An article in the January 2007 issue of the Pediatric Blood & Cancer examines the use of videoconferencing between industrialized and developing countries as a way of improving patient care. The journal is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/pbc.
Pediatric oncology has seen vast improvements in survival rates in industrialized countries over the last several decades, but developing nations are still lagging behind, despite the fact that up to 85 percent of childhood malignancies occur in these countries. Obstacles to advances in the development of pediatric oncology programs include poverty, malnutrition, lack of education, and compliance. Additional factors are a shortage of pediatric oncologist specialists, a lack of cross communication between different disciplines, which leads to delayed and improper referrals, and the tendency to seek multiple second opinions due to a distrust of the quality of available medical care.
Efforts to improve medical care in developing countries include twinning programs that involve the exchange of personnel between participating institutions, a practice that is time consuming and expensive. Telemedicine, another way of communicating and distributing information, is already being used in industrialized countries for educational purposes, second opinions and quality assurance in a number of fields, but there are few reports of its impact in developing countries.
Led by Ibrahim Qaddoumi of the King Hussein Cancer Center in Amman, Jordan, and Eric Bouffet of the Hospital for Sick Children in Toronto, Canada, a systematic twinning program was established for children with brain tumors. This twining program included videoconferencing as an essential component, where a 20 videoconference sessions were conducted between the two hospitals between December 2004 and May 2006 to discuss 64 patients, some of them several times. For 23 patients, clinical care recommendations resulting from the conferences differed significantly from the original plan and were mostly followed. The most common recommendation involved a change in the initial diagnosis or grading of the tumor which resulted in significant treatment changes. Other recommendations included second look surgery or involved different diagnostic or treatment issues.
Up to six cases were discussed in each conference, which covered the majority of the cases seen at King Hussein Cancer Center each year. The impact on patient care and the neurooncology service was positive, as was the impact on patient compliance and trust from families. "The discussion and subsequent opinion obtained via the videoconference was perceived by patients and families as a formal second opinion and deepened their trust in the treating team and enhanced their compliance rate," the authors state. The videoconferencing also helped introduce new concepts into Jordan, such as the role of second surgery, alternatives to radiation therapy for certain tumors, the evolution of radiation therapy techniques, and the benefit of external pathology review for cases where the diagnosis is difficult. The authors note that pediatric oncology twinning initiatives should be multidisciplinary and should include neurosurgeons, radiation oncologists, pathologists and neuroradiologists. They conclude: "We hope that telemedicine, as an innovative tool, will disseminate in different fields of pediatric oncology, and contribute to reduce the gap between wealthy countries and those with limited resources."
Article: Impact of Telemedicine on Pediatric Neurooncology in a Developing Country: The Jordanian-Canadian Experience," Ibrahim Qaddoumi, Asem Mansour, Awni Musharbash, James Drake, Maisa Swaidan, Tarik Tihan, Eric Bouffet," Pediatric Blood & Cancer; January 2007; (DOI: 10.1002/pbc.21085).
Journal
Pediatric Blood & Cancer