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.
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References
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
Ohaegbulam SC (1999) Geographical neurosurgery. Neurol Res 21:161–170
Stiller CA, Nectoux J (1994) International incidence of childhood brain and spinal tumours. Int J Epidemiol 23:458–464
Ohgaki H (2009) Epidemiology of brain tumors. Methods of Molecular Biology, Cancer Epidemiology 472
Usmani GN (2001) Pediatric oncology in the third world. Curr Opin Pediatr 13:1–9
White Y, Castle VP, Haig A (2013) Pediatric oncology in developing countries: challenges and solutions. J Pediatr 162:1090–1091, 1091 e1091
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
Yaris N, Mandiracioglu A, Buyukpamukcu M (2004) Childhood cancer in developing countries. Pediatr Hematol Oncol 21:237–253
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
Valsecchi MG, Steliarova-Foucher E (2008) Cancer registration in developing countries: luxury or necessity? Lancet Oncol 9:159–167
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
Organization WH (2002) National cancer control programmes: policies and managerial guidelines. World Health Organization
Parkin DM (2006) The evolution of the population-based cancer registry. Nat Rev Cancer 6:603–612
Mayor S (2008) Registries needed to track cancer deaths in poor countries, says report. BMJ 336:299
Pearce MS, Parker L (2001) Childhood cancer registrations in the developing world: still more boys than girls. Int J Cancer 91:402–406
Parkin DM, Cancer IAfRo, Registries IAoC (1998) International Incidence of Childhood Cancer. International Agency for Research on Cancer
Parker L (1998) Children’s cancer in the developing world: where are the girls? Pediatr Hematol Oncol 15:99–103
Anwar W, Boulos DNK (2012) Cancer registries in Africa: an emerging need. J Afr Cancer 4:140–141
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
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
Parkin DM, Wabinga H, Nambooze S (2001) Completeness in an African cancer registry. Cancer Causes Control: CCC 12:147–152
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
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
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
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
Levin VA (1999) Neuro-oncology: an overview. Arch Neurol 56:401–404
Parkes J, Davidson A (2010) Paediatric neuro-oncology. JAfr Cancer 2:61–62
Oliver K (2007) Society for Neuro-Oncology 12th Annual Scientific Meeting and Education Day. The International Brain Tumour Alliance, Dallas
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
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
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
de Villiers JC (1996) A place for neurosurgery in a developing country? Surg Neurol 46:403–407
Albright AL, Ferson SS (2012) Developing pediatric neurosurgery in a developing country. J Child Neurol 27:1559–1564
Bergen DC (2009) WHO/WFN atlas of country resources for neurological disorders. J Neurol Sci 285:S16
Kalangu KK (2000) Pediatric neurosurgery in Africa—present and future. Childs Nerv Syst 16:770–775
El Khamlichi A (2001) African neurosurgery: current situation, priorities, and needs. Neurosurgery 48:1344–1347
Choi JU (2007) The promotion of pediatric neurosurgery throughout the world. Childs Nerv Syst 23:929–936
Peter JC (2003) Paediatric neurosurgery—a Southern African perspective. Childs Nerv Syst 19:133–136
El Khamlichi A (2005) Neurosurgery in Africa. Clin Neurosurg 52:214–217
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
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
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
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
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
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
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
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
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
Benediktsson H, Whitelaw J, Roy I (2007) Pathology services in developing countries: a challenge. Arch Pathol Lab Med 131:1636–1639
Adeyi OA (2011) Pathology services in developing countries—the West African experience. Arch Pathol Lab Med 135:183–186
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
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
Ludwin SK, Adams JH, Webster HF (1991) How International is the International Society of Neuropathology? Brain Pathol 1:225
Kerr DA, Kaschula RO (2013) Pediatric pathology services in Africa. Arch Pathol Lab Med 137:767–774
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
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
Cha S (2006) Update on brain tumor imaging: from anatomy to physiology. AJNR Am J Neuroradiol 27:475–487
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
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
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
(2010) Baseline country survey on medical devices. World Health Organization
Mindel S (1997) Role of imager in developing world. Lancet 350:426–429
Ball WS Jr (2000) Twenty year retrospective: pediatric neuroradiology. AJNR Am J Neuroradiol 21:29–36
Elmeligy M (1996) Cost effectiveness of radiology: economic and diagnositic considerations in developing countries. Acad Radiol 3(suppl 1):S125–S127
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
Himelstein BP, Hilden JM, Boldt AM, Weissman D (2004) Pediatric palliative care. N Engl J Med 350:1752–1762
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
Wolfe J (2011) Recognizing a global need for high quality pediatric palliative care. Pediatr Blood Cancer 57:187–188
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
Goulios H, Patuzzi RB (2008) Audiology education and practice from an international perspective. Int J Audiol 47:647–664
Krefting L (1992) Strategies for the development of occupational therapy in the Third World. Am J Occup Ther 46:758–761
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.
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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
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DOI: https://doi.org/10.1007/s00381-015-2771-x