Background and Aims

Amidst the Worldwide COVID-19 Public Health Emergency, the El Salvador National Pediatric Cancer Program Team (ESNPCPT) recognized the importance of expanding Telemedicine as a useful model during this catastrophic scenario to optimize the care of pediatric cancer patients (PCP). This study aims to describe the Telemedicine approach to reduce risk exposure for patients and the medical team while centering the full in site-attention for those patients in active treatment.

Methods

In response to the COVID-19 outbreak, TM team (TMT) sorted PCP before they arrived for their clinic appointments. TMT contacted all primary caregivers (PCG) of Follow-up PCP (FUPCP) by phone or FACEBOOK to shift their clinic appointments to TM. PCG received instructions to perform the patient's Blood Work (BW) at a local laboratory, send results via WhatsApp, and report any symptoms. Oncologists reviewed daily patient’s results; healthy patients received a future appointment, while patients with altered BW or alarming symptoms (AS) received a next day appointment. Using descriptive statistics, TMT reported real-time recorded data in a Google drive spreadsheet, and the Medical Support System.

Results

Annually, the ESNPCPT receives an average of 262 New PCP (NPCP), 326 Active Treatment PCP (ATPCP), and 988 Follow-up PCP (FUPCP). In 2020 PCP compliance with their clinical appointments decreased to 68% (2680/ 3925) compared to the 2017-2019 period PCP compliance of 95% (29290 / 30976). PCP compliance with TM appointments increased to 93% (164 / 177) compared to the 2017-2019 period TM compliance of 63% (87 /139). Six patients (5 FUPCP, 1 ATPCP) reported symptoms, 2 relapses were detected. Thirteen patients missed TM appointments, 2 were in transition from FUPCP to survivorship clinic, 11 patients did not find a laboratory open for their BW.

Conclusions

During COVID-19 outbreak, TM becomes a useful model, permitting FUPCP to get supportive care while optimizing resources for ATPCP and medical staff.

Background and Aims

The Global Initiative for Childhood Cancer aims to achieve 60% survival by 2030. Survival in many countries in sub-Saharan Africa is below 20% and death during treatment is common . Improved supportive care can reduce treatment-related mortality and allow more intense anti-cancer treatment, thus increasing cure rates. SUCCOUR is a project launched in 2019 by the ‘Wilms Africa’ group to improve supportive care in Africa. The objective of this study was to evaluate current practices and outcomes in nutrition, febrile neutropenia and death during treatment.

Methods

A prospective, observational study was conducted in five hospitals in sub-Saharan Africa (Kenya, Malawi, Cameroon, Zimbabwe, Ghana). Data were collected from September 2019 – March 2020. All children below 16 years with a newly diagnosed cancer treated with curative intent were included. Data were abstracted using standard case report forms by trained personnel. Uncertain data were confirmed by treating clinicians in real time.

Results

256 patients were enrolled (median age 6.3 years, range 0.2 – 17 years, 54% male). All data were complete. Most common cancer was Burkitt lymphoma (65/256, 24%). 56 (22%) had a mid-upper-arm-circumference (MUAC) indicating acute malnutrition. 168 (68%) parents or guardians reported occasional insufficient food at home. 212 (82%) patients received nutritional support during their hospital stay. 103 (40%) had a documented febrile neutropenic (FN) episode, of whom 12 (12%) died. Median time of onset of fever to receiving antibiotics was 30 minutes (range 0 minutes to 76 hours). Overall 37 of 256 (14%) patients died during treatment of whom at least 81% (30/37) are considered to have died of a treatment related cause based on signs, symptoms and laboratory results in the week preceding death.

Conclusions

This baseline assessment of the current situation will facilitate the development and prioritisation of supportive care interventions, and provide a benchmark for evaluating future interventions.

Background and Aims

Pediatric Palliative Care (PPC) is a nascent subspecialty that aims on achieving the best possible quality of life for children with life-threatening illnesses. To attain this goal in adeveloping country, the Pediatricians require adequate knowledge and skill in this subjectt. Assessment of competency and educational needs in Pediatricians is the first step towards this aim.

Methods

A multi-center, cross-sectional, self-reported online survey, conducted in Pediatric residents and young Pediatricians from various teaching hospitals in Pakistan. Data was analyzed in terms of descriptive statistics using SPSS 16.

Results

Total 284 Pediatric residents and Senior Registrars from 13 different teaching hospitals of Punjab, Pakistan recorded their responses, with mean age of 30.19 years (+/- 2.67 SD) and male to female ratio of 1:1.2. Regarding self-confidence in the performance of end-of-life clinical skills, competence (Mean >2.5) was reported in 11 out of 16 PPC skills while the top 3 skills reported with significant levels of lack of competence (Mean <2.5) were: 1) Assessment and management of terminal delirium, agitation, anxiety [M=2.07, SD=0.93, 95% CI=(1.96, 2.18)], 2) Use of adjuvant analgesics [M=2.19, SD 1.02, 95% CI=(2.07, 2.31)], 3) Discussing treatment withdrawal [M=2.40, SD=0.97, 95% CI=(2.28, 2.51)]. Regarding interest(s) in learning about end-of-life clinical topics, all of the 10 topics included in the survey reached significant level of interest in learning (Mean >2.5). The top 3 recommended topics were: 1) Pain assessment and management [M=3.42, SD=0.84, 95% CI=(3.32,3.52)] , 2) Assessment and management of terminal delirium, agitation, anxiety [M=3.37, SD=0.79, 95% CI=(3.28,3.46)], 3) Assessment and management of terminal dyspnea [M=3.30, SD=0.89, 95% CI=(3.20,3.42)].

Conclusions

This study highlighted the areas of lack of competence of Pediatricians in the field of PPC in a developing country and also notified essential educational topics of palliative care. This may help design the future curriculum of Pediatric Medicine in Pakistan with addition of important concepts of PPC.

Background and Aims

Children with cancer across Africa have a reported survival rate of 0-70%. Palliative care is an essential paediatric oncology service in all settings and should be provided at start of treatment. We examined potential links between Gini index (GI) (measures economic inequality) and World Bank Economic Status (WBS) of African countries and their capacity to provide palliative care.

Methods

Data from the SIOP Global Mapping Project included availability of: 1. palliative care, 2. bereavement practitioners, 3. support groups and 4. spiritual/religious support. GI and WBS for individual countries were obtained by internet search. Data was analysed using SPSS v.26, with Chi square, Student’s t-test and Spearman’s coefficient to determine presence and strength of significant relationships between GI,WBS and palliative care services.

Results

Global Mapping responses from 48/54 African countries represented 119 hospitals (hospitals per country range=0-13). Mean GI was 42.4 (range 27.6-63). Fourteen countries reported all four services (Mean GINI: 41.7, Range: 31.8 – 63), while 11 countries reported none (Mean GINI: 43.8, Range: 32.8 – 56.2). The mean total under-15 population was 39.6% (range 18%=50%). There were no differences or correlations between the number or availability of palliative support services in WBS groups, or across Gini indices.

Conclusions

High childhood cancer mortality rates in Africa require increased focus on palliative and supportive care services. The lack of difference in the provision of supportive services across two economic indicators may be due to sample size, cultural factors, dearth of local palliative care training/specialists, or lack of high-income countries in Africa for comparison.

Provision and availability of palliative and supportive care services may not rely on the availability of resources or income inequality. Future research should investigate low palliative care uptake in African childhood cancer treatment facilities despite the low cost of services, high mortality and paucity of supportive care resources African countries.