美国-墨西哥边境地区儿童白血病的生存状况：利用加强卫生系统模式建立可持续的白血病护理。

Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models.

机构信息

Peckham Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, San Diego, CA.

Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego, La Jolla, CA.

出版信息

JCO Glob Oncol. 2023 Jun;9:e2300123. doi: 10.1200/GO.23.00123.

DOI:10.1200/GO.23.00123

PMID:37269343

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10497272/

Abstract

PURPOSE

Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence.

METHODS

In 2013, through a partnership between North-American and Mexican institutions, we used the WHO , a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators.

RESULTS

Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% ( = .023), 73% to 100% ( < .001), and 48% to 55% ( = .031), respectively. All sustainability indicators improved between 2013 and 2017.

CONCLUSION

Using the health systems strengthening WHO model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.

摘要

目的

在大多数中低收入国家（LMICs），儿科白血病的治疗效果不佳，而这些国家的医疗体系也难以应对癌症。在 LMICs 中有效地治疗白血病需要管理流行病学数据；提供医疗保健劳动力专业培训；制定基于证据的治疗方法和支持性护理方案；确保药物和设备的可及性；提供患者和家庭的心理社会、财务和营养支持；与非政府组织合作，并确保治疗的依从性。

方法

2013 年，通过北美和墨西哥机构之间的合作，我们使用世界卫生组织（WHO）的一个卫生系统强化模型，在墨西哥的一家公立医院实施了一个旨在改善急性淋巴细胞白血病（ALL）治疗效果的白血病护理可持续性计划。我们前瞻性评估了 2008 年至 2012 年（实施前）和 2013 年至 2017 年（实施后）在蒂华纳总医院就诊的 ALL 患儿的临床特征、风险分类和生存结果。我们还评估了项目的可持续性指标。

结果

我们的方法使白血病服务得到了充分的人员配置，可持续的培训计划，基于证据和数据驱动的项目来改善临床结果，以及通过当地合作伙伴为药物、用品和人员提供资金。在整个 ALL 患儿、低危 ALL 患儿和高危 ALL 患儿的队列中，实施前后 5 年的总生存率从 59%提高到 65%（=0.023），从 73%提高到 100%（<0.001），从 48%提高到 55%（=0.031）。所有可持续性指标在 2013 年至 2017 年间都有所改善。