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IN C TR Temesgens Legacy IN C TR Temesgen in Washington DC.

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Presentation on theme: "IN C TR Temesgens Legacy IN C TR Temesgen in Washington DC."— Presentation transcript:


2 IN C TR Temesgens Legacy

3 IN C TR Temesgen in Washington DC

4 IN C TR The Global Pattern of Childhood Cancer and Advances made in High Income countries Aziza Shad MD Lombardi Comprehensive Cancer Center Georgetown University Hospital Washington DC, USA and INCTR USA

5 IN C TR 2020 16-20 million new cancer cases each year ¾ of these in developing or resource-poor countries

6 IN C TR Developed and Developing Countries Some Facts Developing countries GNP per capita is 350$ 125 countries in the world Developed countries GNP per capita > 25000$ 10 countries in the world 1/5 of the people in the highest income countries have 86% of the GNP The bottom 1/5 have 1% of the GNP

7 IN C TR Estimates of Population Millions

8 IN C TR World Population Facts In 1990, developing countries accounted for 78% of the worlds population and 86% of the worlds children below the age of 15 It is predicted that by 2030, 90% of the worlds children will live in developing countries

9 IN C TR The Global Childhood Cancer Burden

10 IN C TR Patterns of Childhood Cancer 40-50% of all pediatric cancer in the world is leukemia or lymphoma treatment largely chemotherapy, but needs expertise Pattern of cancer particularly different in Sub- Saharan Africa – high incidence of KS and BL KS largely HIV-related; preventable with HAART Brain tumors more common in more developed countries – higher incidence than lymphomas May be partly due to failure to recognize Retinoblastoma also probably higher incidence but lack of rural data misleading

11 IN C TR Frequencies (%) USA-WBrazilUgandaZimbabwe Leukemias 3128621 Lymphomas 10212911 CNS 2113111 Sympathetic 9214 Retinoblastoma 3869 Renal 79415 Hepatic 2012 Bone 4634 Soft Tissue 744118

12 IN C TR USA Whites 83-92 (0-14 yrs) Data from IARC IICC 1998 ALL 31% NHL 10% CNS 21% 14 per 100K

13 IN C TR Uganda 92-95 (0-14 yrs) Data from IARC IICC 1998 KS >66% KS or BL 18 per 100K

14 IN C TR Pattern of Cancer in Ethiopia There are no reliable statistics on the incidence of pediatric cancer in Ethiopia With 42 million children under the age of 18 years, there could be as many as 5,628 new cases of pediatric cancer each year in Ethiopia.

15 IN C TR Pattern of Cancer in Ethiopia Leukemia Lymphoma Retinoblastoma Wilms tumor Bone and soft tissue sarcomas

16 IN C TR Childhood Cancer Survival USA – approximately 12,400 children and adolescents < 20 years are diagnosed with cancer / yr 7500 of these children are < 15 years of age Dramatic progress in treatment of cancer in children in developed countries in the last 25 years 80% of children and adolescents diagnosed before the age of 20 are cured

17 IN C TR Relative 5 yr Survival Rates (SEER) All Sites, M and F Percent

18 IN C TR Five Year Survival Rates (SEER) 1992-8, 0-14 years Percent

19 IN C TR

20 Childhood Cancer in Developing Countries – The Reality Cure rate in developing countries currently <30% Currently, only 20% of all children with cancer receive treatment sufficient to give them a chance for cure

21 IN C TR Annual Deaths versus Cases NB. Data extrapolated from existing registries – the true situation is probably significantly worse

22 IN C TR The Problem: a Vicious Cycle Limited Resources Many Patients With Advanced Disease and Many Potential Patients LOW CAPACITY POOR ACCESS High Mortality Rate Unmet need for terminal care

23 IN C TR Access to Care

24 IN C TR poverty lack of pediatric cancer units lack of education and health knowledge lack of transport and communication infections Problems faced by patients anemia

25 IN C TR Late Diagnoses Courtesy, Dr Ashraf

26 IN C TR Shortage of antibiotics Few specialized units Shortage Of cancer drugs Poor facilities Doctors & nurses Problems faced By medical personnel patients Poor training

27 IN C TR The Case to treat Pediatric Cancer Many childhood cancers are highly curable if detected early Treatment protocols have been adapted for use in low income countries that use readily available and inexpensive generic drugs.

28 IN C TR The Solution: Build Capacity Less Limited Resources Fewer Patients with More Limited Disease and Fewer Potential Patients Prevention Education Screening GREATER CAPACITY IMPROVED ACCESS Lower Mortality Rate Less need and greater capacity for terminal care

29 IN C TR The International Network for Cancer Treatment and Research (INCTR) A not-for-profit, non-governmental organization founded in 1998 by the UICC and the Institut Pasteur in Brussels The National Cancer Institute, USA assists the INCTR by providing financial, technical and intellectual support INCTR assists developing countries through a structured program of research collaboration, education and training

30 IN C TR INCTR Mission Statement INCTR is dedicated to helping build capacity for cancer treatment and research in countries in which such capacity is presently limited ……and to increase the quantity and quality of cancer research throughout the world. CatalysisConcerted Effort Communication Sustainability

31 IN C TR The Goals Cancer Cure Cancer Prevention Improvement in Quality of life

32 IN C TR The Mechanism Establishment of long term collaborative projects which will have an immediate impact on prevention or treatment Associate such projects with education and training Use information collected in the course of such projects as a foundation on which to build future endeavors

33 IN C TR The Tool: Collaboration Multiple networks: organizations, institutions, experts, supporters

34 IN C TR INCTRs Network Offices and BranchesCollaborating Units

35 IN C TR INCTR PEDIATRIC ONCOLOGY PROGRAM Education and Training Clinical Research Palliative Care


37 IN C TR EDUCATIONAL ACTIVITIES Pediatric Oncology Training Programs Educational Workshops Fellowship Program Visiting Experts Program Collaborative Efforts with other Oncology Groups Development of Educational Material Telemedicine I-Path Program

38 IN C TR TRAINING AND EDUCATION Practical Management of Common Pediatric Cancers Supportive Care Program Guidelines for management of complications of treatment, blood transfusions, febrile neutropenia


40 IN C TR Projects: Childhood Cancer RETINOBLASTOMA Early detection and treatment OSTEOSARCOMA Treatment of metastatic disease LEUKEMIA (ALL) Treatment and molecular studies BURKITTS LYMPHOMA Treatment and molecular studies PALLIATIVE CARE



43 IN C TR IMPORTANCE OF PEDIATRIC PALLIATIVE CARE 60% of children will die of their disease in the setting of low and middle income countries

44 IN C TR PAX INITIATIVES Nepal (Kathmandu and Bhaktapur) India (Hyderabad) Tanzania (Dar es Salaam) Pakistan (early stages) Brazil Collaborative Efforts INCTR and MECC Educational initiatives 3 rd edition of Guidelines published

45 IN C TR

46 GOALS FOR ETHIOPIA Train doctors to recognize and identify early stage cancers Train a core group of pediatricians to treat patients using cost effective protocols designed for developing nations Help establish a sufficient supply of essential chemotherapy drugs Increase capacity to offer palliative care to patients with incurable disease

47 IN C TR GOALS FOR ETHIOPIA Twinning program with Georgetown University and INCTR for training and education Curriculum for Fellowship Program in Pediatric Oncology and Palliative Care Telemedicine education Center of Excellence in Pediatric Cancer

48 IN C TR Participation


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