METHODS: A 10-question survey was distributed among chairs of pediatric oncology services. Centers were classified according to patient volume into high- (HVC; 100 or more new cases per year), medium- (MVC; 31-99 cases), and low-volume centers (LVC; 30 cases or less), respectively. National referral centers (NRC) were identified.
RESULTS: Total 307 centers in 20 countries were identified (271 responded), and 264 responses were evaluable, accounting for 78% of the expected cases (21,359 cases per year). Seventy-seven percent of patients are treated in public centers, including additional support by civil society organizations. We found that 66% of the patients are treated in 70 centers of excellence, including 21 NRC. There was a median of one pediatric oncologist every 21 newly diagnosed patients (44 for NRC), and in 84% of the centers, nurses rotated to other services. A palliative care team was lacking in 25% of the centers. LVC with public funding have significantly lower probability of having a palliative care team or trained pediatric oncology surgeons. Psychosocial, pharmacy, and nutrition services were available in more than 93% of the centers. No radiotherapy facility was available on campus in nine of 21 NRC.
CONCLUSIONS: Most children with cancer in Latin America are treated in public HVC. There is a scarcity of pediatric oncologists, specialized nurses and surgeons, and palliative care teams, especially in centers with public funding.
方法:一项由10个问题组成的调查分布在儿科肿瘤学服务的主席之间。中心根据患者数量分为高(HVC;每年100例或更多新病例),中型(MVC;31-99例),和低容量中心(LVC;30例或更少),分别。确定了国家转诊中心(NRC)。
结果:确定了20个国家的307个中心(271个答复),264个回答是可评估的,占预期病例的78%(每年21,359例)。77%的患者在公共中心接受治疗,包括民间社会组织的额外支持。我们发现,66%的患者在70个卓越中心接受治疗,包括21个NRC。每21名新诊断患者中就有一名儿科肿瘤学家(NRC为44),在84%的中心,护士轮转到其他服务。25%的中心缺乏姑息治疗小组。拥有公共资金的LVC拥有姑息治疗团队或训练有素的儿科肿瘤外科医生的可能性大大降低。社会心理,药房,超过93%的中心提供营养服务。21个NRC中有9个在校园内没有放射治疗设施。
结论:拉丁美洲大多数患有癌症的儿童在公共HVC中接受治疗。儿科肿瘤学家很少,专业护士和外科医生,和姑息治疗小组,特别是在有公共资金的中心。