Ninety percent of the world’s children live in low-middle income countries (LMICs), where 80% of the total paediatric cancer cases are diagnosed. Childhood cancers account for two percent of the global cancer burden. However, looking at all life-years lost from cancer, childhood cancer constitutes the fourth most relevant malignancy after lung, breast and colon cancers. International collaborative studies helped develop treatment schedules combining surgery, radiotherapy and chemotherapy in an optimal way, which has resulted in an increase in survival rates from 20-30% in the 1970s to more than 70-80% in the first decade of the 21st century. Most cases of childhood cancer, if diagnosed at an early stage, are highly curable and many effective treatment regimens are well established, relatively simple and inexpensive.
The objective of this CRP was to establish a knowledge base on current practices and problems in optimization of radiotherapy treatment for children in LMICs.
The project included two components, namely: [1] a survey of paediatric radiotherapy practices through the use of a web-based questionnaire distributed to 189 radiotherapy centers worldwide, and [2] a database related to individual patient data. In this second component, eight leading radiotherapy centres in LMICs treating a significant number of children were selected and grouped under the Paediatric Radiation Oncology Network (PRON) in 2009. These centers were located in Brazil, Cuba, Egypt, India, Indonesia, Mongolia and Turkey. Under IAEA coordination, this group developed a database consisting of 46 variables relative to individual patients treated with radiotherapy in those centres. The data from the centres was collected online and stored within the Paediatric Oncology Network Database (POND), which was developed and provided by the International Outreach Program of the St. Jude Children’s Research Hospital in Memphis, TN in the USA.
Between 2009 and 2012, data on 1329 paediatric radiotherapy patients were collected. The data identified some factors in which LMICs fared poorly in relation to high-income-countries (HICs).
Multidisciplinary decision-making in tumour-boards was lower in LMICs (65%) than in HICs (92%). The use of Cobalt-60 units was more frequent in LMICs, while the use of immobilization accessories was less common and the use of CT-based treatment planning was also less frequent. Problems of access to radiotherapy services related to distance from the treatment centre, limited resources and family support, accommodation facilities and also lack of awareness by physicians and the public of the potential role of radiotherapy in combatting paediatric cancers were limiting factors as well.
This set of data has been useful to evaluate strategies and patterns of radiotherapy practice in developing countries, where the ultimate goals are to improve survival, minimize toxicities and improve quality of life of paediatric cancer patients. This was a first attempt to assess the quality of practice of paediatric radiotherapy from a global health perspective.
Researchers from Brazil, Cuba, Egypt, India, Indonesia, Mongolia, Turkey and the USA participated in this CRP.
The results of the CRP were presented in the annual meeting of the Paediatric Radiation Oncology Society (PROS) in Ljubljana, Slovenia on 24-27 June, 2015.
For more information, please see the CRP description:
http://www.dgdingfa.net/projects/crp/e33031
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