RESUMO
BACKGROUND: The International Society of Paediatric Oncology Society Global Mapping Program aims to describe the local pediatric oncology capacities. Here, we report the data from Latin America. METHODS: A 10-question survey was distributed among chairs of pediatric oncology services. Centers were classified according to patient volume into high- (HVC; 100 or more new cases per year), medium- (MVC; 31-99 cases), and low-volume centers (LVC; 30 cases or less), respectively. National referral centers (NRC) were identified. RESULTS: Total 307 centers in 20 countries were identified (271 responded), and 264 responses were evaluable, accounting for 78% of the expected cases (21,359 cases per year). Seventy-seven percent of patients are treated in public centers, including additional support by civil society organizations. We found that 66% of the patients are treated in 70 centers of excellence, including 21 NRC. There was a median of one pediatric oncologist every 21 newly diagnosed patients (44 for NRC), and in 84% of the centers, nurses rotated to other services. A palliative care team was lacking in 25% of the centers. LVC with public funding have significantly lower probability of having a palliative care team or trained pediatric oncology surgeons. Psychosocial, pharmacy, and nutrition services were available in more than 93% of the centers. No radiotherapy facility was available on campus in nine of 21 NRC. CONCLUSIONS: Most children with cancer in Latin America are treated in public HVC. There is a scarcity of pediatric oncologists, specialized nurses and surgeons, and palliative care teams, especially in centers with public funding.
RESUMO
BACKGROUND: Latin American countries are improving childhood cancer care, showing strong commitment to implement the Global Initiative for Childhood Cancer, but there are scant publications of the situation at a continental level. METHODS: As part of the International Society of Paediatric Oncology Global Mapping project, delegates of each country participating in the Latin American Society of Pediatric Oncology (SLAOP) and chairs of national pediatric oncology societies and cooperative groups were invited to provide information regarding availability of national pediatric cancer control programs (NPCCP), pediatric oncology laws, pediatric oncology tumor registries, and training programs and support to diagnosis and treatment. RESULTS: Nineteen of the 20 countries participating in SLAOP responded. National delegates reported nine countries with NPCCP and four of them were launched in the past 5 years. National pediatric tumor registries are available in eight countries, and three provided published survival results. Fellowship programs for training pediatric oncologists are available in 12 countries. National delegates reported that eight countries provide support to most essential diagnosis and treatments and 11 provide partial or minimal support that is supplemented by civil society organizations. Seven countries have a pediatric oncology law. There are three international cooperative groups and four national societies for pediatric oncology. CONCLUSION: Despite many challenges, there were dramatic advances in survivorship, access to treatment, and availability of NPCCP in Latin America. Countries with highest social development scores in general provide more complete support and are more likely to have NPCCP, training programs, and reported survival results.
RESUMO
El cáncer resulta de la interacción entre susceptibilidad genética y exposición ambiental; su diagnóstico está relacionado con la edad y existe un marcador que incrementa su incidencia después de los años reproductivos. Los nutrientes y la exposición a tóxicos contribuyen en forma importante al riesgo de padecer algunos cánceres. La nutrición influye en el riesgo de cáncer directamente a través de carcinógenos presentes en los alimentos o indirectamente como la respuesta hormonal y metabólica al crecimiento y la obesidad. La prevención del cáncer podría comenzar antes de la concepción, las futuras madres deben iniciar su embarazo con un peso saludable y evitar ganancia excesiva o bajo peso gestacional. Los micronutrientes son importantes para el desarrollo embriológico y crecimiento fetal. Los hábitos inadecuados en edades tempranas de la vida, la ingesta de toxinas incluidas en ciertos alimentos desencadenan mecanismos fisiopatológicos que se traducen finalmente en modificación del patrón genómico de los niños, que conlleva más tarde a la aparición de enfermedades oncológicas en la edad adulta. Recomendaciones: alimentación exclusiva con leche humana hasta los 6 meses y a partir de ese momento, incorporar alimentos complementarios adecuados; mantener un peso corporal adecuado, comer una dieta variada, incluir diariamente vegetales y frutas, incrementar la ingesta diaria de fibra, limitar la ingesta total de grasas, bebidas alcohólicas, alimentos curados con sal, ahumados y preservados con nitritos. El pediatra debe colaborar con los padres y profesores en el fomento de hábitos saludables que acompañarán a lo largo de su vida a los niños de hoy.
Cancer results from the interaction of genetic susceptibility and environmental exposure. The diagnosis of cancer is related to age and there is a net increase in cancer incidence after the childbearing years. Nutrients and toxic exposures contribute significantly to the risk of some cancers. Nutrition as a determinant of growth and body development also influences cancer risk directly through carcinogens in food or indirectly as the hormonal and metabolic response to growth and obesity. Cancer prevention may begin before conception, so expectant mothers should start your pregnancy at a healthy weight and avoid excessive weight gain or low during pregnancy. Micronutrients are important for embryonic development and fetal growth. Inadequate habits at an early age of life, given by ingestion of toxins contained in certain foods trigger pathophysiological mechanisms that eventually result in modification of the genomic pattern of children, which later leads to the emergence of oncological diseases in adulthood. Children should be fed exclusively on breast milk until 6 months of age and thereafter incorporate adequate complementary foods. Suggested recommendations firmly established base are analyzed are: maintain a healthy body weight, eating a varied diet, daily include various vegetables and fruits, increase daily fiber intake, limit total fat intake, alcohol, salt-cured foods, smoked and preserved with nitrites. The pediatrician can and should work with parents and teachers in promoting healthy habits that accompany you throughout your life to the children of today.
RESUMO
Los pacientes con cáncer son población de riesgo para adquirir infección por virus de hepatitis B por estar expuestos a métodos que favorecen la inoculación parenteral del virus. Cuantificar los anticuerpos contra el antígeno de superficie para el virus de hepatitis B en pacientes sin títulos protectores al momento de su ingreso en el servicio de hematooncología pediátrica que recibieron un esquema corto de vacunación (0, 1 y 2 meses). Entre marzo de 2008 y 2009, se recibieron 40 pacientes, excluyéndose 17 posteriormente del estudio, 8 por presentar marcadores positivos de infección para hepatitis B y 9 con títulos mayores de 100UI/L. Dieciséis pacientes sin títulos protectores recibieron vacuna recombinante. Se determinaron serologías para hepatitis B: Antígeno de superficie, Anticuerpo contra el antígeno de superficie y anticore, cada 3 meses, por 1 año, considerándose como títulos protectores anticuerpo contra el antígeno de superficie mayor de 100UI/L De los 16 (100%) pacientes que recibieron vacunación, 15 (94%) alcanzaron títulos protectores, los cuales presentaron descenso del anticuerpo contra el antígeno de superficie durante el tiempo de estudio. Los pacientes vacunados alcanzaron seroprotección con posterior disminución progresiva de sus títulos protectores lo que justifica su revacunación...
Patients with cancer are a population in risk of being infected by Hepatitis B virus as a consequence of being exposed to methods favoring the parenteral inoculation of the virus. Quantifying the antibodies against the surface antigen for Hepatitis B virus in patients without protection titers when admitted to the pediatric hematology-oncology service and who received a short vaccination schedule (0, 1, and 2 months). Between March 2008 and 2009, 40 patients were received, from which later on 17 were excluded from the study since 8 showed infection positive markers for Hepatitis B, and 9 with values higher than 100IU/L. 16 patients without protection titers were recombinant- vaccinated. Serologies for Hepatitis B were determined: Surface Antigen, Antibody against surface antigen, and anticore every 3 months during 1 year, being considered as the antibody protectors against the surface antigen higher than 100IU/L. Out of the 16 patients (100%) who were vaccinated: 15 (94%) reached protection titers, showing antibody decrease against surface antigen in the study term. Vaccinated patients reached seroprotection with later progressive diminishing of protection titers, thus justifying revaccination...
Assuntos
Humanos , Masculino , Feminino , Criança , Hepatite B/patologia , Neoplasias/complicações , Neoplasias/patologia , Vacinas contra Hepatite B/uso terapêutico , Gastroenterologia , Oncologia , PediatriaRESUMO
El cáncer en niños representa aproximadamente el 2 por ciento de todos los casos de Cáncer, de estos aproximadamente un 70 por ciento corresponden a Tumores Sólidos. El tipo y distribución de los Tumores Malignos en niños difieren marcadamente de los que ocurren en los adultos. La clasificación de estas patologías por Tipo Histológico es de gran importancia para poder entender la etiogía y progresión de estas enfermedades. Material y Método: Se evaluaron 1147 pacientes < de 15 años con diagnóstico Histológico de Tumor Sólido Maligno que consultaron al S.A. Hospital de Niños J.M. de los Ríos. Caracas. Desde enero 1985 a diciembre 1995. Todos fueron clasificados según Grupos Histológicos, sexo y edad. Resultados: Los Grupos Histológicos más frecuentes fueron: Linfomas y otras Neoplasias Reticuloendoteliales 27,50 por ciento, Neoplasias del S.N.C. 17,35 por ciento, Sarcomas de Partes Blandas 15,51 por ciento, Tumores Renales 10,02 por ciento, Tumores Germinales 9,67 por ciento. Como Tipo Histológico específico, los más frecuentes son: Linfoma No Hodgkin 11,76 por ciento, Rabdomiosarcoma 9,93 por ciento, Tumor de Wilms 8,54 por ciento, Enfermedad de Hodgkin 8,19 por ciento, Tumores Gliales 8,19 por ciento, Tumores Neuroectodermicos Primitivos 6,89 por ciento, Tumores Germinales Gonadales 6,88 por ciento. La relación (V:H) varia según los tipos Histológicos: Predominio de varones en Linfomas y otra Neoplasias Reticuloendoteliales (V:H 2,3:1); Enfermedad de Hodgkin (V:H 6:1). Predominio de Hembras en: Tumores Germinales (V:H 0,48:1). En la distribución por edad se evidencian diferencias marcadas entre los tipos Histológicos: predominio de Sarcomas de Partes Blandas, Tumores Germinales, Histiocitosis, Tumor de Wilms y Neuroblastoma en menores de 1 año. Picos de mayor incidencia en el grupo de 1-4 años en los Linfomas No Hodgkin, Tumor de Wilms, Neuroblastoma y Retinoblastoma. Incremento gradual en la incidencia a medida que aumenta la edad en los Grupos de Tumores Oseos y Carcinomas. Al comparar los resultados con datos Nacionales provenientes de MSAS y los del programa SEER en los E.U. se evidencian de los diferentes Tumores Sólidos