'Twinning' US- based and Rwandan physicians improve lymphoma outcomes in children
In an African county lacking any specialists in children's cancers, a team approach that "twins" Rwandan physicians with Boston-based pediatric oncologists has shown it can deliver expert, curative care to young patients stricken with lymphoma.
The first-of-its-kind strategy is credited for curing at least 5 of 10 children at a rural Rwandan hospital; two others are in remission while receiving chemotherapy, and three children have died. The long-distance team approach was designed by Sara Stulac, MD, MPH, director of pediatrics for Partners In Health, and during the last year further developed and formalized through a partnership with pediatric oncologist Leslie Lehmann, MD, Kathleen Houlahan, RN, BA, MHA, pediatric oncology nurse and nurse director of the Jimmy Fund Clinic at Dana-Farber/Children's Cancer Center, and Larry Shulman, MD, medical oncologist and chief medical officer of Dana-Farber Cancer Institute.
Lehmann will present the results (abstract 4222) at the American Society of Hematology's 2011 annual meeting, Session 901, Monday, Dec. 12, in Hall GH of the San Diego Convention Center.
"We show that we can safely deliver care using this model an American-trained pediatrician supervising a Rwandan-trained generalist who are together supervised through phone calls from a U.S-based pediatric oncologist," says Lehmann, who is clinical director of the pediatric stem cell transplant program at Dana-Farber/Children's Hospital Cancer Center.
While nations in the developing world have traditionally devoted their limited public health resources to epidemic infectious diseases such as malaria and diarrhea, life-threatening non-communicable conditions like cancer and heart disease are of growing concern.
"There are not enough pediatric oncologists in the world" to provide specialized cancer care for children in developing countries, Lehmann says. "And there's not a single trained pediatric oncologist in Rwanda," a country of more than 11 million people.
In the Western world, 80 percent of children can be cured of lymphoma, but this success rate requires definitive diagnosis, expert administration of chemotherapy, and experienced follow-up care. The "twinning" team approach leverages in-country medical and nursing resources by adding the long-distance supervision and treatment-planning of Dana-Farber/Children's pediatric specialists in blood cancers.
The children described in Lehmann's report were treated over the past four years at the Rwinkwavu government hospital in rural Rwanda. The hospital is supported by Paul Farmer's Partners In Health, which works with governments in impoverished areas of the world to improve health care.
About five years ago, Stulac, a pediatrician then based in Rwanda as the clinical director for Partners In Health's project, set up the care model based at Rwinkwavu, along with Sara Chaffee, MD, of Dartmouth-Hitchcock Medical Center. Rounding out the group are Alain Uwumugambi, MD, a general physician trained in Rwanda; Merab Nyishime, RN, head pediatric nurse at Rwinkwavu Hospital, and a Rwandan nurse coordinator, Jean Bosco Bigirimana, RN. All are authors on the paper.
Lehmann says that accurate diagnosis of lymphoma is essential and sometimes difficult. "You don't want mistakes," she emphasizes. Children underwent biopsies and staging X-rays in Rwanda, and the results were sent to Brigham and Women's Hospital in Boston for all diagnoses.
Next, the pediatric oncologist (Lehmann) oversaw the development of a treatment plan. Patients received surgery at the national referral hospital, as needed. When a patient required chemotherapy, the drugs were prescribed by one of the U.S.-trained pediatricians, and administered by Rwandan nurses under the supervision of the local general physician and supported by the American-trained pediatrician, Lehmann explained.
For radiation therapy, children were taken to facilities in bordering Uganda. Throughout treatment, Lehmann consulted with the team in weekly conference calls or more often, if needed.
The 10 patients covered in the ASH report ranged from 3 to 15 years in age. All were diagnosed with lymphoma, which is more common in children in Rwanda than in the U.S. Five patients completed therapy four receiving CHOP or ABVD chemotherapy, and the fifth had the disease removed surgically and has not needed chemotherapy. Those five children have no evidence of disease in follow-up ranging from four months to four years and are considered cured, Lehmann said.
Two patients are currently on chemotherapy and their cancer is in remission. Two children died from treatment-related complications, and a third died when the lymphoma progressed during treatment.
"This is the beginning of a new model," says Lehmann. "In the past, doctors weren't comfortable having complicated oncology care delivered without a local oncology specialist available. Having a specialist on-site would be ideal but as global health moves into oncology, there are not enough oncologists to provide that kind of care so alternative approaches must be developed and carefully assessed."
Provided by Dana-Farber Cancer Institute
- Experts in pediatric palliative care to discuss challenges in this emerging field Oct 15, 2011 | not rated yet | 0
- Study identifies barriers to successful treatment of children with sarcoma in low-income countries Oct 20, 2010 | not rated yet | 0
- Injured children may not be getting best possible care May 02, 2011 | not rated yet | 0
- Cancer study finds adolescents don't get same access to latest treatments as younger patients Jan 15, 2008 | not rated yet | 0
- Childhood cancer survivors face long-term risk of GI complications, study finds Oct 22, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
Cancer 19 hours ago | not rated yet | 0
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
Cancer 19 hours ago | not rated yet | 1
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer May 18, 2013 | 5 / 5 (2) | 0
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer May 17, 2013 | not rated yet | 0
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer May 17, 2013 | not rated yet | 0 |
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
7 hours ago | not rated yet | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
8 hours ago | 5 / 5 (2) | 0 |
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
7 hours ago | 5 / 5 (1) | 0 |
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
8 hours ago | 5 / 5 (3) | 0 |
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
12 hours ago | not rated yet | 0
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
7 hours ago | not rated yet | 0