Pediatric Cancer Units and Optimization of Resources

Abstract

In this chapter we review information regarding and provide recommendations for the conceptualization, building, and development of pediatric cancer units (PCU) in countries with limited resources. The chapter is specifically geared to clinicians in low- and middle-income countries (LMC) but can also be informative to partners and researchers from high-income countries (HIC) seeking to learn about the structure, function, and potential of PCUs in countries with limited resources. The chapter begins addressing what the authors conceptualize as a PCU, reasons for building them, and a description of key components of PCUs across the resource spectrum. The chapter then addresses why and how clinicians can make valuable contributions to the burden of pediatric cancer, even in extreme resource-limited settings (ERLS) and presents four examples: the case-by-case approach; protocol development and prioritization; comprehensive integration of pain, palliative, and psychosocial services; and capacity building and education through the twinning model. The final sections of the chapter address lessons to be learned from the global response to the HIV/AIDS epidemic, the World Health Organization’s recommendations for addressing the burden of cancer in LMC, and understanding the unique pressure that addressing pediatric cancer can impose on overburdened health systems in LMC. The authors conclude discussing assumptions that can discourage clinicians and staff practicing pediatric oncology in countries with limited resources and providing final recommendations on how to optimize resources. Some of the concepts discussed in this chapter are not yet well studied. Therefore, in some instances the information and recommendations provided in this chapter reflect the authors’ opinions, as generated from their personal experience addressing pediatric cancer in countries with limited resources.