Approximately 90% of children with cancer live in low-income and middle-income countries (LMICs), where 5-year survival is lower than 20%. Treatment-related mortality in high-income countries is approximately 3-5%; however, in LMICs, treatment-related mortality has been reported in up to 45% of children with cancer. This study aimed to systematically explore the burden of treatment-related mortality in children with cancer in LMICs and to explore the association between country income level and treatment-related mortality.For this systematic review and meta-analysis we identified articles published between Jan 1, 2010, and June 22, 2021, describing treatment-related mortality in paediatric patients (aged 0-21 years) with cancer in LMICs. We searched PubMed, Trip, Web of Science, Embase, and the WHO Global Metric Index databases. The search was limited to full-text articles and excluded case reports (<10 patients) and haematopoietic stem-cell transplantation recipients. Two reviewers independently screened studies for eligibility, extracted data from included publications, and evaluated data quality. Random and mixed-effects models were used to estimate treatment-related mortality burden and trends. The Cochran-Q statistic was used to assess heterogeneity between studies. This study is registered on PROSPERO (CRD42021264849).Of 13 269 identified abstracts, 501 studies representing 68 351 paediatric patients with cancer were included. The treatment-related mortality estimate was 6·82% (95% CI 5·99-7·64), accounting for 30·9% of overall mortality (4437 of 14 358 deaths). Treatment-related mortality was inversely related to country income. Treatment-related mortality was 14·19% (95% CI 9·65-18·73) in low-income countries, 9·21% (7·93-10·49) in lower-middle-income countries, and 4·47% (3·42-5·53) in upper-middle-income countries (Cochran-Q 42·39, p<0·0001). In upper-middle-income countries, the incidence of treatment-related mortality decreased over time (slope -0·002, p=0·0028); however, outcomes remained unchanged in low-income (p=0·21) and lower-middle-income countries (p=0·16).Approximately one in 15 children receiving cancer treatment in LMICs die from treatment-related complications. Although treatment-related mortality has decreased in upper-middle-income countries over time, it remains unchanged in LMICs. There is an urgent need for targeted supportive care interventions to reduce global disparities in childhood cancer survival.American Lebanese Syrian Associated Charities and National Cancer Institute. 

Treatment-related mortality in children with cancer in low-income and middle-income countries: a systematic review and meta-analysis.

The probability of survival for childhood cancer in many low- and middle-income countries (LMIC) is less than 30 %. Myths and misconceptions among the general public concerning childhood cancers have detrimental effects on early detection and treatment. This study aimed to assess public perceptions of childhood cancer among the public. We conducted a cross-sectional survey with 310 respondents by using an interview schedule. Most (n = 244, 79.7 %) participants were aware of the occurrence of childhood cancer in the community and the curability of cancer in children. The respondents’ knowledge was mainly derived from online media (television, cinema, or social media). Most (61.8 %, n = 189) respondents knew that blood cancer was the most common malignancy among children. Among the causative factors, the infectious nature, environmental factors, and curse of god were perceived as reasons by 19.6 %, 29 %, and 33 % of the subjects, respectively. Half of the cohort felt that the child would never return to normal life after treatment completion. The reasons for hesitancy to treat even after knowing the curability of the disease were fear of treatment expenses, wrong beliefs, wrong/lack of information, fear of side effects, and lack of family support. Despite the advances in the diagnosis and treatment of childhood cancers, cancer remains a stigma in our community, interfering with the reintegration process of children into society, which is a significant barrier to improving survival outcomes. 

Public perception on Childhood Cancer from a population-based study in South India: Lessons to learn to avoid stigma

In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership. 

Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI)

Background Burkitt's lymphoma (BL) in the pediatric population has significant burden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarce data on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is a cross-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on the Children’s Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patient demographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistant gram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.

/pdf/infection-associated-mortality-during-induction-chemotherapy-1canu0id.pdf

Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt’s Lymphoma

ABSTRACT Introduction Optimal outcomes during childhood cancer treatment require effective management of toxicities, often called supportive care. A lack of agreement on what comprises supportive care limits the development and provision of comprehensive guidance (for this work, we have defined supportive care as any disease‐ or treatment‐related condition experienced by children with cancer, excluding psychosocial conditions, palliative care, survivorship, or procedural topics). To address this gap, we conducted a consensus‐building exercise among global experts to define and prioritize topics for supportive care. Methods Two rounds of brainstorming and prioritization exercises were conducted. A multidisciplinary panel nominated by professional societies and cooperative groups was formed to ensure geographic and resource representation using snowball sampling. An internal expert panel generated an initial list of supportive care topics. In round one, the multidisciplinary panel reviewed the initial list and recommended additional topics, followed by prioritization in round two using a seven‐point Likert scale. Results were summarized using descriptive statistics. Results The multidisciplinary panel consisted of 57 members representing 32 countries. The initial list included 46 topics; 161 additional topics were suggested. After removing duplicates and out‐of‐scope additions, the final list contained 62 topics. Febrile neutropenia, sepsis, bloodstream infections, and pain were ranked highest priority. Mortality, morbidity, and frequency of the event were identified as the most important factors influencing prioritization. Conclusion Through a multidisciplinary and globally representative process, we identified core supportive care topics and factors influencing their prioritization for childhood cancer. Outputs from this work will inform efforts to generate resource‐adapted recommendations for a global audience. This supports ongoing WHO CureAll work to develop a health systems‐level policy brief of supportive care requirements in the management of children with cancer. 

A Multidisciplinary Consensus‐Building Exercise to Define and Prioritize Topics in Supportive Care of Children With Cancer at a Global Level

Abstract Background An estimated 400,000 children develop cancer worldwide. Of those, 90% occur in low- and middle-income countries, where survival rates can be as low as 30%. To reduce the childhood cancer survival gap between high- and low- and middle-income countries (LMIC), the World Health Organization launched the Global Initiative for Childhood Cancer in 2018, to support governments in building sustainable childhood cancer programs, with the aim to increase access and quality of care for children with cancer. Developing a high-quality and trained workforce is key to the success of childhood cancer services, but more information is needed on the interventions used to develop and train a workforce. The objective of this review is to understand the key factors described in the literature in relation to the development and training of a workforce in childhood cancer (defined here as ages 0–19) in LMIC, including challenges, interventions and their outcomes. Methods We will include sources of evidence that describe the development or training of a childhood cancer workforce in health services that diagnose, refer or treat children and adolescents with cancer, in low- and middle-income countries as defined by the World Bank. The following databases will be searched: OVID Medline, Embase and Pubmed from 2001 to present with no restriction of language. Grey literature searches will also be performed in Proquest Dissertation and Theses, as well as relevant organizations’ websites, and conference proceedings will be searched in conference websites. In addition, references lists will be reviewed manually. Two people will screen abstracts and full-texts and extract data. Data will be presented in a table or chart, with an accompanying narrative summary responding to the review questions. A framework synthesis will be conducted: data will be charted against a framework adapted from the 2016 WHO Global Strategy for Human Resources for Heath: Workforce 2030. Discussion This scoping review will allow to map the existing literature on workforce development in LMIC, identify potential interventions and highlight data and knowledge gaps. This constitutes a first step towards adopting successful strategies more broadly, formulating research priorities and developing effective policies and interventions. Systematic review registration Open Science Framework osf.io/3mp7n 

/pdf/the-development-and-education-of-a-workforce-in-childhood-fdlf2kua.pdf

The development and education of a workforce in childhood cancer services in low- and middle-income countries: a scoping review protocol


 
 The COVID-19 pandemic brought unprecedented challenges to health care systems across the world. Health care professionals were burdened with time constraints as they balanced care for a large number of patients while managing crippling resource shortages. In the pandemic’s early stages, it was challenging for health care providers to provide evidence-based therapies due to the novel nature of COVID-19. There were also pressures to adopt unproven, yet highly touted treatments based on media reports and social media postings. These challenges were identified by Critical Care Services Ontario (CCSO), a provincial health organization that ensures the integration of the critical care system in Ontario, Canada. Since traditional methods of knowledge translation were inaccessible during the pandemic, CCSO created a webinar series titled Ontario Critical Care Clinical Practice Rounds (OC3PR) to share evidence-based practices with critical care professionals.
 
 
 
 We sought to develop and implement a webinar series to connect critical care professionals with the best available evidence and clinical expertise during the COVID-19 pandemic. We were also interested in gathering attendee perceptions of OC3PR as an educational tool.
 
 
 
 CCSO collaborated with 5 regional critical care leaders in Ontario to develop and implement OC3PR. This committee identified presentation topics based on perceived urgency and demand and selected presenters with expertise on their respective discussion topic. To promote accessibility, OC3PR was facilitated on the Zoom platform, live simulcasted on Youtube, and subsequently posted on Youtube for asynchronous viewing. Attendees also had the opportunity to share inquiries in live questions-and-answers sessions facilitated by the presenters. Finally, to gather the perceptions of and experiences with OC3PR, we invited attendees to partake in a web-based questionnaire at the end of each session.
 
 
 
 In total, 19 webinars were presented from November 26, 2020, to December 2, 2021, with 1481 registered unique attendees from within Canada and internationally and 17,533 Youtube visits. OC3PR presentation topics centered on resource rationing, patient therapies, staffing challenges, infection control, and vaccination. In addition, 22 follow-up questionnaires yielded 408 responses from attendees, which were composed of physicians (32%), registered nurses (15%), and other health care professionals. Our survey results suggest that OC3PR is beneficial to professionals as the majority of the respondents strongly agreed that it was of acceptable quality, enhanced their knowledge, relevant to their practice, and allotted appropriate timing for interactive components. Most (98%) respondents also reported that they would attend another OC3PR session.
 
 
 
 The success of OC3PR as an accessible educational tool made it evident to CCSO that it would continue this forum in a postpandemic context. Although the webinar series was created for critical care professionals, it can be adapted by other health organizations to improve the integration of their health networks and enhance the support they provide for their workers.
 
 
 
 None declared.


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Development and Implementation of Ontario Critical Care Clinical Practice Rounds

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The development and education of a workforce in childhood cancer services in low- and middle-income countries: a scoping review protocol

Development and Implementation of Ontario Critical Care Clinical Practice Rounds