Skip to main content

Advertisement

Log in

Challenges and opportunities to advance pediatric neuro-oncology care in the developing world

  • Review Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

As the morbidity and mortality associated with communicable diseases continue to decrease in the developing world, the medical burden of childhood cancer continues to expand. Although international aid and relief groups such as the World Health Organization recognize the importance of childhood cancer, their main emphasis is on the more easily treated malignancies, such as leukemias and lymphomas, and not pediatric brain tumors, which are the second most common malignancy in children and the leading cause of cancer-related deaths in the pediatric population. Addressing the needs of these children is a growing concern of several professional neuro-oncology-related societies. Thus, the goal of this review is to describe the current state of pediatric neuro-oncology care in the developing world, address the current and future needs of the field, and help guide professional societies’ efforts to contribute in a more holistic and multidisciplinary manner.

Methods

We reviewed the literature to compare the availability of neuro-oncology care in various regions of the developing world with that in higher income nations, to describe examples of successful initiatives, and to present opportunities to improve care.

Results

The current challenges, previous successes, and future opportunities to improve neuro-oncology care are presented. The multidisciplinary nature of neuro-oncology depends on large teams of highly specialized individuals, including neuro-oncologists, neurosurgeons, neurologists, radiologists, radiation oncologists, pathologists, palliative care specialists, oncology nurses, physical therapists, occupational therapists, speech therapists, pediatric intensivists, and social workers, among others.

Conclusion

Pediatric neuro-oncology is one of the most complex types of medical care to deliver, as it relies on numerous specialists, subspecialists, support staff, and physical resources and infrastructure. However, with increasing collaboration and advancing technologies, developed nations can help substantially improve neuro-oncology care for children in developing nations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ries LG, Smith MA, Gurney J, Linet M, Tamra T, Young J, Bunin G (1999) Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995. Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995

  2. Ohaegbulam SC (1999) Geographical neurosurgery. Neurol Res 21:161–170

    CAS  PubMed  Google Scholar 

  3. Stiller CA, Nectoux J (1994) International incidence of childhood brain and spinal tumours. Int J Epidemiol 23:458–464

    Article  CAS  PubMed  Google Scholar 

  4. Ohgaki H (2009) Epidemiology of brain tumors. Methods of Molecular Biology, Cancer Epidemiology 472

  5. Usmani GN (2001) Pediatric oncology in the third world. Curr Opin Pediatr 13:1–9

    Article  CAS  PubMed  Google Scholar 

  6. White Y, Castle VP, Haig A (2013) Pediatric oncology in developing countries: challenges and solutions. J Pediatr 162:1090–1091, 1091 e1091

    Article  PubMed  Google Scholar 

  7. Medina LS, Kuntz KM, Pomeroy S (2001) Children with headache suspected of having a brain tumor: a cost-effectiveness analysis of diagnostic strategies. Pediatrics 108:255–263

    Article  CAS  PubMed  Google Scholar 

  8. Yaris N, Mandiracioglu A, Buyukpamukcu M (2004) Childhood cancer in developing countries. Pediatr Hematol Oncol 21:237–253

    Article  PubMed  Google Scholar 

  9. Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, Atun R, Blayney D, Chen L, Feachem R, Gospodarowicz M, Gralow J, Gupta S, Langer A, Lob-Levyt J, Neal C, Mbewu A, Mired D, Piot P, Reddy KS, Sachs JD, Sarhan M, Seffrin JR (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376:1186–1193

    Article  PubMed  Google Scholar 

  10. Valsecchi MG, Steliarova-Foucher E (2008) Cancer registration in developing countries: luxury or necessity? Lancet Oncol 9:159–167

    Article  PubMed  Google Scholar 

  11. Curado MP, Voti L, Sortino-Rachou AM (2009) Cancer registration data and quality indicators in low and middle income countries: their interpretation and potential use for the improvement of cancer care. Cancer Causes Control: CCC 20:751–756

    Article  PubMed  Google Scholar 

  12. Organization WH (2002) National cancer control programmes: policies and managerial guidelines. World Health Organization

  13. Parkin DM (2006) The evolution of the population-based cancer registry. Nat Rev Cancer 6:603–612

    Article  CAS  PubMed  Google Scholar 

  14. Mayor S (2008) Registries needed to track cancer deaths in poor countries, says report. BMJ 336:299

    Article  PubMed Central  PubMed  Google Scholar 

  15. Pearce MS, Parker L (2001) Childhood cancer registrations in the developing world: still more boys than girls. Int J Cancer 91:402–406

    Article  CAS  PubMed  Google Scholar 

  16. Parkin DM, Cancer IAfRo, Registries IAoC (1998) International Incidence of Childhood Cancer. International Agency for Research on Cancer

  17. Parker L (1998) Children’s cancer in the developing world: where are the girls? Pediatr Hematol Oncol 15:99–103

    Article  CAS  PubMed  Google Scholar 

  18. Anwar W, Boulos DNK (2012) Cancer registries in Africa: an emerging need. J Afr Cancer 4:140–141

    Article  Google Scholar 

  19. Krishnamurthy S, Stewart C, Krishnan V (1994) A computerised cancer registry data and validation system in India—its implications for developing countries. Comput Methods Programs Biomed 44:109–117

    Article  CAS  PubMed  Google Scholar 

  20. Orem J, Wabinga H (2009) The roles of national cancer research institutions in evolving a comprehensive cancer control program in a developing country: experience from Uganda. Oncology 77:272–280

    Article  PubMed  Google Scholar 

  21. Parkin DM, Wabinga H, Nambooze S (2001) Completeness in an African cancer registry. Cancer Causes Control: CCC 12:147–152

    Article  CAS  PubMed  Google Scholar 

  22. Quintana Y, Patel AN, Arreola M, Antillon FG, Ribeiro RC, Howard SC (2013) POND4Kids: a global web-based database for pediatric hematology and oncology outcome evaluation and collaboration. Stud Health Technol Inform 183:251–256

    PubMed  Google Scholar 

  23. Ribeiro RC, Steliarova-Foucher E, Magrath I, Lemerle J, Eden T, Forget C, Mortara I, Tabah-Fisch I, Divino JJ, Miklavec T, Howard SC, Cavalli F (2008) Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study. Lancet Oncol 9:721–729

    Article  PubMed Central  PubMed  Google Scholar 

  24. Messing-Junger AM, Janssen G, Pape H, Bock WJ, Gobel U, Lenard HG, Schmitt G (2000) Interdisciplinary treatment in pediatric patients with malignant CNS tumors. Childs Nerv Syst 16:742–750

    Article  CAS  PubMed  Google Scholar 

  25. Qaddoumi I, Unal E, Diez B, Kebudi R, Quintana Y, Bouffet E, Chantada G (2011) Web-based survey of resources for treatment and long-term follow-up for children with brain tumors in developing countries. Childs Nerv Syst 27:1957–1961

    Article  PubMed Central  PubMed  Google Scholar 

  26. Levin VA (1999) Neuro-oncology: an overview. Arch Neurol 56:401–404

    Article  CAS  PubMed  Google Scholar 

  27. Parkes J, Davidson A (2010) Paediatric neuro-oncology. JAfr Cancer 2:61–62

    Google Scholar 

  28. Oliver K (2007) Society for Neuro-Oncology 12th Annual Scientific Meeting and Education Day. The International Brain Tumour Alliance, Dallas

    Google Scholar 

  29. Qaddoumi I, Musharbash A, Elayyan M, Mansour A, Al-Hussaini M, Drake J, Swaidan M, Bartels U, Bouffet E (2008) Closing the survival gap: implementation of medulloblastoma protocols in a low-income country through a twinning program. Int J Cancer 122:1203–1206

    Article  CAS  PubMed  Google Scholar 

  30. Baskin JL, Lezcano E, Kim BS, Figueredo D, Lassaletta A, Perez-Martinez A, Madero L, Caniza MA, Howard SC, Samudio A, Finlay JL (2013) Management of children with brain tumors in Paraguay. Neuro-Oncology 15:235–241

    Article  PubMed Central  PubMed  Google Scholar 

  31. Parkes J, Hendricks M, Ssenyonga P, Mugamba J, Molyneux E, Schouten-van Meeteren A, Qaddoumi I, Fieggen G, Luna-Fineman S, Howard S, Mitra D, Bouffet E, Davidson A, Bailey S (2014) SIOP PODC adapted treatment recommendations for standard-risk medulloblastoma in low and middle income settings. Pediatr Blood Cancer: n/a-n/a

  32. de Villiers JC (1996) A place for neurosurgery in a developing country? Surg Neurol 46:403–407

    Article  PubMed  Google Scholar 

  33. Albright AL, Ferson SS (2012) Developing pediatric neurosurgery in a developing country. J Child Neurol 27:1559–1564

    Article  PubMed  Google Scholar 

  34. Bergen DC (2009) WHO/WFN atlas of country resources for neurological disorders. J Neurol Sci 285:S16

    Article  Google Scholar 

  35. Kalangu KK (2000) Pediatric neurosurgery in Africa—present and future. Childs Nerv Syst 16:770–775

    Article  CAS  PubMed  Google Scholar 

  36. El Khamlichi A (2001) African neurosurgery: current situation, priorities, and needs. Neurosurgery 48:1344–1347

    PubMed  Google Scholar 

  37. Choi JU (2007) The promotion of pediatric neurosurgery throughout the world. Childs Nerv Syst 23:929–936

    Article  PubMed  Google Scholar 

  38. Peter JC (2003) Paediatric neurosurgery—a Southern African perspective. Childs Nerv Syst 19:133–136

    PubMed  Google Scholar 

  39. El Khamlichi A (2005) Neurosurgery in Africa. Clin Neurosurg 52:214–217

    PubMed  Google Scholar 

  40. Delaney G, Jacob S, Featherstone C, Barton M (2005) The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 104:1129–1137

    Article  PubMed  Google Scholar 

  41. Barton M, Frommer M, Shafiq J (2006) Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol 7:584–595

    Article  PubMed  Google Scholar 

  42. Murthy NS, Chaudhry K, Rath GK (2008) Burden of cancer and projections for 2016, Indian scenario: gaps in the availability of radiotherapy treatment facilities. Asian Pac J Cancer Prev 9:671–677

    CAS  PubMed  Google Scholar 

  43. Tatsuzaki H, Levin CV (2001) Quantitative status of resources for radiation therapy in Asia and Pacific region. Radiother Oncol: J Eur Soc Ther Radiol Oncol 60:81–89

    Article  CAS  Google Scholar 

  44. Zubizarreta EH, Poitevin A, Levin CV (2004) Overview of radiotherapy resources in Latin America: a survey by the International Atomic Energy Agency (IAEA). Radiother Oncol: J Eur Soc Ther Radiol Oncol 73:97–100

    Article  Google Scholar 

  45. Rosenblatt E, Izewska J, Anacak Y, Pynda Y, Scalliet P, Boniol M, Autier P (2013) Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database. Lancet Oncol 14:e79–e86

    Article  PubMed  Google Scholar 

  46. Abdel-Wahab M, Bourque J-M, Pynda Y, Iżewska J, Van der Merwe D, Zubizarreta E, Rosenblatt E (2013) Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol 14:e168–e175

    Article  PubMed  Google Scholar 

  47. Levin V, Tatsuzaki H (2002) Radiotherapy services in countries in transition: gross national income per capita as a significant factor. Radiother Oncol 63:147–150

    Article  PubMed  Google Scholar 

  48. Konski A (2004) Radiotherapy is a cost-effective palliative treatment for patients with bone metastasis from prostate cancer. Int J Radiat Oncol Biol Phys 60:1373–1378

    Article  PubMed  Google Scholar 

  49. Benediktsson H, Whitelaw J, Roy I (2007) Pathology services in developing countries: a challenge. Arch Pathol Lab Med 131:1636–1639

    PubMed  Google Scholar 

  50. Adeyi OA (2011) Pathology services in developing countries—the West African experience. Arch Pathol Lab Med 135:183–186

    PubMed  Google Scholar 

  51. Del Bigio MR, Hainfellner JA, McLean CA, Powell SZ, Sikorska B, Takahashi H, Weis J, Xuereb JH (2013) Neuropathology training worldwide—evolution and comparisons. Brain Pathol

  52. Ahmad Z, Qureshi A, Khurshid A (2009) The practice of histopathology in a developing country: difficulties and challenges; plus a discussion on the terrible disease burden we carry. J Clin Pathol 62:97–101

    Article  CAS  PubMed  Google Scholar 

  53. Ludwin SK, Adams JH, Webster HF (1991) How International is the International Society of Neuropathology? Brain Pathol 1:225

    Article  CAS  PubMed  Google Scholar 

  54. Kerr DA, Kaschula RO (2013) Pediatric pathology services in Africa. Arch Pathol Lab Med 137:767–774

    Article  PubMed  Google Scholar 

  55. Santiago TC, Jenkins JJ, Pedrosa F, Billups C, Quintana Y, Ribeiro RC, Qaddoumi I (2012) Improving the histopathologic diagnosis of pediatric malignancies in a low-resource setting by combining focused training and telepathology strategies. Pediatr Blood Cancer 59:221–225

    Article  PubMed  Google Scholar 

  56. Deetz CO, Scott MG, Ladenson JH, Seyoum M, Hassan A, Kreisel FH, Nguyen TT, Frater JL (2013) Use of a United States-based laboratory as a hematopathology reference center for a developing country: logistics and results. Int J Lab Hematol 35:77–81

    Article  CAS  PubMed  Google Scholar 

  57. Cha S (2006) Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 27:475–487

    CAS  PubMed  Google Scholar 

  58. Mollura DJ, Mazal J, Everton KL, Group R-ACW, Azene EM, Collaros P, Dabek F, DeStigter KK, El-Shayal TS, Garra BS, Gill T, Hayes C, Iosifescu S, Jimenez P, Khandelwal N, Kenney P, Lexa F, Lewin JS, Lungren MP, Mayo-Smith W, Medlen K, Nordvig AS, O'Hara-Rusckowski D, Quansah S, Silfen E, Singh T, Sydnor R, Tahvildari A, Teninty B, Timmreck EJ, Watson L (2013) White paper report of the 2012 RAD-AID Conference on International Radiology for Developing Countries: planning the implementation of global radiology. J Am College Radiol: JACR 10:618–624

    Article  Google Scholar 

  59. Smith MA, Freidlin B, Gloeckler Ries LA, Simon R (1998) Trends in reported incidence of primary malignant brain tumors in children in the United States. JNCI J Ntnl Cancer Inst 90:1269–1277

    Article  CAS  Google Scholar 

  60. Qaddoumi I, Ezam N, Swaidan M, Jaradat I, Mansour A, Abuirmeileh N, Bouffet E, Al-Hussaini M (2009) Diffuse pontine glioma in Jordan and impact of up-front prognosis disclosure with parents and families. J Child Neurol 24:460–465

    Article  PubMed  Google Scholar 

  61. (2010) Baseline country survey on medical devices. World Health Organization

  62. Mindel S (1997) Role of imager in developing world. Lancet 350:426–429

    Article  CAS  PubMed  Google Scholar 

  63. Ball WS Jr (2000) Twenty year retrospective: pediatric neuroradiology. AJNR Am J Neuroradiol 21:29–36

    PubMed  Google Scholar 

  64. Elmeligy M (1996) Cost effectiveness of radiology: economic and diagnositic considerations in developing countries. Acad Radiol 3(suppl 1):S125–S127

    Article  PubMed  Google Scholar 

  65. Saad R, Huijer HA, Noureddine S, Muwakkit S, Saab R, Abboud MR (2011) Bereaved parental evaluation of the quality of a palliative care program in Lebanon. Pediatr Blood Cancer 57:310–316

    Article  PubMed  Google Scholar 

  66. Himelstein BP, Hilden JM, Boldt AM, Weissman D (2004) Pediatric palliative care. N Engl J Med 350:1752–1762

    Article  CAS  PubMed  Google Scholar 

  67. Patterson H (2007) Nobody can afford a brain tumor: the financial impact of brain tumors on patients and familiers: a summary of findings. Report from the National Brain Tumor Foundation. A Report From the National Brain Tumor Foundation

  68. Wolfe J (2011) Recognizing a global need for high quality pediatric palliative care. Pediatr Blood Cancer 57:187–188

    Article  PubMed  Google Scholar 

  69. Ghosn M, Boutros C, Geara S, Kattan J, Nasr F, Chahine G (2011) Experience with palliative care in patients with advanced cancer at a tertiary care hospital in a developing country. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 19:573–575

    Article  Google Scholar 

  70. Goulios H, Patuzzi RB (2008) Audiology education and practice from an international perspective. Int J Audiol 47:647–664

    Article  CAS  PubMed  Google Scholar 

  71. Krefting L (1992) Strategies for the development of occupational therapy in the Third World. Am J Occup Ther 46:758–761

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors acknowledge Angela J. McArthur, PhD, Department of Scientific Editing, St. Jude Children’s Research Hospital, Memphis, TN, for her assistance with this review.

Funding

This work was supported by Cancer Center Support Grant CA21765 and by the American Lebanese Syrian Associated Charities (ALSAC).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ibrahim Qaddoumi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, M.H., Boop, F. & Qaddoumi, I. Challenges and opportunities to advance pediatric neuro-oncology care in the developing world. Childs Nerv Syst 31, 1227–1237 (2015). https://doi.org/10.1007/s00381-015-2771-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2771-x

Keywords

Navigation