Background and Aims: Late detection is a critical factor related to high childhood cancer mortality in low- and middle-income countries. A previous study in Peru showed that DT (Diagnosis Time), the time interval between the onset of symptoms and the definitive diagnosis, was 107 days. A strategy with multiple interventions has been implemented to reduce DT as part of the Global Initiative for Childhood Cancer. This study analyzes the reduction in the DT of childhood cancer in Peru in the last four years. Methods: Data of children and adolescents registered in the GICC hospital-based registry were retrospectively analyzed. Patients belonged to eleven hospitals nationwide. The association between clinical-demographic variables and DT was investigated. Other intervals analyzed were patient time (PT), medical time (MT), and treatment time (TT). Results: This study included 2,268 patients under the age of 20 registered between 2020 and 2023. The median DT was 26 days (IQR: 9–61), and the mean DT was 57 days (SD: 97.8; range: 0–962). Patients whose parents had lower educational levels, those aged 12 to 20 years, and those diagnosed with solid tumors had significantly longer DT. The median PT (time interval between the onset of symptoms until the first contact with a healthcare professional) was 19.5 days (IQR: 7-44), Early child education and primary educational level of parents was associated with longer PT. The median MT (time interval between the first contact with a healthcare professional and the definitive diagnosis) was 10 days (IQR:2-30). A comparative analysis of the data collected from 2012-2014, and the data collected in this study was made. The Kruskal-Wallis analysis showed a significant reduction in DT, mainly at the expense of MT between both periods (p<0.001), demonstrating the impact of the strategy on the interval that depends on healthcare professionals. The median TT (time interval between the definitive diagnosis of cancer until the start of treatment) was 8 days (IQR:1-19), with no significant reduction over time compared to the 2012–2014 period. Conclusions: Over the past four years, the early detection strategy has proven effective in reducing the DT of childhood cancer in Peru. This strategy should be incorporated into public policies to ensure its sustainability and the continuous improvement of outcomes.

Background: Equitable access to essential pediatric oncology medicines is critical for improving childhood cancer outcomes in Latin America. However, persistent disparities in availability, affordability, and quality of these medicines threaten treatment continuity and survivalThis study aimed to assess the regional landscape of access, availability, and quality of essential pediatric oncology medicines from the perspective of frontline healthcare professionals, and to identify structural barriers and opportunities for system-level improvement. Methods: A cross-sectional survey was conducted among 148 health professionals involved in the care of children and adolescents with cancer across 137 institutions in 19 Latin American countries. Respondents included national focal points for childhood cancer, responsible for supporting the implementation of the WHO CureAll framework at country level, and country delegates from the Latin American Society of Pediatric Oncology (SLAOP), ensuring participation of professionals with recognized leadership and technical expertise. A structured online questionnaire collected data on the availability, access, financing, and quality of essential pediatric oncology medicines, as well as procurement mechanisms and civil society involvement. Key outcome measures were stratified by country income level, geographic subregion, and institution type. Results: While 70% of respondents reported government-financed medicines, barriers such as administrative delays, coverage denial, and out-of-pocket payments remained widespread, especially in Central America and Mexico. Professionals in low- and middle-income countries were 2.9 times more likely to report medicine unavailability (p=0.0008) and 3.5 times more likely to request family purchases (p=0.002). Quality concerns, particularly with asparaginase, were reported by half of respondents. Civil society organizations played a pivotal role in bridging supply gaps and advocating for access, with notable engagement in countries with weaker health coverage. Conclusions: The study highlights structural and geographic inequities in pediatric oncology medicine access and quality across Latin America. Strengthening procurement systems, regulatory oversight, and civil society partnerships is essential. Regional initiatives like GPACCM and CureAll, which promote centralized purchasing and health system strengthening, are critical to ensuring equitable and sustainable access to safe and effective childhood cancer treatment.

The ongoing COVID-19 pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year. Four cross-sectional surveys were electronically distributed among pediatric onco-hematologist in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners. 453 pediatric onco-hematologists from 20 countries responded the first survey with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active on-going patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48, 95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability. Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.

A document by Cecilia Ugaz. Click on the document to view its contents.

Background The diagnostic delay in children and adolescents with cancer is a public health problem in Peru leading to high rates of advanced disease and mortality. We aimed to evaluate the implementation and utility of ONCOpeds, a mobile application that provides consultations, in reducing the latency to diagnosis (LD) and referral time (RT) in children and adolescents diagnosed with cancer in Peru. Material and methods A multicenter pilot study was conducted in the region of Callao between November 2017 and April 2018. Attending primary care physicians were trained in the use of ONCOpeds in 5 educational sessions. Patients younger than 18 years living in Callao and diagnosed with cancer from all the pediatric cancer units were analyzed in two groups: referred by the mobile application or by the conventional referral. Results ONCOpeds was successfully installed in the smartphone devices of 78 attending physicians of Callao. During this period, 23 new cases of cancer in children and adolescents from Callao were collected. Ten patients were referred through the application and 13 in a conventional manner. The LD and RT were reduced in the group referred by ONCOpeds by 66% and 68%, respectively; however, only the RT reached statistical significance (p = 0.02). Conclusions The implementation of the use of ONCOpeds was feasible in this pilot study, having a potential utility in improving the diagnosis and referral in children and adolescents with suspected cancer. A larger study at the national level is required to demonstrate the effectiveness of this telemedicine tool.

A document by Jacqueline Montoya. Click on the document to view its contents.