(P55) Assessment of International Patient Access to Pediatric Oncology Treatment Resources at the University of Miami and Jackson Health Systems From 2007-2016

Abstract

Pediatric cancer care is highly specialized, with adequate treatment resources often not available in several low- and middle-income countries (LIMCs). Located in close proximity to several Latin American LIMCs, Miami serves as a unique referral center for many of these patients. We sought to collect demographic and treatment information regarding the international pediatric oncology patients referred to the University of Miami (UM) and Jackson Health System (JHS) to better characterize this unique cohort. An Institutional Review Board (IRB) approved study was conducted in which the UM/JHS tumor registry was queried for all international pediatric oncology patients, aged 21 years or younger, treated between 2007-2016. Sociodemographic and clinical data were extracted. 141 international pediatric patients were evaluated at UM/JHS, and 128 patients received treatment at these facilities. The average age of presentation was 11.0 years and included 52.5% males and 47.5% females. Median follow up, calculated as the duration of time between the first office visit at UM/JHS and the date of last follow up, was 11.0 months (range, 1-257 months). Referrals were from the Caribbean Islands (50.4%), South America (34.8%), Central America (11.3%), and Middle East/Africa (3.5%). Peru was the most well represented country (18.4%), followed by the Bahamas (11.35%), Dominican Republic (7.8%), and Haiti (7.1%). Patients most frequently sought care for leukemia (33.3%), central nervous system tumors (18.4%), lymphoma (9.2%), osteosarcoma (7.8%), and other sarcomas (8.5%). Among treated patients, 49.6% received treatment in their home country and sought treatment at UM/JHS due to a need for more specialized care with 28.4% seeking care due to recurrence of disease. The treatments received at UM/JHS during the initial phase of care included chemotherapy alone (19.9%), radiotherapy alone (3.6%), surgery alone (10.6%), radiotherapy in combination with other forms of treatment (40.4%), or other combinations (15.6%). Of note, 44% of patients received radiotherapy as part of their definitive cancer management, with 2.8% receiving treatment in the palliative setting. Approximately 44% of international pediatric oncology referrals to UM/JHS required radiotherapy as part of management. As radiotherapy resources are particularly sparse in select regions of Latin America, fostering international partnerships for pediatric radiotherapy referrals may facilitate improved patient care.