Determining Pediatric Radiotherapy Capacity in Mexico

Abstract

A 2019 report demonstrated that Mexico and Central America have the highest total incidence of childhood cancers in the Western Hemisphere. Mexican children face disparities in cancer outcome. In Mexico, the 5-year survival estimates for ependymoma and intracranial germ cell tumors, two pediatric brain tumor types, are approximately 20%, which is dramatically lower than the survival outcomes reported in the US of 80% or higher. We sought to determine the self-identified treatment patterns, needs, and concerns of Mexican radiation oncologists for pediatric cancer management.Stakeholder planning began the summer of 2019. Partnering with local experts and the national Sociedad Mexicana de Radioterapeutas (SOMERA), we reviewed and designed a Spanish-language survey to ascertain pediatric radiotherapy capacity. The survey consisted of 35 questions and was distributed through the SOMERA listserv with promotion on social media. The survey was open from July 11 through August 30, 2020. Descriptive statistics were conducted. For frequencies, we report median (range). Surveys were stored in Qualtrics.A total of 94 radiation oncologists attempted, and 79 completed, the survey and identified as working in Mexico, representing 20 different cities. Of those, 58 (73%) responded saying they had treated a pediatric patient within the past year with median 9 years of practice (1-38). Forty-four (76%) felt comfortable with treating a pediatric patient, and 36 (62%) said they were familiar with national protocols for pediatric cancer treatment. The median number of pediatric cases seen in the past year by respondents was 9.5 (0 - 195). The three most common tumors treated were Hodgkin lymphoma (2; 0-21), medulloblastoma (1.5; 0-20), and Wilms tumor (1; 0-20), respectively. The median percentage of pediatric patients treated palliatively was 10%. Also, 26% responded having access to a multidisciplinary tumor board. Regarding supports, the majority had access to nutrition, rehabilitation, endocrinology, and anesthesia; 14% had access to fertility services, 27% had access to neurocognitive support, 11% responded noting no support, and only 1 respondent had child-life support. When asked what challenges they face as physicians, 20% expressed a lack of treatment spots and extended delay to new start, and 16% noted challenges with access to pediatric oncology and multidisciplinary teams.We present the first national survey of Mexican radiation oncologists with an intent to explore pediatric radiotherapy capacity. Through partnership with SOMERA, many centers were represented across the country. The majority of respondents who had treated a child patient felt comfortable doing so. Limited resources include access to fertility, child-life, and neurocognitive services. Wait times and lack of treatment spots were the most common physician challenges identified by respondents.