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

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.

Methods:

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

Discussion/Conclusion:

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.