By Jo Cavallo

Posted: 5/26/2023 12:04:00 PM

Final Up to date: 5/26/2023 11:19:27 AM

The implementation of a collaborative program between North American and Mexican medical establishments to attain sustainable, high-quality care at a public hospital in the US–Mexico border area for kids with acute lymphoblastic leukemia (ALL) and enhance outcomes has resulted in important enhancements in 5-year general survival for these sufferers. In response to the examine’s findings, the 5-year general survival charges for kids with standard-risk and high-risk ALL improved from 52% to 82% and from 46% to 76%, respectively. The examine by Aristizabal et al will likely be offered in the course of the 2023 ASCO Annual Assembly (Summary 1502).

Enhancements in remedy over the previous 5 a long time for kids with ALL have resulted in remedy charges reaching practically 90% in high-income international locations. Nonetheless, in low-resource international locations, remedy charges for childhood ALL plummet to between 40% and 70% due to a mess of things, together with health-care techniques in these settings which can be ill-equipped to handle most cancers look after these sufferers.

On this examine, Paula Aristizabal, MD, MAS, a pediatric hematologist-oncologist at Rady Kids’s Hospital–San Diego and Affiliate Professor of Pediatrics within the Division of Pediatric Hematology/Oncology at UC San Diego Well being, and colleagues investigated how worldwide collaborative methods could enhance outcomes for kids with leukemia in low- and middle-income international locations, particularly those who share a border with high-income international locations.

Research Methodology

In 2013, in a partnership between North American and Mexican establishments, the researchers used a well being techniques strengthening mannequin developed by the World Well being Group (WHO) referred to as Framework for Motion—which included domains in care supply providers, workforce, info techniques, entry to important medicines, financing, and management and governance—to implement a sustainable program with the objective of bettering ALL outcomes at Hospital Basic in Tijuana, Mexico.

The researchers evaluated program sustainability indicators and prospectively assessed medical options, danger classification, and survival outcomes in 109 kids with ALL on the hospital from 2008 to 2012 (earlier than implementation of this system) and from 2013 to 2017 (after implementation).

• A collaborative cross-border program between establishments in Mexico and California resulted in improved 5-year general survival for kids with standard- and high-risk ALL being handled in Tijuana.
• Reductions in survival disparities in most cancers outcomes are possible with cross-border packages, particularly borders which can be shared between high- and low-middle revenue international locations.

Key Outcomes

The researchers’ strategy led to a completely staffed leukemia service on the hospital with sustainable coaching packages; evidence-based, data-driven initiatives to enhance medical outcomes; and funding for medicines, provides, and personnel by native partnerships.

They discovered that the preimplementation and postimplementation 5-year general survival for kids with standard-risk and high-risk ALL improved from 52% to 82% and from 46% to 76%, respectively. All sustainability indicators considerably improved between 2013 and 2017.

“By utilizing a well being techniques strengthening strategy, we improved leukemia care and survival in a public Mexican hospital within the U.S.-Mexico border area. The demonstrated improve in general survival throughout a decade after the implementation of our program validates the usage of the well being techniques strengthening fashions, as they don’t seem to be solely efficacious in bettering medical outcomes, but additionally function [a] financially and organizationally technique of constructing sustainable capability. Our mannequin serves for example for future worldwide partnerships geared toward sustainably bettering most cancers outcomes in low- and middle-income international locations. Future analysis ought to consider finest practices in establishing world well being collaborations with specific consideration paid towards the person circumstances that influence health-care supply regionally in every distinctive neighborhood,” concluded the examine authors.  

Scientific Significance

In an ASCO press briefing detailing the findings of this examine, Dr. Aristizabal stated that utilizing a mix of twinning—the partnering of a middle of excellence in a high-income nation with a middle in a low- and middle-income nation to share information, expertise, and organizational abilities—and the WHO Framework for Motion mannequin that’s targeted on sustainability was efficient in decreasing leukemia survival disparities. “Sustained enhancements in most cancers outcomes in low- and middle-income international locations are possible with progressive cross-border packages, notably in borders which can be shared between a high-income nation and a low-income nation, ” stated Dr. Aristizabal.

“As I’ve heard Princess Dina Mired of Jordan [President-Elect of the Union for International Cancer Control (UICC)] say many occasions, ‘Your zip code shouldn’t decide in case you survive most cancers,’” stated moderator of the press briefing, Julie R. Gralow, MD, FACP, FASCO, Chief Medical Officer and Government Vice President of ASCO, commenting on Dr. Aristizabal’s findings. “And that is an instance of kids being so shut in proximity and never having the identical benefits. Your program targeted on capability constructing primarily, however in prior discussions, you’ve additionally instructed us that due to this partnership that was occurring, you have been capable of have medicine provided by the Mexican Ministry of Well being, which was not customary throughout the nation. In order that partnership additionally then concerned the Mexican authorities in having access to the drug as properly, which I believe is a vital part.”

“It takes a number of companions—not only a village, however a number of companions—to attain these outcomes,” concluded Dr. Gralow.

Disclosure: Funding for this examine was offered by Rady Kids’s Hospital San Diego, Patronato Basis. For full disclosures of the examine authors, go to coi.asco.org.

The content material on this put up has not been reviewed by the American Society of Scientific Oncology, Inc. (ASCO®) and doesn’t essentially mirror the concepts and opinions of ASCO®.