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Report
The Paul P. Carbone Award Lecture for International Oncology
Giuseppe Masera, University of Milano-Bicocca, S.Gerardo Hospital, Monza, Italy
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Every year about 200,000 new cases of childhood cancer are diagnosed world-wide, some 85% of whom live in low and middle income countries (LMI) – a figure that is projected to increase to over 90% in the next 15-20 years. When adequately treated, childhood cancer has a high cure rate (overall 5-year survival is 75-80%), but unfortunately, most children in the world receive poor or no therapy. While survival rates have constantly increased in economically advanced countries since the 1960s this has not been the case in countries with limited resources, creating a progressively increasing “mortality gap” that will be difficult to eliminate. As countries develop and infectious diseases are increasingly well controlled, non-communicable diseases (including cancer) take on increasing importance. Because of the young median age of their populations childhood cancer accounts for a increasing fraction of all cancer in LMI. Together, these observations provide ample justification for directing more resources into pediatric cancer in developing countries.
Our own experience with Nicaragua began in 1986 when we replied to a request from Dr. Fernando Silva, a Pediatrician-Poet, who was the Director of the “La Mascota Hospital” in Managua. This led to the development of a collaborative program with the following goals:
- To develop a well-equipped Pediatric Cancer Unit (PCU) at La Mascota Hospital, and twinned with the University of Monza, and an outreach program to peripheral hospitals in Nicaragua.
- To improve survival in children with cancer by providing the best possible (in the local context) standardized treatment at no cost and associated with financial support for needy families.
- To provide continuing education for health professionals.
- To develop financial support from diverse sources to ensure sustainability.
- To create a “therapeutic alliance” among health professionals and parents/volunteers, in order to sensitize health authorities and mobilize resources.
- To reduce refusal and abandonment of therapy, a significant problem in Managua, by developing a psychosocial program and a “long-distance adoption” program.
- To promote formal research projects in order to encourage a scientific approach and ensure continuous progress.
The success of this program, in the early 1990’s, led to a new idea: the extension of this approach to other Latin American countries through the establishment of other twinning programs. The Monza International School for Pediatric Hematology/Oncology (MISPHO) was created and, since 1996, meetings for discussions and training have been organized with the participation of about 40 pediatric-oncologists from 15 countries (Bolivia, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay, and Venezuela). Additional twinning programs were established between Honduras, El Salvador and Guatemala with St. Jude; Paraguay with Modena and Madrid; Colombia with Boston; and the Dominican Republic with the University of Colorado College of Medicine, (Aurora, USA).
In 1998 the “Asociacion de Hemato-Oncologia Pediatrica de Centro America” (AHOPCA), was created, which included all the Central American countries and the Dominican Republic and collaborated with the International Out-reach Program of St. Jude, the Pediatric Oncology Group of Ontario (POGO) and MISPHO.
After more than 20 years the “La Mascota Program” has achieved the following:
- a well functioning Pediatric Hemato-Oncology Unit that has treated about 2,700 children with an overall survival rate of approximately 60%
- excellent facilities, including 32 patient rooms, an outpatient clinic, an operating room for minor procedures and day surgery, a hematology laboratory and a hostel for patient families with 18 rooms and 2 play-rooms.
- the involvement of Nicaraguan civil society through the Parents’ Association (MAPANICA) and volunteers (CONANCA).
The La Mascota Program demonstrates that a global, long-term twinning program is feasible, rewarding, and able to create new opportunities and new collaborations.
Consequently, we believe that “an attempt to reduce the gap in mortality from childhood cancer between developed and less developed countries should become an integral part of the care and research activities of hemato-oncological departments in developed countries and is not simply an exercise in solidarity”.
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