{"id":46517,"date":"2024-02-15T12:00:00","date_gmt":"2024-02-15T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2024\/childhood-cancer-latin-america-catching-treatment-complications"},"modified":"2024-11-03T15:11:53","modified_gmt":"2024-11-03T15:11:53","slug":"how-a-simple-tool-is-saving-lives-of-children-with-cancer-in-latin-america","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/how-a-simple-tool-is-saving-lives-of-children-with-cancer-in-latin-america\/","title":{"rendered":"How a Simple Tool Is Saving Lives of Children with Cancer in Latin America"},"content":{"rendered":"

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Advances in the treatment of childhood cancer have led to remarkable progress. In high-income countries like the United States, more than 80% of children with cancer survive their disease. <\/p>\n

In stark contrast, however, only 20% of children with cancer in lower-income countries survive their disease. Close to one-third of those deaths are caused not by the cancer, but by complications from the treatment<\/a> such as severe infections, organ failure, and hemorrhage<\/a>.<\/p>\n

But an international team led by St. Jude Children\u2019s Research Hospital is hoping to change that statistic in Latin America with a simple tool called a pediatric early warning system (PEWS). The warning system identifies children who are suffering from severe treatment-related complications<\/a> and guides the clinical team through the next steps for care.<\/p>\n

Early warning systems \u201care pretty ubiquitously used in hospitals that care for children in high-resource settings. But, prior to our work, [PEWS] were very underused in resource-limited settings,\u201d said Asya Agulnik, M.D., M.P.H., director of the global critical care program at St. Jude. <\/p>\n

Through a program called Proyecto Escala de Valoraci\u00f3n de Alerta Temprana (EVAT), Dr. Agulnik and the team have supported implementation of an early warning system in nearly 100 hospitals across Latin America and Spain. <\/p>\n

The results have been consistent and extremely positive: the early warning system has helped save the lives of many children hospitalized with cancer<\/a>.<\/p>\n

\u201cChildrens\u2019 health conditions were deteriorating, and we didn\u2019t know until they were in critical condition,\u201d said one nurse at a hospital in Ecuador. \u201cBut with [PEWS] everything changed \u2026 [now] we don\u2019t wait until it\u2019s too late\u201d to escalate their care. <\/p>\n

But will these hospitals continue to use the early warning system long-term? <\/p>\n

That\u2019s a critical question because only long-term use of tools like PEWS \u201cresults in truly beneficial progress,\u201d said Marie Ricciardone, Ph.D., a program director in NCI\u2019s Center for Global Health<\/a>.<\/p>\n

Through a 7-year project funded by NCI, a team of researchers at St. Jude and Washington University aim to learn what factors help keep the early warning system in use at low-resource hospitals in Latin America. And once they understand what makes PEWS stick, the funding will also help them develop strategies to keep the tool in use at hospitals that are struggling to maintain it.<\/p>\n

There\u2019s been very little research on what promotes sustained use of effective programs and tools, noted Virginia McKay, Ph.D., of Washington University in St. Louis, the project\u2019s co-leader.<\/p>\n

And even less is known about sustaining health programs and tools in low-resource settings, Dr. McKay explained. But sustainability is especially important in that context because the initial investment for implementing a new program or tool is typically expensive, she argued. <\/p>\n

\u201cIn low-resource settings, you may only get one opportunity every once in a while to do something new because the resources are so constrained. So, it\u2019s really important that [the new program or tool] is sustainable,\u201d Dr. McKay explained. <\/p>\n

\u201cIf [the new project is] successful, it has the potential to really remarkably change the outcomes for pediatric cancer in Latin America,\u201d emphasized Dr. Ricciardone, who oversees the study\u2019s funding.<\/p>\n

Deaths related to cancer treatment<\/h2>\n

Childhood cancer is an unforgiving disease that, in many cases, requires intense and harsh treatment. Doctors strive to give each child enough treatment to knock the cancer out for good, but not so much that the child\u2019s body is irreparably harmed.  <\/p>\n

It\u2019s a delicate balancing act that isn\u2019t always achieved. Sometimes, complications from the treatment can tragically take a child\u2019s life.<\/p>\n

While such deaths are a rare occurrence in high-income countries, they are a significant challenge in low- and middle-income countries, where there are few medical facilities and specialized resources to meet the unique needs of children with cancer. <\/p>\n

Many hospitals in lower-income countries are understaffed and have high staff turnover rates. Some countries, like El Salvador, have only a single hospital equipped to deliver cancer care to children. <\/p>\n

Even with those limitations, there\u2019s recently been great improvements in access to effective cancer treatments in low- and middle-income countries, Dr. Agulnik said.<\/p>\n

\u201cBut there hasn\u2019t been a concordant focus on supportive care<\/a>,\u201d which includes intensive care facilities, tools for pain management, and measures for preventing infections, she pointed out.<\/p>\n

\u201cIf you don\u2019t have all of those things\u2014not only the equipment, but also the processes and the protocols and the practices of how to use them\u2014you [will] have more complications from treatment,\u201d she said. <\/p>\n

A recent study found that there hasn\u2019t been any change in cancer treatment\u2013related deaths in low-income and lower middle-income countries <\/a>over the past 30 years. <\/p>\n

Bringing research advances to the real world<\/h2>\n

Dr. Agulnik\u2014a specialist in pediatric critical care\u2014cares for children in critical condition, often in the pediatric intensive care unit (ICU). Among all her patients, children with cancer are typically the sickest and require the most medical attention, she said. <\/p>\n

As a young doctor, she often thought about children with cancer in hospitals that have far fewer resources than St. Jude. She wanted to do better for those patients.<\/p>\n

When it comes to preventing cancer treatment\u2013related deaths, the problem isn\u2019t a lack of affordable, effective strategies, Dr. Agulnik explained. Early warning systems are a low-cost, proven way to avoid these deaths. <\/p>\n

Rather, the problem lies in taking proven tools like early warning systems and working them into routine medical practice, she said. The branch of research focused on getting effective treatments and tools into routine health care is called implementation science.<\/p>\n

It typically takes years for a new research advance to reach patients, noted Dr. McKay. As an implementation scientist, Dr. McKay helps researchers get their innovations out of the lab and into routine medical practice. <\/p>\n

\u201cWe start with scientific information \u2026 then we actually have to get it integrated and then we have to maintain it,\u201d Dr. McKay said. \u201cThere are problems at absolutely every point in this [pipeline] that leads to innovations not being used.\u201d <\/p>\n

Many new treatments or tools are proven effective in clinical studies \u201cand then nothing else happens. Bringing it to the real world is really where the challenge is,\u201d Dr. Ricciardone agreed. <\/p>\n

That\u2019s often because implementation is an afterthought of the research process, Dr. McKay said. And even less thought is given to the long-term use of new treatments or tools, she added.<\/p>\n

But researchers at Washington University and St. Jude have been considering these aspects from the beginning of Proyecto EVAT, as well as for many other cancer research advances.  <\/p>\n

A pediatric early warning system<\/h2>\n

Pediatric early warning systems consist of two relatively simple steps. <\/p>\n

First, a nurse does a physical exam and takes the child\u2019s vital signs and uses a score chart to calculate a score for the child\u2019s condition. The nurse then uses an algorithm to determine what level of care the child needs. The scores are also tied to a color system that makes it easy to communicate to other staff members.<\/p>\n

For instance, if the score is low (green), the child continues to receive routine care. But if the score is high (yellow or red), the child gets an intensive care consultation.<\/p>\n

For Proyecto EVAT, the team took a pediatric early warning system that was originally developed by Boston Children’s Hospital and translated it into Spanish. They then adapted the tool to fit the procedures of each hospital it was implemented in.<\/p>\n

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A PEWS score chart used to assess the condition of a child being treated for cancer. <\/p>\n

Credit: Dr. Adolfo Cardenas-Aguirre, St. Jude<\/p>\n<\/p><\/div>\n<\/figcaption><\/figure>\n<\/div>\n

With PEWS, \u201cwe do a thorough job to see every detail of the patient in [their] neurological, cardiac, respiratory status,\u201d said Patty Mej\u00eda, a nurse at a hospital in El Salvador. \u201cWe even take the parent\u2019s worry and the nurse\u2019s concern [into account], which we didn\u2019t do before.\u201d<\/p>\n

PEWS \u201cis a communication tool that, in the end, allows us as nurses to communicate to the doctor how the patient is,\u201d said Nidia Romero, a nurse at a hospital in Guatemala.<\/p>\n

Before PEWS was implemented, a nurse could tell a doctor that a child\u2019s condition didn\u2019t look good.<\/p>\n

But now, the nurse can say that a patient\u2019s PEWS is red, and the doctor will immediately know what that means, explained Silvana Espinoza, a nurse supervisor at a hospital in M\u00e9xico. <\/p>\n

Bringing PEWS to Latin America<\/h2>\n

In Guatemala, a children\u2019s oncology hospital called Unidad Nacional de Oncolog\u00eda Pedi\u00e1trica provides care to more than half of all children with cancer in the country. Prior to 2013, the hospital didn\u2019t have a protocol for managing children with cancer whose condition was worsening. <\/p>\n

But the staff were very motivated to change that, Dr. Agulnik said. In 2013, she and others joined forces with the hospital to implement PEWS. After the tool was implemented, there were fewer unplanned transfers of children with cancer to the pediatric ICU<\/a>. <\/p>\n

PEWS \u201cis a very useful tool that has facilitated the detection of the deterioration of our patients,\u201d said Gladys Aceituno, chief nurse at the children\u2019s oncology hospital in Guatemala. <\/p>\n

With the success of PEWS in Guatemala, Dr. Agulnik and her colleagues began expanding their efforts to other countries. They have since supported PEWS implementation in nearly 100 hospitals in 20 countries. Altogether, more than 16,000 nurses and physicians have been trained to use the tool.<\/p>\n

The effort has been a resounding success. The early warning system has helped hospital staff identify critical illness earlier and provide appropriate care for those patients in a timely way. <\/p>\n

As a result, deaths among young cancer patients in critical condition dropped from 39% to 29%<\/a>. The researchers estimated that PEWS use throughout the study period at all centers could have averted about 80 deaths.<\/p>\n

What\u2019s more, hospitals that previously had the highest rates of treatment-related deaths saw the greatest reduction of deaths among patients in critical condition after implementing PEWS. <\/p>\n

\u201cThis work is an example of how implementation science can\u2014and, we think, should\u2014be used to reduce global disparities in childhood cancer outcomes,\u201d Dr. Agulnik said.<\/p>\n

PEWS has also led to other benefits for the hospitals and the patients and families they serve<\/a>. It has improved communication between families and medical teams, boosted the confidence of medical providers, and resulted in cost savings for many hospitals.<\/p>\n

For many staff members, talking about the impact of Proyecto EVAT is emotional. In several hospitals, the work is dedicated to the memory of \u201ca patient who deteriorated when we didn\u2019t have PEWS, and we didn\u2019t do what we had to do,\u201d said Ang\u00e9lica Mart\u00ednez, a doctor and PEWS team leader at a hospital in M\u00e9xico.<\/p>\n

Sustaining PEWS long-term<\/h2>\n

Since implementing PEWS, some hospitals have used it consistently while others have struggled to maintain it, and still others have abandoned it altogether, Dr. McKay said. Through the new NCI-funded project, called INSPIRE, the researchers are starting to uncover why.<\/p>\n

In a recent study, they interviewed more than 70 doctors, nurses, and administrators who helped implement PEWS at their respective hospitals. Through these interviews, the researchers learned that things like having supportive hospital leadership helped sustain PEWS<\/a>. But ongoing challenges included the need for continuous training due to high staff turnover. <\/p>\n

The COVID-19 pandemic also required some hospitals to direct nearly all their efforts on pandemic-related measures, forcing some to move PEWS to the sidelines<\/a>.<\/p>\n

The INSPIRE team is now taking a more quantitative and empirical approach to identifying factors that sustain PEWS in hospitals in Latin America. The project is also an opportunity to develop strategies to improve hospitals\u2019 ability to sustain PEWS.<\/p>\n

\u201cTo my knowledge, [the INSPIRE project] is the first of its kind,\u201d Dr. McKay said, moving sustainability research from theory to actual assessment. <\/p>\n

Dr. Ricciardone agreed, saying there are no other NCI-funded projects like INSPIRE. \u201cThis is unique,\u201d she said.<\/p>\n

Implementation scientists have \u201cdone a lot of work to understand how to make people aware of evidence-based interventions, how to entice them to adopt them, [and] how to get them up and running,\u201d Dr. McKay said. But there\u2019s been much less research on what promotes and prevents sustained use of effective programs and tools, she added. <\/p>\n

Dr. McKay and her colleagues have long called attention to the large gaps in knowledge about sustainability of health programs and tools<\/a>. They have also worked to define what sustainability is and ways to measure whether a program or tool is sustainable<\/a>. <\/p>\n

Given the general lack of information about sustainability, lessons learned about PEWS could potentially contribute to the success of other cancer programs and interventions, Dr. Ricciardone noted. <\/p>\n

\u201cWhat’s exciting for me is that I do believe that [this work] will have real-world impact for years down the line,\u201d Dr. McKay said. \u201cAnd for me, that is wildly rewarding.\u201d <\/p>\n

Source<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

February 15, 2024, by Nadia Jaber Advances in the treatment of childhood cancer have led to remarkable progress. In high-income countries like the United States, more than 80% of children with cancer survive their disease.  In stark contrast, however, only 20% of children with cancer in lower-income countries survive their disease. Close to one-third of […]<\/p>\n","protected":false},"author":2,"featured_media":46518,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-46517","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/46517","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=46517"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/46517\/revisions"}],"predecessor-version":[{"id":47122,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/46517\/revisions\/47122"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media\/46518"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=46517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=46517"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=46517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}