Pediatric cancer

1. Achieving early diagnosis in childhood cancer: standard, advantages and road blocksLatin American perspectivesSidneiEpelman, M.D.

2. Pediatric cancer • World - 250.000 new children with cancer/year • Up to 70% can be cured • 80% of children live in less developed countries • Many don´t get diagnosed or access to treatment • 200.000 children with cancer die/year but 100.000 can be saved with access to treatment • Cancer causes more death globally than AIDS, malaria and tuberculosis

3. Pediatric cancer • Excellent cure rates • Clinical trials • Laboratory and epidemiological research • High cure rates • Access to medical care • Correct diagnosis • Referral to a comprehensive center • Adequate treatment

4. Early diagnosis • Early diagnosis of cancer is a fundamental goal in oncology – affords the opportunity of treatment with curative intent, while disease burden is still in earliest stages. • Prognosis is improved and cure attained with minimal side or late effects • Importance of timely access to qualify healthcare

5. Cure rates in developing countries • 20-30% lower than high- income countries • Advance disease - late diagnosis • Difficulties of access of diagnosis and treatment – large distances and lack of center • Toxicity • Abandonment of therapy - Compliance

6. Causes of delay in diagnosis and treatment of childhood cancer • Time between development of symptoms and initial health care contact • Time between initial health-care contact and referral to the treating oncologist • Time between first oncology contact and initiation of cancer therapy depends on disease factors

7. Causes of delays • Patient and/or parent • Disease • Healthcare system • Factors related to diagnosis delay • Child´s age at diagnosis – worse in adolescent • Parent level of education • Type of cancer • Presentation of symptoms • Tumor site • Cancer stage • First medical consulted

8. Reasons for poor results in developing countries • Lack of awareness of the early signs • Considered incurable • Facilities • Expertise • Communication and collaboration among elements of health care community • Diagnosis and treatment approach • Compliance

9. Project must identified • Reasons for late diagnosis • Assess knowledge among primary health care providers • Educational programs to increase awareness of early signs • Comprehensive centers

10. Recommendantions of American action plan for childhood cancer • Access to care and patterns of care • Assure all children and adolescent suspected of having cancer are referred to a pediatric cancer center • Establish national standards of quality care for children and adolescent with cancer, medical and psychosocial • Quantify curuttent patterns and outcomes of all phases of childhood cancer • Participation in clinical trials

11. Recommendantions of American action plan for childhood cancer • Advocacy and professional issues • Ensure access • Assess the need for fellowships and scholarships for training • Accelerate application of new therapeutic technologies

12. General recommendations for suspected cancer • Children who present with symptoms and signs of cancer should be referred to a pediatrician • Cancer in children is rare and may present with symptoms and signs associated with common conditions • Parent is usually best observer • Persistent parental anxiety should be a sufficient reason for referral of a child • Persistent back pain in a child or young person can be a symptom of cancer is indication for an examination, investigation • Primary healthcare professional should be alert of high risk population • Primary health care professional should establish good communication with parents