by 25 publications

(32 citation statements)

References 25 publications

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“…If a guideline requires a resource not widely available in LMICs, alternatives will be required, such as the use of latex balloons in place of incentive spirometry devices for preventing and treating acute chest syndrome in patients with sickle cell disease (SCD) (Asare et al, 2016;Patel et al, 2016). The successful development of guidelines requires improved knowledge on the effectiveness of existing local and cultural practices; local experts should be able to set priorities and ask relevant research questions that will make such guidelines more applicable (Tol et al, 2014;Israels et al, 2015).…”

Section: Guideline Development and Review In Lmicsmentioning

confidence: 99%

“…A large proportion of those who begin a course of anticancer treatment default and are unable to complete it (Israels et al, 2015). In a report from Zambia, over 45% of patients abandoned their anticancer treatment for various reasons (Slone et al, 2014).…”

Section: Challenges Faced By Clientsmentioning

confidence: 99%

“…Thus, whatever guideline is designed for use should be feasible for implementation taking into consideration the available drugs (Israels et al, 2015). Along with chemotherapy, surgery and radiotherapy that are often given prominence; caregivers of patients with malignancies and other chronic haematological diseases in LMICs require counselling, including spiritual support, to enable them deal appropriately with the disease (Israels et al, 2015).…”

Section: Challenges Faced By Clientsmentioning

confidence: 99%

“…Along with chemotherapy, surgery and radiotherapy that are often given prominence; caregivers of patients with malignancies and other chronic haematological diseases in LMICs require counselling, including spiritual support, to enable them deal appropriately with the disease (Israels et al, 2015). This will have to be repeated over several sessions and in a language that the caregiver(s) and patient understand to enable them process the diagnosis, prognosis of the disease, treatment costs and side-effects of treatment as well as the treatment goal.…”

Section: Challenges Faced By Clientsmentioning

confidence: 99%

“…This reduces their tolerance for anticancer agents and, at the same time, they are at increased risk for severe infections during treatment; this is compounded by late presentation with advanced stage disease. So the intensity of treatment has to be reduced to avoid drug toxicity because supportive care may not be readily available (Harif et al, 2008;Israels et al, 2015). Low dose hydroxycarbamide has also been tried in adults with SCD in a bid to prevent toxicities, with promising results (Akingbola et al, 2016).…”

Section: Challenges Faced By Healthcare Professionalsmentioning

confidence: 99%

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Guidelines in lower‐middle income countries

2017

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Summary Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower‐middle income countries (LMICs), there is a paucity of well‐designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation.

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Section: Guideline Development and Review In Lmicsmentioning

confidence: 99%

Section: Challenges Faced By Clientsmentioning

confidence: 99%

Section: Challenges Faced By Clientsmentioning

confidence: 99%

Section: Challenges Faced By Clientsmentioning

confidence: 99%

Section: Challenges Faced By Healthcare Professionalsmentioning

confidence: 99%

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Guidelines in lower‐middle income countries

2017

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Impact of the COVID‐19 pandemic on pediatric oncology providers globally: A mixed‐methods study

Sniderman

Graetz

Agulnik

et al. 2022

Cancer

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BACKGROUND: Coronavirus disease 2019 (COVID-19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide. METHODS: A 60-item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery. RESULTS:The survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID-19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID-19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing. CONCLUSIONS: COVID-19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high-quality care.

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Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

et al. 2021

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Background Pediatric acute myeloid leukemia (AML) is a challenging disease to treat in low‐ and middle‐income countries (LMICs). Literature suggests that survival in LMICs is poorer compared with survival in high‐income countries (HICs). Aims This study evaluates the outcomes of Kenyan children with AML and the impact of sociodemographic and clinical characteristics on outcome. Methods and Results A retrospective medical records study was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, between January 2010 and December 2018. Sociodemographic and clinical characteristics, and treatment outcomes were evaluated. Chemotherapy included two “3 + 7” induction courses with doxorubicin and cytarabine and two “3 + 5” consolidation courses with etoposide and cytarabine. Supportive care included antimicrobial prophylaxis with cotrimoxazole and fluconazole, and blood products, if available. Seventy‐three children with AML were included. The median duration of symptoms before admission at MTRH was 1 month. The median time from admission at MTRH to diagnosis was 6 days and to the start of AML treatment 16 days. Out of the 55 children who were started on chemotherapy, 18 (33%) achieved complete remission, of whom 10 (56%) relapsed. The abandonment rate was 22% and the early death rate was 46%. The 2‐year probabilities of event‐free survival and overall survival were 4% and 7%, respectively. None of the sociodemographic and clinical characteristics were significantly associated with outcome. Conclusion Survival of Kenyan children with AML is dismal and considerably lower compared with survival in HICs. Strategies to improve survival should be put in place including better supportive care, optimization of the treatment protocol, and reduction of the abandonment rate and time lag to diagnosis with sooner start of treatment.

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Treating Children With Cancer Worldwide—Challenges and Interventions

Cited by 25 publications

References 25 publications

Guidelines in lower‐middle income countries

Guidelines in lower‐middle income countries

Impact of the COVID‐19 pandemic on pediatric oncology providers globally: A mixed‐methods study

Outcomes of pediatric acute myeloid leukemia treatment in Western Kenya

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