ABSTRACT
Objective: To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods: A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results: Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions: The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.
ABSTRACT
[ABSTRACT]. Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evalu- ation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.
[RESUMEN]. Objetivo. Informar sobre los avances de Perú en el periodo transcurrido a partir de junio del 2019, en relación con la puesta en práctica de la Iniciativa Global de la Organización Mundial de la Salud contra el Cáncer Infantil utilizando el marco CureAll, que es posible replicar en los países de ingresos bajos y medianos. Métodos. Se utilizó un método mixto de evaluación participativa y documental. En la evaluación participativa intervinieron las partes interesadas de diversas instituciones gubernamentales, organizaciones sin fines de lucro y asociados internacionales. El aspecto documental consistió en un examen de los datos sobre el entorno regulatorio, los proyectos nacionales y las intervenciones llevadas a cabo. El Ministerio de Salud involucró a más de 150 participantes que formaron los comités de trabajo que han elaborado documentos normativos y regulatorios a fin de reforzar los servicios de asistencia. Resultados. Entre los logros cabe citar la disminución del 18,6% al 8,5% de la tasa nacional de abandono del tratamiento, la aprobación de la Ley de Cáncer Infantil, las mejoras en el tratamiento de los pacientes con neutropenia febril y la reducción de las tasas de episodios de deterioro clínico y de mortalidad en los pacientes hospitalizados. El marco de aplicación de CureAll permite que los equipos locales pongan en práctica estrategias específicas y realicen un seguimiento de los resultados iniciales en el ámbito de la oncología pediátrica. Conclusiones. Los resultados obtenidos reflejan el trabajo en equipo, el liderazgo de las autoridades, el respaldo técnico de los profesionales y el apoyo de las organizaciones implicadas. En el futuro, será necesario adoptar nuevas medidas para asegurar su viabilidad, y será preciso contar con herramientas de seguimiento para garantizar el éxito de las actividades planificadas.
[RESUMO]. Objetivo. Relatar o progresso, desde junho de 2019, da implementação da Iniciativa Global da Organização Mundial da Saúde para o Câncer Infantil no Peru, no âmbito do marco CureAll, que pode ser replicado em países de baixa e média renda. Método. Foi utilizado um método misto de avaliação participativa e documental. A avaliação participativa incluiu interessados diretos de diferentes instituições governamentais, organizações sem fins lucrativos e parceiros internacionais. O aspecto documental consistiu em uma revisão de dados sobre o ambiente regulatório, projetos nacionais e intervenções implementadas. O Ministério da Saúde do Peru contou com mais de 150 participantes para a formação de comitês de trabalho, que elaboraram políticas e documentos normati- vos para fortalecer os serviços de atenção primária à saúde. Resultados. Entre os resultados alcançados estão a redução da taxa nacional de abandono do tratamento, de 18,6% para 8,5%, a aprovação da Lei do Câncer Infantil, melhorias no manejo de pacientes com neu- tropenia febril e redução nas taxas de deterioração clínica e mortalidade de pacientes hospitalizados. A implementação do CureAll permite que as equipes locais adotem estratégias específicas e monitorem os resultados iniciais em oncologia pediátrica. Conclusões. Os resultados obtidos refletem o trabalho em equipe, a liderança das autoridades, o suporte técnico dos profissionais e o apoio das organizações envolvidas. Serão necessárias mais ações para garantir a sustentabilidade, além de ferramentas de monitoramento para assegurar o sucesso das atividades planejadas.
Subject(s)
Neoplasms , Child Health , Health Programs and Plans , Health Policy , Peru , Neoplasms , Child Health , Health Programs and Plans , Health Policy , Peru , Child Health , Health Programs and Plans , Health PolicyABSTRACT
ABSTRACT Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.
RESUMEN Objetivo. Informar sobre los avances de Perú en el periodo transcurrido a partir de junio del 2019, en relación con la puesta en práctica de la Iniciativa Global de la Organización Mundial de la Salud contra el Cáncer Infantil utilizando el marco CureAll, que es posible replicar en los países de ingresos bajos y medianos. Métodos. Se utilizó un método mixto de evaluación participativa y documental. En la evaluación participativa intervinieron las partes interesadas de diversas instituciones gubernamentales, organizaciones sin fines de lucro y asociados internacionales. El aspecto documental consistió en un examen de los datos sobre el entorno regulatorio, los proyectos nacionales y las intervenciones llevadas a cabo. El Ministerio de Salud involucró a más de 150 participantes que formaron los comités de trabajo que han elaborado documentos normativos y regulatorios a fin de reforzar los servicios de asistencia. Resultados. Entre los logros cabe citar la disminución del 18,6% al 8,5% de la tasa nacional de abandono del tratamiento, la aprobación de la Ley de Cáncer Infantil, las mejoras en el tratamiento de los pacientes con neutropenia febril y la reducción de las tasas de episodios de deterioro clínico y de mortalidad en los pacientes hospitalizados. El marco de aplicación de CureAll permite que los equipos locales pongan en práctica estrategias específicas y realicen un seguimiento de los resultados iniciales en el ámbito de la oncología pediátrica. Conclusiones. Los resultados obtenidos reflejan el trabajo en equipo, el liderazgo de las autoridades, el respaldo técnico de los profesionales y el apoyo de las organizaciones implicadas. En el futuro, será necesario adoptar nuevas medidas para asegurar su viabilidad, y será preciso contar con herramientas de seguimiento para garantizar el éxito de las actividades planificadas.
RESUMO Objetivo. Relatar o progresso, desde junho de 2019, da implementação da Iniciativa Global da Organização Mundial da Saúde para o Câncer Infantil no Peru, no âmbito do marco CureAll, que pode ser replicado em países de baixa e média renda. Método. Foi utilizado um método misto de avaliação participativa e documental. A avaliação participativa incluiu interessados diretos de diferentes instituições governamentais, organizações sem fins lucrativos e parceiros internacionais. O aspecto documental consistiu em uma revisão de dados sobre o ambiente regulatório, projetos nacionais e intervenções implementadas. O Ministério da Saúde do Peru contou com mais de 150 participantes para a formação de comitês de trabalho, que elaboraram políticas e documentos normativos para fortalecer os serviços de atenção primária à saúde. Resultados. Entre os resultados alcançados estão a redução da taxa nacional de abandono do tratamento, de 18,6% para 8,5%, a aprovação da Lei do Câncer Infantil, melhorias no manejo de pacientes com neutropenia febril e redução nas taxas de deterioração clínica e mortalidade de pacientes hospitalizados. A implementação do CureAll permite que as equipes locais adotem estratégias específicas e monitorem os resultados iniciais em oncologia pediátrica. Conclusões. Os resultados obtidos refletem o trabalho em equipe, a liderança das autoridades, o suporte técnico dos profissionais e o apoio das organizações envolvidas. Serão necessárias mais ações para garantir a sustentabilidade, além de ferramentas de monitoramento para assegurar o sucesso das atividades planejadas.
ABSTRACT
BACKGROUND: Macrophage activation syndrome (MAS) is characterized by excessive activation of macrophages and lymphocytes, leading to multiorgan dysfunction. As the initial manifestation of systemic lupus erythematosus (SLE), MAS is rare in children. Due to the COVID-19 pandemic, it is vital to identify the MAS as it shares similar characteristics with the multisystem inflammatory syndrome in children (MIS-C). CASE REPORT: We report the case of an 11-year-old male adolescent with symptoms of MIS-C. Although with negative results of RT-PCR (reverse transcription-polymerase chain reaction) and serology for SARS-CoV-2, contact with a positive COVID-19 relative was reported. When admitted to a referral hospital center, the patient received standard treatment for MIS-C. Although the same scheme was given on three occasions, the patient showed no response to initial therapy. Thus, the patient was classified as a refractory case. When the study was extended to other differential diagnoses, we found MAS associated with SLE. Therefore, the patient was treated with etoposide, cyclosporine, dexamethasone, and methotrexate and showed a good clinical response. CONCLUSIONS: MAS associated with SLE is rare in the pediatric population. MAS shares inflammatory markers with the MIS-C and is often confused with rheumatologic, infectious, and neoplastic entities. Reporting this case is important to identify differential diagnoses in patients presenting as MIS-C and decide on timely treatment, as it could be harmful or even fatal if a definitive diagnosis is not obtained on time.
INTRODUCCIÓN: El síndrome de activación de macrófagos (SAM) se caracteriza por una activación excesiva de los macrófagos y de los linfocitos que conduce a una disfunción multiorgánica. Como manifestación inicial del lupus eritematoso sistémico (LES), el SAM es poco común en la infancia. Debido a la pandemia de COVID-19, es importante identificar el SAM, ya que comparte características similares con el síndrome inflamatorio multisistémico en niños (MIS-C, por sus siglas en inglés). CASO CLÍNICO: Presentamos el caso de un varón de 11 años con síntomas de MIS-C. Resultó negativo en la prueba de reacción en cadena de la polimerasa con retrotranscriptasa y en la serología para SARS-CoV-2, aunque reportó contacto con un familiar positivo para COVID-19. Ingresó en un centro hospitalario de referencia y recibió tratamiento estandarizado para MIS-C. A pesar de recibir el mismo esquema en tres ocasiones, no mostró respuesta a la terapia inicial, por lo que fue clasificado como caso refractario. Al ampliar el estudio para otros diferenciales, se encontró SAM asociado con LES, por lo que el paciente recibió tratamiento con etopósido, ciclosporina, dexametasona y metotrexato, y mostró buena respuesta clínica. CONCLUSIONES: La asociación entre el SAM y el LES es rara en la población pediátrica. El SAM comparte marcadores inflamatorios con el MIS-C y suele confundirse con enfermedades reumatológicas, infecciosas y neoplásicas. La importancia de reportar este caso es identificar los diagnósticos diferenciales en los pacientes que se presentan como MIS-C, y decidir el tratamiento con prontitud, pues podría ser dañino o incluso fatal si no se obtiene un diagnóstico definitivo a tiempo.
Subject(s)
COVID-19 , Lupus Erythematosus, Systemic , Macrophage Activation Syndrome , Adolescent , COVID-19/complications , Child , Humans , Lupus Erythematosus, Systemic/diagnosis , Macrophage Activation Syndrome/diagnosis , Male , Pandemics , SARS-CoV-2 , Systemic Inflammatory Response SyndromeABSTRACT
BACKGROUND: Diagnosis delay in children and adolescents with cancer is a public health problem in Peru that leads to high rates of advanced disease and mortality. We aimed to assess the implementation feasibility and potential utility of ONCOpeds®, a mobile application that provides consultations with pediatric oncologists, in reducing the latency to diagnosis (LD) and referral time (RT) among children and adolescents in Peru diagnosed with cancer. MATERIAL AND METHODS: A prospective pilot study was conducted in the region of Callao between November 2017 and April 2018. Primary and secondary care providers were trained on the use of ONCOpeds in five educational sessions. Patients younger than 18 years who resided in Callao and were diagnosed with cancer at four pediatric cancer units in Lima were analyzed by referral type: ONCOpeds facilitated or conventional. RESULTS: ONCOpeds was successfully installed in the smartphones of 78 primary and secondary care providers of Callao. During the study period, 23 new cases of cancer in children and adolescents from the region were diagnosed. Ten patients received ONCOpeds-facilitated referrals and 13 received conventional referrals. The RT decreased among those who received ONCOpeds-facilitated referrals by 66% (P = 0.02); however, the LD did not significantly decrease with the use of ONCOpeds. CONCLUSIONS: The implementation of ONCOpeds was found to be feasible in this pilot study, having a potential utility in improving early diagnosis and referral in children and adolescents newly diagnosed with cancer. Directions for future research include multicenter studies with a larger population to further test the application's effectiveness.
Subject(s)
Early Detection of Cancer/methods , Mobile Applications , Neoplasms/diagnosis , Adolescent , Child , Child, Preschool , Female , Humans , Income , Infant , Male , Neoplasms/epidemiology , Peru/epidemiology , Pilot Projects , Prospective StudiesABSTRACT
BACKGROUND: The latency to diagnosis is the time between the detection of a patient's first symptoms and the cancer diagnosis. The aim of this study was to identify the latency to the diagnosis of cancer in children in Peru and the clinical and sociodemographic factors associated with this latency. METHODS: All patients diagnosed with lymphoma and solid tumors between 2012 and 2014 at a social security referral hospital in Peru were retrospectively evaluated. Clinical and demographic variables were analyzed to assess their association with the latency to diagnosis. RESULTS: A total of 284 patients younger than 18 years of age were included in the study. The median time to diagnosis was 8.8 weeks, with a median patient interval of 2 weeks and diagnostic interval of 4.4 weeks. We found significant differences in the latency to diagnosis for different types of cancer (longer for Hodgkin lymphoma and shorter for Wilms tumor). Older children had significantly longer latencies to diagnosis (P = 0.048; OR: 1.05, 95% CI [1.0-1.1]), as did children who were first diagnosed by a general physician rather than by a pediatrician or surgeon (P = 0.028; OR: 2.1, 95% CI [1.1-4.2]). Parental age, level of education, marital status, metastatic disease, clinical stage, and gender did not significantly affect latency to diagnosis as analyzed by a multivariate analysis. CONCLUSION: In Peru, median latency to diagnosis was comparable to that described in developing countries, where the index of suspicion for childhood cancer remains low. It is crucial to establish strategies to optimize early diagnoses using associated factors.
Subject(s)
Delayed Diagnosis , Hodgkin Disease/diagnosis , Neoplasms/diagnosis , Adolescent , Age Factors , Child , Child, Preschool , Female , Hodgkin Disease/pathology , Humans , Male , Neoplasm Staging , Neoplasms/pathology , Parents , Retrospective StudiesABSTRACT
Ovarian and paraovarian neoplasms are uncommon in children, mainly originating from germ cell tumors and, least frequently, epithelial tumors. There is an association between genital tract tumors and Proteus syndrome, a rare, sporadic, and progressive entity, characterized by a postnatal overgrowth in several tissues caused by a mosaic mutation in the AKT1 gene. We describe a 20-month-old asymptomatic infant with Proteus syndrome who developed an endometrioid paraovarian borderline cystic tumor. This is the youngest patient so far reported in the literature with this rare syndrome and an adnexal tumor of borderline malignancy. A total of nine patients have been described with female tract tumors and associated Proteus syndrome, which includes bilateral ovarian cystadenomas and other benign masses. A paraovarian neoplasm is extremely rare in children and could be considered a criterion for Proteus syndrome. Standardized staging and treatment of these tumors are not well established; however, most authors conclude that these neoplasms must be treated as their ovarian counterparts.