IN C TR Temesgens Legacy IN C TR Temesgen in Washington DC

IINNCCTRTRIINNCCTRTR Temesgen’s Legacy

IINNCCTRTRIINNCCTRTRTemesgen in Washington DC

IINNCCTRTRIINNCCTRTR

The Global Pattern of Childhood Cancer and

Advances made in High Income countries

Aziza Shad MDLombardi Comprehensive Cancer

CenterGeorgetown University Hospital

Washington DC, USAand

INCTR USA


2020 16-20 million new cancer cases each year ¾ of these in developing or resource-poor

countries


Developed and Developing Countries

Some Facts Developing countries

GNP per capita is 350$125 countries in the world

Developed countries GNP per capita > 25000$10 countries in the world

1/5 of the people in the highest income countries have 86% of the GNP

The bottom 1/5 have 1% of the GNP


Estimates of Population

0

1000

2000

3000

4000

5000

6000

7000

2002 2005 2010 2015 2020

Less Developed More Developed

Mill

ions


World Population Facts

In 1990, developing countries accounted for 78% of the world’s population and 86% of the world’s children below the age of 15

It is predicted that by 2030, 90% of the world’s children will live in developing countries


The Global Childhood Cancer Burden

0

50000

100000

150000

200000

0- 14 years 0- 19 years

More Developed Countries Less Developed Countries


Patterns of Childhood Cancer

40-50% of all pediatric cancer in the world is leukemia or lymphoma treatment largely chemotherapy, but needs

expertise

Pattern of cancer particularly different in Sub-Saharan Africa – high incidence of KS and BLKS largely HIV-related; preventable with

HAART

Brain tumors more common in more developed countries – higher incidence than lymphomasMay be partly due to failure to recognize

Retinoblastoma also probably higher incidence but lack of rural data misleading


Frequencies (%)

USA-WUSA-W BrazilBrazil UgandaUganda ZimbabwZimbabwee

LeukemiasLeukemias 3131 2828 66 2121

LymphomasLymphomas 1010 2121 2929 1111CNSCNS 2121 1313 11 1111SympatheticSympathetic 99 22 11 44RetinoblastomaRetinoblastoma 33 88 66 99RenalRenal 77 99 44 1515HepaticHepatic 22 00 11 22BoneBone 44 66 33 44Soft TissueSoft Tissue 77 44 4141 1818


USA Whites 83-92 (0-14 yrs)

31%

10%

21%

9%

3%

7%

2%

4%7%

3% 0%3%Leukemia

Lymphoma

CNS

Sympathetic NS

Retinoblastoma

Renal

Hepatic

Bone

Soft Tissue

Germ Cell

Carcinomas

OtherData from IARC IICC 1998

ALL 31%NHL 10%CNS 21%

14 per 100K


Uganda 92-95 (0-14 yrs)6%

29%

1%1%6%

4%1%3%

41%

1%3%4%

Leukemia

Lymphoma

CNS

Sympathetic NS

Retinoblastoma

Renal

Hepatic

Bone

Soft Tissue

Germ Cell

Carcinomas

OtherData from IARC IICC 1998

KS

>66%

KS or BL

18 per 100K


Pattern of Cancer in Ethiopia

There are no reliable statistics on the incidence of pediatric cancer in Ethiopia

With 42 million children under the age of 18 years, there could be as many as 5,628 new cases of pediatric cancer each year in Ethiopia.


Pattern of Cancer in Ethiopia

Leukemia Lymphoma Retinoblastoma Wilms tumor Bone and soft

tissue sarcomas


Childhood Cancer Survival

USA – approximately 12,400 children and adolescents < 20 years are diagnosed with cancer / yr7500 of these children are < 15 years of age

Dramatic progress in treatment of cancer in children in developed countries in the last 25 years

80% of children and adolescents diagnosed before the age of 20 are cured


Relative 5 yr Survival Rates (SEER) All Sites, M and F

77.5

0

20

40

60

80

100

1975 1980 1985 1990 1994

Age 0- 14 Age 0- 19

Perc

en

t


Five Year Survival Rates (SEER) 1992-8, 0-14 years

0 20 40 60 80 100

Wilm'Soft TissueNHLNeuroblastomaAMLALLHodgkin'sCNSBone

Percent



Childhood Cancer in Developing Countries – The Reality

Cure rate in developing countries currently <30%

Currently, only 20% of all children with cancer receive treatment sufficient to give them a chance for cure


Annual Deaths versus Cases

0

20000

40000

60000

80000

100000

120000

140000

MoreDeveloped

LessDeveloped

Deaths

Cases

NB. Data extrapolated from existing registries – the true situation is probably significantly worse


The Problem: a Vicious Cycle

Limited Resource

s

Many Patients With Advanced

Disease and Many Potential

Patients

LOW CAPACITY

POOR ACCESS

High Mortality Rate

Unmet need for terminal

care


Access to Care


poverty

lack of pediatric cancer units

lack of education and health knowledge

lack of transport and communication

infections

Problems faced by patients

anemia


Late Diagnoses

Courtesy, Dr Ashraf


Shortage of antibiotics

Few specialized units

ShortageOf cancer

drugs

Poor facilities

Doctors&

nurses

Problems faced By medicalpersonnel

patients

Poortraining


The Case to treat Pediatric Cancer

Many childhood cancers are highly curable if detected early

Treatment protocols have been adapted for use in low income countries that use readily available and inexpensive generic drugs.


The Solution: Build Capacity

Less Limited

Resources

Fewer Patients with More

Limited Disease and Fewer Potential Patients

Prevention

Education

Screening

GREATER CAPACITY

IMPROVED ACCESS

Lower Mortality Rate

Less need and

greater capacity

for terminal

care


The International Network for Cancer Treatment and Research

(INCTR) A not-for-profit, non-governmental

organization founded in 1998 by the UICC and the Institut Pasteur in Brussels

The National Cancer Institute, USA assists the INCTR by providing financial, technical and intellectual support

INCTR assists developing countries through a structured program of research collaboration, education and training


INCTR Mission Statement

INCTR is dedicated to helping build capacity for cancer treatment and research in countries in which such capacity is presently limited ……and to increase the quantity and quality of cancer research throughout the world.

Catalysis Concerted Effort Communication

Sustainability


The Goals

Cancer Cure

Cancer Prevention

Improvement in Quality of life


The Mechanism

Establishment of long term collaborative projects which will have an immediate impact on prevention or treatment

Associate such projects with education and training

Use information collected in the course of such projects as a foundation on which to build future endeavors


The Tool: Collaboration

Multiple networks: organizations, institutions, experts, supporters


INCTR’s Network

Offices and Branches

Collaborating Units


INCTR PEDIATRIC ONCOLOGY PROGRAM

Education and Training

Clinical Research

Palliative Care


PEDIATRIC CANCER IS OUR PRIORITY


EDUCATIONAL ACTIVITIES Pediatric Oncology Training

ProgramsEducational Workshops

Fellowship Program Visiting Experts Program Collaborative Efforts with other

Oncology Groups Development of Educational Material Telemedicine I-Path Program


TRAINING AND EDUCATION

Practical Management of Common Pediatric Cancers

Supportive Care ProgramGuidelines for management of

complications of treatment, blood transfusions, febrile neutropenia


CLINICAL TRAINING AND RESEARCH


Projects: Childhood Cancer

RETINOBLASTOMA

Early detection and treatment

OSTEOSARCOMA

Treatment of metastatic disease

LEUKEMIA (ALL)

Treatment and molecular studies

BURKITT’S LYMPHOMA

Treatment and molecular studies

PALLIATIVE CARE


MUMBAI

DELHI

CHENNAI

• CHENNAI

o DELHI

x MUMBAI


PALLIATIVE CARE


IMPORTANCE OF PEDIATRIC PALLIATIVE CARE

60% of children will die of their disease in the setting of low and middle income countries


PAX INITIATIVES Nepal (Kathmandu and Bhaktapur) India (Hyderabad) Tanzania (Dar es Salaam) Pakistan (early stages) Brazil Collaborative Efforts

INCTR and MECC

Educational initiatives3rd edition of Guidelines published



GOALS FOR ETHIOPIA

Train doctors to recognize and identify early stage cancers

Train a core group of pediatricians to treat patients using cost effective protocols designed for developing nations

Help establish a sufficient supply of essential chemotherapy drugs

Increase capacity to offer palliative care to patients with incurable disease


GOALS FOR ETHIOPIA

Twinning program with Georgetown University and INCTR for training and education

Curriculum for Fellowship Program in Pediatric Oncology and Palliative Care

Telemedicine education Center of Excellence in Pediatric

Cancer


Participation


CURE FOR EVERY CHILD

Documents

IN C TR Temesgens Legacy IN C TR Temesgen in Washington DC