Rosdali Diaz Coronado

and 16 more

Background: Medulloblastoma is the most common malignant brain tumor in children. We aim to determine the survival in children with medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 to 2013 in Peru, a low-middle income country at the time of this analysis. We also describe the barriers and factors influencing outcomes. Methods: Between 1997-2013, data from 103 children older than 3 years with medulloblastoma were analyzed. Two groups of treatment were identified 1997 – 2008 and 2009 – 2013. Event-free (EFS) and overall survival (OS) were obtained using Kaplan-Meier method and prognostic factors by univariate analysis (log-rank test). A survey was created to identify factors that may have influenced outcome. Results: Eighty-nine patients were included; median age was 8.1 years (range: 2.9-13.9 years). Surgical resection was complete in 39 patients. The five-year OS was 63% (95% CI: 53 – 74%) while EFS was 59% (95% CI: 49 – 71%). The variables adversely affecting survival were: anaplastic histology [compared to desmoplastic; OS: HR=3.5, p=0.03; EFS: HR=3.4, p=0.03], metastasis [OS: HR=3.4, p=0.01; EFS: HR=4.4, p=0.003], and treatment post-2008 [OS: HR=2.5, p=0.01; EFS: HR=2.5; p=0.01]. Conclusions: Outcomes for Medulloblastoma at INEN are low compared with high- income countries (HIC). Univariate analysis demonstrated that histological sub-type, metastasis at diagnosis, and treatment post-2008 all negatively affected outcomes in our study. The importance of multidisciplinary teamwork in the care of children with pediatric brain tumors as well as partnerships with loco-regional groups and colleagues in HIC is vastly beneficial.

Gabriela Villanueva

and 34 more

The ongoing COVID-19 pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year. Four cross-sectional surveys were electronically distributed among pediatric onco-hematologist in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners. 453 pediatric onco-hematologists from 20 countries responded the first survey with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active on-going patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48, 95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability. Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.

Liliana Vasquez

and 17 more

Background The diagnostic delay in children and adolescents with cancer is a public health problem in Peru leading to high rates of advanced disease and mortality. We aimed to evaluate the implementation and utility of ONCOpeds, a mobile application that provides consultations, in reducing the latency to diagnosis (LD) and referral time (RT) in children and adolescents diagnosed with cancer in Peru. Material and methods A multicenter pilot study was conducted in the region of Callao between November 2017 and April 2018. Attending primary care physicians were trained in the use of ONCOpeds in 5 educational sessions. Patients younger than 18 years living in Callao and diagnosed with cancer from all the pediatric cancer units were analyzed in two groups: referred by the mobile application or by the conventional referral. Results ONCOpeds was successfully installed in the smartphone devices of 78 attending physicians of Callao. During this period, 23 new cases of cancer in children and adolescents from Callao were collected. Ten patients were referred through the application and 13 in a conventional manner. The LD and RT were reduced in the group referred by ONCOpeds by 66% and 68%, respectively; however, only the RT reached statistical significance (p = 0.02). Conclusions The implementation of the use of ONCOpeds was feasible in this pilot study, having a potential utility in improving the diagnosis and referral in children and adolescents with suspected cancer. A larger study at the national level is required to demonstrate the effectiveness of this telemedicine tool.