Sara Stulac1,2,3,4, Richard B Mark Munyaneza5, Jeanne Chai1, Jean Bosco Bigirimana6, Merab Nyishime5, Neo Tapela2,5,6, Sara Chaffee7, Leslie Lehmann4,8, Lawrence N Shulman1,2,3,8. 1. Partners In Health, Boston, Massachusetts. 2. Brigham and Women's Hospital, Boston, Massachusetts. 3. Harvard Medical School, Boston, Massachusetts. 4. Boston Children's Hospital, Boston, Massachusetts. 5. Ministry of Health, Kigali, Rwanda. 6. Inshuti Mu Buzima, Kigali, Rwanda. 7. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 8. Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
BACKGROUND: More than 85% of pediatric cancer cases and 95% of deaths occur in resource-poor countries that use less than 5% of the world's health resources. In the developed world, approximately 81% of children with cancer can be cured. Models applicable in the most resource-poor settings are needed to address global inequities in pediatric cancer treatment. PROCEDURE: Between 2006 and 2011, a cohort of children received cancer therapy using a new approach in rural Rwanda. Children were managed by a team of a Rwandan generalist doctor, Rwandan nurse case manager, Rwanda-based US-trained pediatrician, and US-based pediatric oncologist. Biopsies and staging studies were obtained in-country. Pathologic diagnoses were made at US or European laboratories. Rwanda-based clinicians and the pediatric oncologist jointly generated treatment plans by telephone and email. RESULTS: Treatment was provided to 24 patients. Diagnoses included lymphomas (n = 10), sarcomas (n = 9), leukemias (n = 2), and other malignancies (n = 3). Standard chemotherapy regimens included CHOP, ABVD, VA, COP/COMP, and actino-VAC. Thirteen patients were in remission at the completion of data collection. Two succumbed to treatment complications and nine had progressive disease. There were no patients who abandoned treatment. The mean overall survival was 31 months and mean disease-free survival was 18 months. CONCLUSIONS: These data suggest that chemotherapy can be administered with curative intent to a subset of cancer patients in this setting. This approach provides a platform for pediatric cancer care models, relying on local physicians collaborating with remote specialist consultants to deliver subspecialty care in resource-poor settings.
BACKGROUND: More than 85% of pediatric cancer cases and 95% of deaths occur in resource-poor countries that use less than 5% of the world's health resources. In the developed world, approximately 81% of children with cancer can be cured. Models applicable in the most resource-poor settings are needed to address global inequities in pediatric cancer treatment. PROCEDURE: Between 2006 and 2011, a cohort of children received cancer therapy using a new approach in rural Rwanda. Children were managed by a team of a Rwandan generalist doctor, Rwandan nurse case manager, Rwanda-based US-trained pediatrician, and US-based pediatric oncologist. Biopsies and staging studies were obtained in-country. Pathologic diagnoses were made at US or European laboratories. Rwanda-based clinicians and the pediatric oncologist jointly generated treatment plans by telephone and email. RESULTS: Treatment was provided to 24 patients. Diagnoses included lymphomas (n = 10), sarcomas (n = 9), leukemias (n = 2), and other malignancies (n = 3). Standard chemotherapy regimens included CHOP, ABVD, VA, COP/COMP, and actino-VAC. Thirteen patients were in remission at the completion of data collection. Two succumbed to treatment complications and nine had progressive disease. There were no patients who abandoned treatment. The mean overall survival was 31 months and mean disease-free survival was 18 months. CONCLUSIONS: These data suggest that chemotherapy can be administered with curative intent to a subset of cancerpatients in this setting. This approach provides a platform for pediatric cancer care models, relying on local physicians collaborating with remote specialist consultants to deliver subspecialty care in resource-poor settings.
Authors: Henry Miller; Jeremy S Slone; Eric Raabe; Nader Kim El-Mallawany; Parth Mehta; B Ryan Phelps Journal: Pediatrics Date: 2017-09-14 Impact factor: 7.124