Study identifies barriers to successful treatment of children with sarcoma in low-income countries

October 20, 2010

BOSTON--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 will be 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.
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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.

The annual SIOP congress, the largest pediatric oncology meeting in the world, is being hosted this year by Dana-Farber/Children's Hospital Cancer Care, a partnership between Dana-Farber Cancer Institute and Children's Hospital Boston. It is being held Thursday, Oct. 21, through Sunday, Oct. 24, at the John B. Hynes Veterans Memorial Convention Center in Boston.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute. It provides adult cancer care with Brigham and Women's Hospital as Dana-Farber/Brigham and Women's Cancer Center and it provides pediatric care with Children's Hospital Boston as Dana-Farber/Children's Hospital Cancer Center. Dana-Farber is the top ranked cancer center in New England, according to U.S. News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding.

Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 12 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 392-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit: www.childrenshospital.org/newsroom.

Dana-Farber Cancer Institute

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