Pediatric Oncology Symposium in Addis Ababa
- Mary Louise Cohen, osteosarcoma survivor, Dr. Carlos Rodriguez-Galindo, Wondu Bekele and Aziza Shad.
The First International Symposium in Pediatric and Adolescent Oncology in Ethiopia was held in Addis Ababa, from January 18-21, 2011. The conference, locally sponsored by Mathiwos Wondu the YeEthiopia Cancer Society, marked the launch of a collaborative initiative to improve survival rates for children and adolescents with highly curable cancers in Ethiopia. The collaboration is between INCTR US A, the Division of Pediatric Hematology Oncology, Georgetown University Hospital, Washington DC, the Federal Ministry of Health, Addis Ababa University Faculty of Medicine and Black Lion Hospital (also know as Tikur Anbessa Hospital) in Addis Ababa.
The symposium brought together physicians, residents, nurses and pharmacists from Black Lion Hospital and other hospitals from around the country for an introduction to the field of pediatric oncology. Symposium topics covered the spectrum of the pediatric cancer experience, from diagnosis to treatment, supportive care, palliative and end of life care, and family education and support.
Conference faculty, who came from the US , Europe, Israel, Asia and Africa, volunteered their time to participate in the symposium. The presenters brought clinical and research expertise in pediatric oncology, palliative care, oncology nursing, infection control and patient/family support. Many of the faculty members have been engaged in oncology initiatives in developing countries, and several serve on the Strategy Planning Group that is helping to shape and direct the collaborative initiative.
The symposium opened with welcoming remarks from Dr. Milliard Derbrew, Dean, Medical Faculty, Addis Ababa University, who highlighted the commitment of the medical faculty and Black Lion Hospital to the development and success of the pediatric oncology program. Dr. David Nelson, Chair, Depar tment of Pediatrics, Georgetown University Medical Center, welcomed the conference participants and thanked the visiting faculty for volunteering their time, expertise and commitment to the initiative.
Dr. Shad from Georgetown University and Dr. Michael Weintraub from Hadassah-Hebrew University Medical Center, gave presentations providing context to the challenge and opportunity of pediatric cancer in developing countries. Dr. Weintraub highlighted epidemiological differences between adults with cancer vs. children and adolescents, difficulties in estimating the burden of childhood cancer in low-income countries, patterns of care, barriers to care, dramatic improvements in pediatric cancer survival in high-income countries, and the genetic basis for cancer.
Introduct ion to the discipline of pediatric oncology
Several foundational presentations were given on the infrastructure and clinical requirements of a pediatric cancer unit. Dr. Shad provided an overview of the essential elements of a pediatric cancer care unit (PCU). Initially developed by SIOP and more recently updated by INCTR, the classification of PCUs in levels I, II and III, is based on diagnostic and treatment capacity, support services and clinical staff. Dr. Carlos Rodriguez-Galindo, Dana-Farber Cancer Institute and Children’s Hospital Boston, discussed early signs of childhood cancer. Dr. Sameer Bakhshi, from the Dr. B. R. A. Institute Rotary Cancer Hospital, AIIMS, New Delhi, presented case studies from his clinic on the diagnosis and staging of several common childhood cancers.
- Faculty and participants outside the meeting room.
Dr. Nina Hurwitz, Director, INCTR Pathology Education, highlighted the need to adopt diagnostic tools and methods to the locally available therapeutic options and the need for better communications between pathologists and hematologists, in the context of hematological malignancies, to minimize delays and ensure accuracy in determining a diagnosis. Dr. Hurwitz also introduced the iPath tool, which allows for on-line review of cases and development of a consensus diagnosis by multiple pathologists.
Disease-specific presentations
Conference faculty gave a series of presentations on common childhood cancers. Each session began with an overview of the specific disease, followed a review of strategies for management of the disease in a developing country and panel discussions of the experience of the clinicians. In addition, the Ethiopian doctors in the audience shared their perspective on particular challenges in Ethiopia and there was discussion concerning similarities and differences and the fact that most patients in Ethiopia would have much more advanced disease, and therefore need potentially more toxic and expensive therapy. Thus, emphasis on earlier diagnosis, and therefore on improving public awareness as well as that of primary care physicians to the existence and potential curability of childhood cancer would be very important. Diseases discussed included retinoblastoma, Wilms tumor, acute lymphoblastic leukemia, chronic myeloid leukemia, non-Hodgkin lymphoma and bone and soft tissue sarcomas. In addition to the participants mentioned so far, Dr. David Korones, Rochester School of Medicine and Dentistry, Dr. Shamvil Ashraf, Children Hospital of Karachi, Dr. Cristina Stefan, Tygerberg Children’s Hospital, Stellenbosch, and Dr. Amha Gebremedhin, Black Lion Hospital gave presentations on specific malignancies. Dr. Patricia Scanlan, INCTR’s coordinator for pediatric oncology in East Africa, concluded the session with her experience in building a pediatric cancer center of excellence in Tanzania.
Julia Challinor, PhD, UCSF School of Physiologic Nursing, and Melissa Adde, RN, MS, Director of the INCTR Clinical Trials Office, reviewed the value of clinical data to advance research and care, along with misperceptions about clinical research and barriers to standardized collection of clinical information. The need to base care on evidence, particularly evidence obtained in the context of limited resources, and to take into consideration local attitudes and beliefs was emphasized.
Supportive care / Palliative Care
Building capacity to deliver appropriate supportive and palliative care is an important goal of the INCTR Ethiopia program. The symposium included a series of expert presentations on supportive care, along with palliative and end of life care. Topics included co-morbidities in children with cancer (Dr. Stefan), oncologic emergencies (Dr. Korones), management of febrile neutropenia (Dr. Bakhshi), transfusion of children undergoing cancer treatment (Dr. Prassana Kumar, Oman Medical College) and immunizations in immunocompromised children (Dr. David Nelson).
Dr. Gayatri Palat, MNJ Institute of Oncology and RCC, Hyderabad, India, presented the range of needs - medical, emotional, psycho-social and financial - that patients and families face, and the acute nature of the problems in many developing countries. Dr. Palat also presented on the management of pain, and Dr. Barbro Norrstrom Mittag-Leffler, from Lund, Sweden, explored symptom management at the end of life.
The conference concluded with a session on communications skills, led by Dr. David Korones, Dr. Julia Challinor and Dr. Savitri Singh-Carlson, California State University, Long Beach. The audience engaged actively in a discussion around the need for effective communication with pediatric patients, parents, and siblings.
Participant evaluations of the symposium were extremely positive, giving high marks for the breadth and level of content, and quality of presentations. Attendees were clearly grateful for the commitment of everyone involved with the project. One attendee said, “I believe the seed you are sowing today will grow much bigger tomorrow.”
