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1. Comprehensive global collaboration in the care of 1182 pediatric oncology patients over 12 years: The Iraqi–Italian experience

Author

Mazin Faisal Al‐Jadiry, Stefania Uccini, Anna Maria Testi, Maria Luisa Moleti, Adil Rabeea Alsaadawi, Amir Fadhil Al‐Darraji, Raghad Majid Al‐Saeed, Safaa A. Faraj Al‐Badri, Ahmed Hatem Sabhan, Hasanein Habeeb Ghali, Samaher Abdulrazzaq Fadhil, Wisam Majeed Abed, Najiha Ahmed Ameen, Yasir Saadoon Abed, Fawaz Salim Yousif, Aseel Rashid Abed, Hanadi Munaf Hussein, Ahmed Mudhafar Shkara, Alfonso Piciocchi, Sara Mohamed, Luigi Ruco, Ibrahim Qaddoumi, and Salma Abbas Al‐Hadad

Subjects
cancer, children, developing countries, pathology review, pediatric oncology, pediatric pathology, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Iraq's health care system has gradually declined after several decades of wars, terrorism, and UN economic sanctions. The Oncology Unit at Children's Welfare Teaching Hospital (CWTH) in Baghdad was lacking basic facilities and support. To address this shortcoming, a humanitarian and educational partnership was established between CWTH and Sapienza University of Rome (SUR). Methods We investigated the outcomes of 80 online and 16 onsite educational sessions and 142 teleconsultation sessions from 2006 to 2014. We also determined the outcomes of pathology reviews by SUR of 1216 tissue specimens submitted by CWTH from 2007 until 2019 for second opinions. The primary outcomes were discordance, concordance, and changes among clinical diagnoses and pathology review findings. The measures included the frequency of teleconsultation and tele‐education sessions, the topics discussed in these sessions, and the number of pathology samples requiring second opinions. Findings A total of 500 cases were discussed via teleconsultations during the study period. The median patient age was 7 years (range, 24 days to 16·4 years), and the cases comprised 79 benign tumors, 299 leukemias, 120 lymphomas, and 97 solid tumors. The teleconsultation sessions yielded 27 diagnostic changes, 123 confirmed diagnoses, and 13 equivocal impacts. The pathology reviews by SUR were concordant for 996 (81·9%) cases, discordant for 186 (15·3%), and inconclusive for 34 (2·8%). The major cause of discordance was inadequate immunohistochemical staining. The percentage of discordance markedly decreased over time (from 40% to 10%). The cause of the improvement is multifactorial: training of two CWTH pathologists at SUR, better immunohistochemical staining, and the ongoing clinical and pathologic telemedicine activities. The partnership yielded 12 publications, six posters, and three oral presentations by CWTH investigators. Interpretation The exchange of knowledge and expertise across continental boundaries meaningfully improved the diagnoses and management of pediatric cancer at CWTH.

Published
2023
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2. Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia Region: A report from the Pediatric Oncology East and Mediterranean (POEM) Group

Author

Tamar Javakhadze, Ülker Koçak, Nisreen Khalifa, Naureen Mushtaq, Anas Obeid, Mouroge H. Al Ani, Abdulhakim Al-Rawas, Ghada Sousan, Mohammad Najajreh, Mahwish Faizan, Azim Mehrvar, Fatiha Gachi, Mohammed Awad Mohammed Abdallah, Yasir Saadoon Abed Al‐Agele, Sima Jeha, Suleiman Al‐Sweedan, Hamoud Hodeish, Raya Saab, Khulood Al‐Saad, Wasil Jastaniah, Houda Boudiaf, Salma Al‐Haddad, Malek Baassiri, Samar Muwakkit, Amani Al Kofide, Sawsan Sati Abbas, Jamila El‐Houdzi, Lilit Sargsyan, M. Khattab, Tezer Kutluk, Krishna Sagar Sharma, Yasser Wali, Khaled M. Ghanem, Aliya Batool, Hacı Ahmet Demir, Muhammad Rafie Raza, Peter Noun, Elie Bechara, and Asim F. Belgaumi

Subjects
Cancer Research, medicine.medical_specialty, Cross-sectional study, Health Personnel, medicine.medical_treatment, media_common.quotation_subject, Disease, Discipline, Middle East, middle‐income countries, 03 medical and health sciences, 0302 clinical medicine, Africa, Northern, Hygiene, Neoplasms, Surveys and Questionnaires, Pandemic, Asia, Western, care delivery, Humans, Medicine, 030212 general & internal medicine, Child, Personal protective equipment, media_common, business.industry, pandemic, Social distance, COVID-19, Original Articles, Hospitals, Radiation therapy, Cross-Sectional Studies, Oncology, Pediatric Oncology, 030220 oncology & carcinogenesis, Family medicine, Original Article, coronavirus disease 2019 (COVID‐19), business, Delivery of Health Care
Abstract

Background Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID‐19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS A 34‐item survey focusing on barriers to pediatric oncology management during the COVID‐19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID‐19 cases and deaths were retrieved from the World Health Organization database. Results In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off‐treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in, The response to the coronavirus disease 2019 (COVID‐19) pandemic has led to significant alterations in access to care for children with cancer. Interventions are needed to mitigate the effects on life‐threatening diseases requiring immediate and uninterrupted therapy, such as childhood cancer.

Published
2020

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