274166 Evaluating the Success of Twinning Programs in the Management of Pediatric Cancers in the Developing World

Monday, October 29, 2012

Narissa Puran, Medical Student (MS2), MS, MPH , Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
Cherec Dickey, Medical Student (MS2), BS , Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
Seema Biswas, MD, MSc, FRCS, FHEA , Ziv Hospital, Safed, Israel
Background: Pediatric cancer in developing countries has traditionally ranked below initiatives for infectious disease and malnutrition as a child health priority, as the provision of cancer services might be prohibitively expensive, require trained man-power and long-term follow-up. Of the 250,000 children diagnosed with cancer annually in the developing world, 200,000 will die without access to treatment. Survival in low and middle-income countries (LIMC) is as low as 35%, while survival in developed countries reaches 85%-a great disparity.

The most successful models in pediatric cancer care are twinning programs. These are partnerships between LIMC and pediatric cancer centers in the developed world that provide training and medical expertise on a long-term basis through diagnosis, staging, treatment and follow-up.


We analyzed all published material about twinning programs in pediatric cancer care from 1997 to 2012 using program websites, reports and medical literature in PubMed, Google Scholar and Science Direct databases. Each program was scored against 10 parameters which were used to construct our presented model for an ideal twinning program.

Results: We analyzed/evaluated 17 twinning programs. Agreed scoring parameters for these programs focused on: 1. Individually-tailored treatment 2. Social issues/access to healthcare 3. Long-term patient/family health education 4. Compliance/retention 5. Local cost-effectiveness 6. Acceptability in local population 7. Flexibility/Innovation 8. Co-operation with local government 9. Integration into local health services 10.Secure long-term funding


Successful twinning programs address the global disparity in pediatric cancer care. Keys-to-success are a sustainable partnership with individualized patient-care, innovation (telemedicine-communication) and access to secure long-term funding.

Learning Areas:
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss how to address pediatric cancer mortality in the developing world through twinning programs, an ideal model of a successful program and understand how to address in detail specific endemic pediatric cancers. Compare models of twinning programs for pediatric cancer care globally (Asia, Central/South America, Africa and Eastern Europe) with specific considerations by location. Discuss why pediatric cancer is a Global Health priority and how sustainable programs can be successful and significantly impact on mortality and reduce suffering. Discuss how programs can be measured against parameters agreed on by a panel of researchers, how these parameters might be agreed on and the pros and cons of this.

Keywords: Access to Health Care, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical student working on this project equally with my project partner, Cherec Dickey in a four-year medical course in Clinical and Global Medicine. Our mentor/preceptor is Dr. Seema Biswas, who has mentored us throughout this project, is a physician and expert in global health. I have completed several research projects focusing on public health, pediatric health,and program development. Cherec Dickey also has extensive experience in global heath, formative research, and epidemiology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.