International Collaboration in Paediatric Oncology

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International Collaboration in Paediatric Oncology
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• Curr Opin Pediatr. 2001 Feb13(1)
• Pediatric oncology in the third world.Usmani
  GN.

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Pediatric oncology in the third world

• access to medical care is inadequate.
• cancer care is expensive
• available at only a few centers,
• excessive patient numbers
• staffed by inadequate numbers of physicians and
  nurses.
• marked geographic variations in incidences
  ,presentations and spectrum of pediatric
  malignancies

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• . To advance the cure rate, investigators have
  formed several parallel initiatives in both
  industrialized and developing countries through
  international collaboration and partnership
• Int J Hematol. 2003 Dec78(5)383-9.

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Improvement of Cure Rates.

• To reach this goal, the way forward will depend
  on international collaboration,
• implementation of global harmonisation,
• prevention of the erosion of biomedical research
  and clinical trials
• increased public and private financial support

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Improvement of Cure Rates.

• Feasibility of curing children with cancer in
  low-income countries
• Practical aspects of treating children with
  cancer in low-income countries

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• International implications and the way forward.

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International implications and the way forward.

• (1) transferring the knowledge, methodologies and
  technologies to countries that are less
  fortunate
• (2) conducting multinational clinical trials in
  conjunction with paediatric cooperative groups in
  other countries
• (3) accessing older adolescent patients who
  currently do not participate in cooperative group
  trials
• (4) merging clinical trials by adult
  collaborative groups that overlap with the
  paediatric groups, as in acute lymphoblastic
  leukaemia, acute myelogenous leukaemia, Hodgkin's
  disease, osteosarcoma and germ cell tumours
• Eur J Cancer. 1997 Aug33(9)1439-47.

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International implications and the way forward.

• ( (5) establishing a stable source of funding for
  national and international cooperative paediatric
  cancer clinical trials
• (6) creating an informatics system that can link
  paediatric cooperative group operation centres
  around the world, and the institutions within
  each collaborative group and
• (7) securing the support of the insurance
  industry and government in covering clinical
  trials.
• Eur J Cancer. 1997 Aug33(9)1439-47.

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• Alliances have been established among government,
• local nongovernmental organizations,
• health care providers, and
• international groups
• to improve the survival rate of childhood
  leukemia in developing countries.

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• setting up worldwide pediatric care units
• establishing standard guidelines for treating
  patients
• undertaking research and
• lobbying international organizations like the
  World Health Organization, United Nations
  Children's Emergency Fund (UNICEF), International
  Union Against Cancer (UICC), and the
  International Society of Pediatric Oncology
  (SIOP)
• to make chemotherapy, supportive care drugs, and
  opioids for palliation uniformly available.
• New outreach training programs would alleviate
  manpower shortages by linking centers from the
  two world regions for training and facilitate
  collaboration with international organizations.

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• "Twinning" partnerships between a
  well-established individual institution or study
  group and a pediatric cancer unit in a developing
  country has proved to be the most successful
  strategy to date.Int J Hematol. 2003
  Dec78(5)383-9.

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• Int J Hematol. 2003 Dec78(5)383-9.
   International collaboration on childhood
  leukemia.Pui CH, Ribeiro RC.Department of
  Hematology-Oncology, St. Jude Children's Research
  Hospital, Memphis, Tennessee

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• Strategies to improve outcomes of children with
  cancer in low-income countries
• Scott C. Howard, Raul C. Ribeiroa, and Ching-Hon
  Pui
• European Journal of Cancer Volume 41, Issue 11 ,
  July 2005, Pages 1584-1587

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• Hematol Oncol Clin North Am. 2001
  Aug15(4)775-87,
• Pediatric hematology-oncology outreach for
  developing countries.Wilimas JA, Ribeiro
  RC.Department of Hematology-Oncology,
  International Outreach Program, St. Jude
  Children's Research Hospital, Department of
  Pediatrics, University of Tennessee Health
  Sciences Center, Memphis, Tennessee, USA.
• 13 countries, a school for Latin American nurses,
  a distance learning website, and
  telecommunications programs,

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• Vol. 291 No. 20, May 26, 2004   
• Establishment of a Pediatric Oncology Program and
  Outcomes of Childhood Acute Lymphoblastic
  Leukemia in a Resource-Poor Area
• Scott C. Howard, MD, MS Marcia Pedrosa, MD
  Mecneide Lins, MD Arli Pedrosa, PsyD Ching-Hon
  Pui, MD Raul C. Ribeiro, MD Francisco Pedrosa,
  MD
• JAMA. 20042912471-2475.

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Volume 352, Issue 9144 , 12 December 1998,
Pages 1923-1926 The Lancet

• North-South twinning in paediatric
  haemato-oncology the La Mascota programme,
  Nicaragua
• ProfG Masera MDa, , F Baez MDb,
• Pediatric Clinic, University of Milan, S Gerardo
  Hospital, 20052 Monza, ItalybPaediatric
  Hemato-Oncology Department, Manuel de Jesus
  RiveraLa Mascota Hospital, Managua,
  NicaraguacOncology Department, S Giovanni
  Hospital, Bellinzona, SwitzerlanddPaediatric
  Oncology Department, Istituto Nazionale Tumori,
  Milan, ItalyeIstituto di Ricerche
  Farmacologiche, Mario Negri, Milan, Italy

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• intellectual, organisational, and financial
  resources can be generated by a twinning
  programme. What is vital for such programmes is a
  long-term commitment to a comprehensive and
  holistic strategy that incorporates supply of
  drugs, training and supervision of health
  professionals, and the care of the children and
  of their parents

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crucial to the success of such
collaborative efforts?
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Succes of Collaborative studies depends on

• strong relationship with pediatric oncologists at
  the partner sites who devote 100 of their
  efforts to the partner program
• element is a fund-raising mechanism
• establishment of alliances that bring together
  the local pediatric oncology unit (hospital), the
  NGO, and public and private institutions,
  including government.

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• collaboration in trials of new agents for
  children with cancer
• proteomic research

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• Collaboration in trials of new agents for
  children with cancer

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challenges include

• ensuring that effective infrastructures are in
  place to safely and efficiently conduct early
  phase clinical trials in children
• obtaining timely access to new agents from
  pharmaceutical sponsors for both preclinical
  testing and for phase I and phase II testing and
  effectively prioritizing new agents for
  evaluation in children so that those agents most
  likely to benefit children with specific cancers
  are brought forward for clinical testing.

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Proteomic research

• Medical research has raised many ethical issues ?

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ethical issues ?

• patient rights, including issues of consent

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ethical issues ?

• Sample transfer should be organized along
  non-profit lines

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ethical issues ?

• Sampling procedures for human volunteers, and
  for patients.
• No risk
• Minimal risk to patients

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ethical issues ?

• Biosafety aspects should be addressed

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ethical issues ?

• Regulations on importation and exportation of
  human tissues?

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ethical issues ?

• Data acquisition and storage
• addressed in accordance with national data
  protection regulations, in particular when using
  computerized databases.

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ethical issues ?

• If follow-up information is to be taken, the
  authorization for such information should be
  requested.
• The right for patient's information (or for no
  information) on the research results should also
  be addressed.

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ethical issues ?

• The patient should be told if the samples are
  transferred to another research laboratory or
  private company.
• Samples and related data should be destroyed on
  request at any time point during the course of
  the study.
• If possible, traceability of the donor should be
  ensured.

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ethical issues ?

• The issues of validation and patenting should be
  also solved, usually by informing the patient
  that he/she will have no commercial rights on
  potential research results.

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• Proteomics. 2003 Aug3(8)1387-96.
•  Ethical and regulatory issues arising from
  proteomic research and technology.Reymond MA,
  Steinert R, Eder F, Lippert H.Department of
  Surgery, Otto-von-Guericke University Magdeburg,
  Leipziger Strasse 44, D-39120 Magdeburg, Germany.