Multidisciplinary Subspecialty Capacity Building for Global Pediatric Oncology

PURPOSE Specialized multidisciplinary care is central to childhood cancer control. Expertise and infrastructure in the pediatric disciplines of hematology, surgery, critical care, nursing, and pathology are as critical as pediatric oncology. Survival of the majority of children with cancer globally remains dismal because of the scarcity of multidisciplinary pediatric subspecialty services. We present the innovative approach and impact of Texas Children’s Global HOPE initiatives to cost-effectively develop capacity for specialized multidisciplinary cancer care for children in sub-Sahara Africa (SSA). METHODS Global HOPE designed and supports subspecialty training and contingent infrastructure building in SSA in the following disciplines that are critical to pediatric cancer care: pediatric hematology and oncology (PHO), pediatric surgery, pediatric critical care, anatomic and molecular pathology, and pediatric oncology nursing. Key principles underlying the design of each disciplinary program are that it enables the implementation of current best evidence-based practices, primarily uses a problem-based learning approach, and is integrated and accredited by the local health sciences university. Training primarily occurs at an African hub where Global HOPE also supports infrastructure for clinical care and research, in addition to onsite faculty and offsite telemedicine support from the headquarters in Houston, TX. RESULTS The PHO and pediatric surgery fellowship programs based at Makerere University, Kampala, are the most advanced thus far. Twenty pediatricians from 6 African countries have enrolled and 8 have graduated from the 2-year PHO program. One surgeon enrolled in the 3-year pediatric surgery fellowship annually and 6 have graduated since inception. The fellowship programs have directly affected patient outcomes because of evidence-based clinical rigor and enhanced clinical infrastructure. All graduates from the 2 fellowships are currently practicing in SSA. CONCLUSION Formal in situ pediatric subspecialty training is feasible in low- and middle-income countries and carries the critical advantages of infrastructure development, direct patient impact, and is less susceptible to brain drain.