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12-12-2011 | General practice | Article

Physician ‘twinning’ program helps Rwandan children with lymphoma


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MedWire News: A first-of-its kind "twinning" strategy between US and Rwandan physicians is an effective way of improving outcomes for children with lymphoma in a country with few cancer specialists, say researchers.

"We show that we can safely deliver care using this model - an American-trained pediatrician supervising a Rwandan-trained generalist - who are together supervised through phone calls from a US-based pediatric oncologist," explained Leslie Lehmann (Children's Hospital Boston, Massachusetts, USA) who presented the research at the American Society of Hematology Annual Meeting in San Diego, California, USA.

In the developed world, lymphoma is largely a curable disease, as 80% of children with the condition are treated successfully. However, successful treatment depends on expert diagnosis and administration of chemotherapy, and experienced follow-up care, processes which simply are not available in many developing countries.

Approximately 5 years ago a twinning program was set up between a hospital in Rwinkwavu, Rwanda and the Dana-Farber cancer center and children's hospital in Boston, Massachusetts, USA with the support of the Partners in Health project.

Since the setting up of the program, which allows general physicians in Rwanda to ask for the help and advice of pediatric cancer specialists in the US, 10 children have been accurately diagnosed and treated for lymphoma.

The children were aged 9.5 years on average and were diagnosed with Hodgkin's lymphoma (HL; n=4), HIV-associated large cell lymphoma (HIVLCL; n=3), and Burkitt's lymphoma (BL; n=3).

Of the children, five (2 HL, 2 HIVLCL, and 1 BL) have been successfully treated and are in remission for their conditions (4 months to 4 years).

Two of the other five (1 HL, 1 HIVLCL) are still being treated, but have gone into remission, and the other three (1 HL, 2 BL) died from complications while being treated.

Lymphoma is a common oncologic condition in children in the developing world, said Lehmann. She emphasized the urgency of the need for specialized care in countries such as Rwanda, a country of 11 million people with no trained pediatric oncologists.

"This is the beginning of a new model," commented Lehmann. "In the past, doctors weren't comfortable having complicated oncology care delivered without a local oncology specialist available. Having a specialist on-site would be ideal - but as global health moves into oncology, there are not enough oncologists to provide that kind of care so alternative approaches must be developed and carefully assessed."

By Helen Albert

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