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International Collaboration in Paediatric Oncology. Curr Opin Pediatr. 2001 Feb;13(1): Pediatric oncology in the third world. Usmani GN . Pediatric oncology in the third world. access to medical care is inadequate. cancer care is expensive available at only a few centers,

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slide2
Curr Opin Pediatr. 2001 Feb;13(1):
  • Pediatric oncology in the third world.Usmani GN.
pediatric oncology in the third world
Pediatric oncology in the third world
  • access to medical care is inadequate.
  • cancer care is expensive
  • available at only a few centers,
  • excessive patient numbers
  • staffed by inadequate numbers of physicians and nurses.
  • marked geographic variations in incidences ,presentations and spectrum of pediatric malignancies
slide4
. To advance the cure rate, investigators have formed several parallel initiatives in both industrialized and developing countries through international collaboration and partnership
  • Int J Hematol. 2003 Dec;78(5):383-9.
improvement of cure rates
Improvement of Cure Rates.
  • To reach this goal, the way forward will depend on international collaboration,
  • implementation of global harmonisation,
  • prevention of the erosion of biomedical research and clinical trials
  • increased public and private financial support
improvement of cure rates6
Improvement of Cure Rates.
  • Feasibility of curing children with cancer in low-income countries
  • Practical aspects of treating children with cancer in low-income countries
international implications and the way forward
International implications and the way forward.
  • (1) transferring the knowledge, methodologies and technologies to countries that are less fortunate;
  • (2) conducting multinational clinical trials in conjunction with paediatric cooperative groups in other countries;
  • (3) accessing older adolescent patients who currently do not participate in cooperative group trials;
  • (4) merging clinical trials byadult collaborative groups that overlap with the paediatric groups, as in acute lymphoblastic leukaemia, acute myelogenous leukaemia, Hodgkin's disease, osteosarcoma and germ cell tumours;
  • Eur J Cancer. 1997 Aug;33(9):1439-47.
international implications and the way forward9
International implications and the way forward.
  • ( (5) establishing a stable source of funding for national and international cooperative paediatric cancer clinical trials;
  • (6) creating an informatics system that can link paediatric cooperative group operation centres around the world, and the institutions within each collaborative group; and
  • (7) securing the support of the insurance industry and government in covering clinical trials.
  • Eur J Cancer. 1997 Aug;33(9):1439-47.
slide10
Alliances have been established among government,
  • local nongovernmental organizations,
  • health care providers, and
  • international groups

to improve the survival rate of childhood leukemia in developing countries.

slide11
setting up worldwide pediatric care units;
  • establishing standard guidelines for treating patients;
  • undertaking research and
  • lobbying international organizations like the World Health Organization, United Nations Children's Emergency Fund (UNICEF), International Union Against Cancer (UICC), and the International Society of Pediatric Oncology (SIOP);
  • to make chemotherapy, supportive care drugs, and opioids for palliation uniformly available.
  • New outreach training programs would alleviate manpower shortages by linking centers from the two world regions for training and facilitate collaboration with international organizations.
slide12
"Twinning" partnerships between a well-established individual institution or study group and a pediatric cancer unit in a developing country has proved to be the most successful strategy to date.Int J Hematol. 2003 Dec;78(5):383-9.
slide13
Int J Hematol. 2003 Dec;78(5):383-9.International collaboration on childhood leukemia.Pui CH, Ribeiro RC.Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
slide14
Strategies to improve outcomes of children with cancer in low-income countries
  • Scott C. Howard, Raul C. Ribeiroa, and Ching-Hon Pui
  • European Journal of Cancer Volume 41, Issue 11 , July 2005, Pages 1584-1587
slide15
Hematol Oncol Clin North Am. 2001 Aug;15(4):775-87,
    • Pediatric hematology-oncology outreach for developing countries.Wilimas JA, Ribeiro RC.Department of Hematology-Oncology, International Outreach Program, St. Jude Children's Research Hospital, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
    • 13 countries, a school for Latin American nurses, a distance learning website, and telecommunications programs,
slide16
Vol. 291 No. 20, May 26, 2004
  • Establishment of a Pediatric Oncology Program and Outcomes of Childhood Acute Lymphoblastic Leukemia in a Resource-Poor Area
  • Scott C. Howard, MD, MS; Marcia Pedrosa, MD; Mecneide Lins, MD; Arli Pedrosa, PsyD; Ching-Hon Pui, MD; Raul C. Ribeiro, MD; Francisco Pedrosa, MD
  • JAMA. 2004;291:2471-2475.
volume 352 issue 9144 12 december 1998 pages 1923 1926 the lancet
Volume 352, Issue 9144 , 12 December 1998, Pages 1923-1926 The Lancet
  • North-South twinning in paediatric haemato-oncology: the La Mascota programme, Nicaragua
  • ProfG Masera MDa, , F Baez MDb,
  • Pediatric Clinic, University of Milan, S Gerardo Hospital, 20052 Monza, ItalybPaediatric Hemato-Oncology Department, Manuel de Jesus Rivera—La Mascota Hospital, Managua, NicaraguacOncology Department, S Giovanni Hospital, Bellinzona, SwitzerlanddPaediatric Oncology Department, Istituto Nazionale Tumori, Milan, ItalyeIstituto di Ricerche Farmacologiche, Mario Negri, Milan, Italy
slide18
intellectual, organisational, and financial resources can be generated by a twinning programme. What is vital for such programmes is a long-term commitment to a comprehensive and holistic strategy that incorporates supply of drugs, training and supervision of health professionals, and the care of the children and of their parents
succes of collaborative studies depends on
Succes of Collaborative studies depends on
  • strong relationship with pediatric oncologists at the partner sites who devote 100% of their efforts to the partner program
  • element is a fund-raising mechanism
  • establishment of alliances that bring together the local pediatric oncology unit (hospital), the NGO, and public and private institutions, including government.
challenges include
challenges include

ensuring that effective infrastructures are in place to safely and efficiently conduct early phase clinical trials in children

obtaining timely access to new agents from pharmaceutical sponsors for both preclinical testing and for phase I and phase II testing; and effectively prioritizing new agents for evaluation in children so that those agents most likely to benefit children with specific cancers are brought forward for clinical testing.

proteomic research
Proteomic research
  • Medical research has raised many ethical issues ?
ethical issues
ethical issues ?
  • patient rights, including issues of consent
ethical issues26
ethical issues ?
  • Sample transfer should be organized along non-profit lines
ethical issues27
ethical issues ?
  • Sampling procedures for human volunteers, and for patients.
  • No risk
  • Minimal risk to patients
ethical issues28
ethical issues ?
  • Biosafety aspects should be addressed
ethical issues29
ethical issues ?
  • Regulations on importation and exportation of human tissues?
ethical issues30
ethical issues ?
  • Data acquisition and storage
  • addressed in accordance with national data protection regulations, in particular when using computerized databases.
ethical issues31
ethical issues ?
  • If follow-up information is to be taken, the authorization for such information should be requested.
  • The right for patient's information (or for no information) on the research results should also be addressed.
ethical issues32
ethical issues ?
  • The patient should be told if the samples are transferred to another research laboratory or private company.
  • Samples and related data should be destroyed on request at any time point during the course of the study.
  • If possible, traceability of the donor should be ensured.
ethical issues33
ethical issues ?
  • The issues of validation and patenting should be also solved, usually by informing the patient that he/she will have no commercial rights on potential research results.
slide34
Proteomics. 2003 Aug;3(8):1387-96.
    • Ethical and regulatory issues arising from proteomic research and technology.Reymond MA, Steinert R, Eder F, Lippert H.Department of Surgery, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany.