Annals of Oncology 15:680-685, 2004
© 2004 European Society for Medical Oncology
Original Paper |
Clinical epidemiology of childhood cancer in Central America and Caribbean countries
Received 28 August 2003; revised 17 December 2003; accepted 2 January 2004Background:
Countries with scarce resources have the right to appropriate essential health care but very few reports discuss how this can be achieved. We assessed the survival of a large cohort of pediatric oncological patients to provide hard data on which to base realistic evaluation and planning schemes.
Patients and methods:
This multicenter retrospective survey covered consecutively diagnosed and treated patients admitted to eight national level hospitals in seven countries in Central America and the Caribbean. The research protocol was discussed extensively, so the data to be collected and the criteria for their evaluation were clearly pre-defined. We analysed 2214 patients diagnosed between 1996 and 1999 with various cancers, classified as hemato-oncological disorders (70%) and solid tumors (30%).
Results:
Three-year overall survival was 48.4% [standard error (SE) 1.3]. Detailed analysis of acute lymphoblastic leukemia highlighted the wide intercountry variability: 3-year survival was 62.2% (SE 5.3) in Cuba, 74.2% (SE 3.3) in Costa Rica, 61.7% (SE 4.9) in Nicaragua, and lower in the other four countries.
Conclusions:
The yield of diagnostic-therapeutic protocols depends largely on the context of care in which they are applied. This paper documents the importance of including epidemiological research in interventions for cooperation in complex health areas such as pediatric oncology.
1 Department of Clinical Medicine, Prevention and Biotechnologies, Section of Medical Statistics, University of Milano-Bicocca, Monza; 2 Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy; 3 Departamento Hematologia y Oncologia Pediatrica de Niños Benjamin Bloom, San Salvador, El Salvador; 4 Pediatric Hemato-Oncology Department Manuel de Jesus Rivera, La Mascota Hospital, Managua, Nicaragua; 5 Servicio de Hemato/Oncologia Pediatrica, Hospital Escuela, Tegucigalpa, Honduras; 6 Unidad National de Oncologia Pediatrica, Guatemala City, Guatemala; 7 Instituto de Hematologia y Immunologia, La Habana; 8 Hospital Pediatrico Juan M. Marquez, La Habana, Cuba; 9 Servicio de Hematologia, Hospital National de Niños, San José, Costa Rica; 10 Servicio de Hematologia, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic; 11 Pediatric Clinic, University of Milano-Bicocca, Monza, Italy
Key words: clinical epidemiology, countries with limited resources, pediatric oncology, survival analysis