ASCO Perspective

“Large disparities in access to high-quality cancer care often exist in low- and middle-income countries. The cross-border U.S.-Mexico partnership in this study illustrates collaborative strategies that can be put into place today that could greatly improve outcomes for children with cancer globally,” said Julie R. Gralow, MD, FACP, FASCO, ASCO Chief Medical Officer and Executive Vice President.

*Release includes data not in the abstract.

ALEXANDRIA, Va. — Five-year overall survival improved by 30% for children with acute lymphoblastic leukemia (ALL) who were treated at the Hospital General-Tijuana in Mexico, after implementation of a cross-border cancer treatment training and access program facilitated in partnership with Rady Children’s Hospital-San Diego and St. Jude Children’s Research Hospital. The research will be presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting and is in press with JCO Global Oncology for publication on Saturday, June 3.

Study at a Glance

Key Findings

Starting in 2012, Rady Children’s Hospital-San Diego and Hospital General-Tijuana launched an initiative aimed at improving childhood leukemia survival and other clinical outcomes by sharing knowledge, expertise, and resources in the treatment of pediatric ALL at the Tijuana hospital. Investigators collected survivorship data for 49 children with ALL who were treated at Hospital General-Tijuana pre-implementation (2008-2012) and for 60 children post-implementation (2013-2017). Between the entire timespan (2008 and 2017), 36 children were diagnosed with standard-risk disease and 73 had high-risk disease.

Between pre-implementation and post-implementation periods, 5-year survival rose from 59% to 65% for all pediatric patients with ALL. It went from 73% to 100% for standard-risk patients and 48% to 55% for high-risk patients. In addition, mechanical ventilation days decreased from 45 to 19 per 1,000-inpatient days, average antibiotic indication time decreased from 67.5 to 35 minutes, and sepsis rates decreased from 30% to 5%. Pediatric blood products transfusion guideline adherence increased from 39% to 80%.

All sustainability indicators covered in the National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model significantly improved between 2013 through 2017. Changes in delivery of care, staffing, access to essential medicines, information systems, funding, and leadership and governance—the domains covered by the WHO Framework for Action, a health-system strengthening model initiated by the US-Mexican partnership starting in 2013—helped improve Hospital General-Tijuana’s care delivery system and outcomes for patients with ALL.

“Effective leukemia management involves workforce specialty training, evidence-based treatments, and supportive care, including access to medications and equipment as well as patient and family psychosocial and financial support, partnerships with non-governmental organizations, and treatment adherence—all of which were lacking in Tijuana pre-implementation,” said lead study author Paula Aristizabal, MD, MAS, a pediatric hematologist/oncologist at Rady Children’s Hospital-San Diego and an associate professor of pediatrics in the Division of Pediatric Hematology/Oncology at the University of California San Diego. “We’re particularly proud that we could work together with our Mexican colleagues to make a difference in these children’s lives.”

Hospital System Improvements

In most low-and middle-income countries, survival rates are usually lower and exacerbated by health care systems that may be ill-equipped to manage cancer. Hospital General-Tijuana is a referral hospital serving approximately three million people.  In 2008, the hospital had no dedicated pediatric oncology or intensive care unit, nor any pediatric oncologists or nurses. Treatment options for children with cancer were limited. Diagnostic equipment was severely limited and needed medications were often lacking.

Six pediatric oncologists and eight pediatricians were recruited between 2013 and 2017. Developing skills, upgrading equipment for the pathology and hematology labs, and building the nursing workforce were early priorities.

The hospital obtained National Mexican accreditation and helped ensure funding through the Popular Insurance Program (Seguro Popular). Hospital General-Tijuana also established a partnership with Patronato, a local grassroots foundation, securing funding for medications and lodging and food subsidies for patients and families. Additional start-up funding was obtained from Rady Children’s Hospital-San Diego and St. Jude Children’s Research Hospital. 

Next Steps

“We feel future research should look at best practices for global health collaborations, such as this one, with a close eye on local circumstances and issues that affect health care delivery in each community,” said Dr. Aristizabal.

The study was funded by Rady Children's Hospital-San Diego, the Mexican Secretary of Health, and the Patronato Foundation.

View the full abstract

View disclosures for:

• Authors – in the abstract
• ASCO Cancer Communications Committee 
• Dr. Gralow
• Dr. Winer

For your readers:

•  Leukemia - Acute Lymphoblastic - ALL - Childhood | Cancer.Net

References:

1. Survival Rates for Childhood Leukemias: https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html

ATTRIBUTION TO THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY ANNUAL MEETING IS REQUESTED IN ALL COVERAGE.

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