Raising the survival rate of children with sarcoma in low-income
countries will require steps to diagnose the disease sooner, train
cancer pathologists, expand radiation therapy services, create
multi-specialty teams to review each case, and other actions, according
to an international study led by Dana-Farber/Children's Hospital Cancer
Center researchers.
The findings were presented at the 42nd Congress of the International
Society of Paediatric Oncology (SIOP) in Boston on Friday, Oct. 22.
The study explored why, despite advances in the treatment of
pediatric acute leukemia in six Central American countries, survival
rates for children with bone and soft-tissue sarcomas remain disproportionately low.
Information was obtained through ongoing collaboration and answers to
a 110-item questionnaire distributed to pediatric cancer physicians in
Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama to
get a better understanding of the barriers to pediatric sarcoma
treatment in the region.
"More than 80 percent of the pediatric cancer burden falls on the
developing world, and the challenges to provide effective treatment of
children with cancer in resource-rich and resource-limited settings are
different," says the study's lead author, Paola Friedrich-Medina, MD, of
Dana-Farber/Children's Hospital Cancer Center.
"This study aims to develop a better understanding of the challenges
to effective treatment of pediatric sarcoma faced by our colleagues in
Central America."
The responses to the questionnaire indicate that there was adequate
access to standard chemotherapy agents, hospital beds, subspecialty
providers, laboratory services, and imaging studies.
But a variety of problem areas were identified, including heavy
caseloads for pediatric oncologists, a disproportionate number of
patients with metastatic (spreading) disease, inconsistent procedures
for assessing the extent of disease and developing a treatment plan, and
less-advanced radiation therapy equipment.
Some of the major barriers to better treatment included family
financial constraints, fear of surgery, and lack of surgical materials
needed to perform limb-sparing procedures.
Other areas of concern were possible inaccuracies in the
interpretation of pathology exams and difficulties in arranging for
experts from different disciplines to participate in cohesive real-time
multidisciplinary meetings.
"We believe that dedicated partnerships between institutions in high-
and low-resource areas can nurture sustainable, comprehensive pediatric
cancer programs in resource-limited settings and foster improved
patient care, quality improvement initiatives, and important research,"
says Friedrich-Medina.
The study's senior author is Federico Antillon-Klussmann, MD, PhD,
Unidad Nacional de Oncología Pediátrica, Guatemala City. Co-authors
include María Sabina Ah Chu-Sanchez, MD, Hospital del Niño de Panama,
Panama City, Panama; Ingrid Carolina Arambu, Hospital Materno Infantil,
Tegucigalpa, Honduras; Paula Aristizabal, MD, Rady Children's Hospital,
San Diego, and Hospital General de Tijuana, Mexico; Fulgencio Baez, MD,
and Roberta Ortiz, MD, Hospital Infantil "La Mascota," Managua,
Nicaragua; Soad Fuentes, MD, Hospital Nacional de Niños Benjamin Bloom,
San Salvador, El Salvador; Yessica Gamboa, Hospital Nacional de Niños,
San Jose, Costa Rica; and Carlos Rodriguez-Galindo, MD, of
Dana-Farber/Children's Hospital Cancer Center.