Paula Carolina Guzman C1, Maria Adelaida Cordoba2, Natalia Godoy3, Alexandra Castaño4, Karina Braga Ribeiro5, Florencia Moreno6, Esther de Vries7. 1. Pediatrics Department, Hospital Militar Central and Faculty of Medicine, Universidad Militar Nueva Granada, Trasversal 3 No. 49-02, Bogotá, Colombia. Electronic address: paulacarolinaguzmanc@gmail.com. 2. Pediatric Palliative Care Unit, Hospital de La Misericordia, Hospital Universitario Fundación Santa Fe de Bogotá and Hospital Militar Central, Av. Caracas #1-65, Carrera 7 No. 117 - 15, Bogotá, Colombia. Electronic address: maria.cordoba@fsfb.org.co. 3. PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 No. 40 - 62, Bogotá, Colombia. Electronic address: natalia.godoy@javeriana.edu.co. 4. Pediatrics department Hospital Universitario Fundación Santa Fe de Bogotá, Carrera 7 No 117-15, Bogotá, Colombia. Electronic address: alexandracastano81@gmail.com. 5. Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Motta Junior, 61, São Paulo, SP, Brazil. Electronic address: kbribeiro@gmail.com. 6. Argentinian Pediatric Oncology Registry, National Cancer Institute, Ministry of Health, J.A: Roca 781 piso 11, CABA, Buenos Aires, Argentina. Electronic address: roha@inc.gob.ar. 7. Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 No. 40 - 62 Bogota, Colombia. Electronic address: estherdevries@javeriana.edu.co.
Abstract
BACKGROUND: Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS: Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS: Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancer patients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS: Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
BACKGROUND: Treatment options for childhood cancer have improved substantially, although in many low- and middle-income countries survival is lagging behind. Integral childhood cancer care involves the whole spectrum from detection and diagnosis to palliative and survivorship care. METHODS: Based on a literature review and expert opinions, we summarized current practice and recommendations on the following aspects of childhood cancer in Latin America: diagnostic processes and time to diagnosis, stage at diagnosis, treatments and complications, survivorship programs and palliative care and end-of-life services. RESULTS: Latin America is a huge and heterogeneous continent. Identified barriers show similar problems between countries, both logistically (time and distance to centers, treatment interruptions) and financially (cost of care, cost of absence from work). Governmental actions in several countries improved the survival of children with cancer, but difficulties persist in timely diagnosis and providing adequate treatment to all childhood cancerpatients in institutions with complete infrastructure. Treatment abandonment is still common, although the situation is improving. Cancer care in the region has mostly focused on acute treatment of the disease and has not adequately considered palliative and end-of-life care and monitoring of survivors. CONCLUSIONS: Decentralizing diagnostic activities and centralizing specialized treatment will remain necessary; measures to facilitate logistics and costs of transportation of the child and caretakers should be implemented. Twinning actions with specialized centers in high income countries for help in diagnosis, treatment and education of professionals and family members have been shown to work. Palliative and end-of-life care as well as childhood cancer survivorship plans are needed.
Authors: Matteo Malvezzi; Claudia Santucci; Gianfranco Alicandro; Greta Carioli; Paolo Boffetta; Karina Braga Ribeiro; Fabio Levi; Carlo La Vecchia; Eva Negri; Paola Bertuccio Journal: Cancer Date: 2021-05-27 Impact factor: 6.860