Abstract A85: Challenges in developing pediatric cancer care in Southern Vietnam
Authors: Assanasen Chatchawin , Rebel Vivienne , Tomlinson Gail 
Published: October 2015

Worldwide, cancer has superseded infection and heart disease as the leading cause of death. Generally viewed as a lesser public health priority in lower to middle income countries (LMIC), 60% of the children worldwide have limited access to effective cancer diagnosis, therapy and supportive care measures. As a result, relapse and treatment related toxicities with fatal outcomes contribute significantly to decreased survival rates compared to developed countries. Survival rates as low as 5% have been previously been reported in Vietnam. These reports utilized surveys based on face-to-face interviews that extrapolated incidence rates and survival data.

Below the 17th parallel the region of southern Vietnam remains isolated with limited access to modern research collaborations and methodologies. Currently, Ho Chi Minh City provides the region's primary pediatric oncology clinical setting. Three hospitals, Blood and Transfusion Hospital, Children's Hospital #2, and Oncology Hospital provide care for the surrounding population of 40 million.

Recognizing that the definitions of underserved populations have blurred in relation to global communities, the University of Texas Health Science Center at San Antonio (UTHSCSA) and the Kids with Cancer Foundation of Vietnam have collaborated to evaluate clinical and educational challenges to improving healthcare delivery in Vietnam. Faculty from UTHSCSA have travelled to southern Vietnam on multiple occasions to interact and help identify gaps in care and academic based infrastructure. Interviews with local hospital administrators, medical school educators, physicians, and nursing staff were undertaken. Local institutional data were also reviewed. Observerships in the United States for Vietnamese pediatric oncologists were also established focusing on establishing on-going mentorship, clinical education, and the development a regional leukemia treatment protocol.

Demographics and clinical data were collected at Oncology Hospital in Ho Chi Minh City, Vietnam for pediatric cancer patients diagnosed from 2003 through 2012. 4534 pediatric oncology cases were identified. The breakdown of cases by classification were similar to USA statistics with the exception of brain tumors, which represented only 5% of cases. Survival statistics were analyzed for certain disease groups. Acute lymphoblastic leukemia (ALL) cases had a 66.2% 5 yr OS. Hodgkin Lymphoma cases had a 92% 5 yr OS. NHL cases had a 41% OS. Rhabdomyosarcoma cases had a 50% 5 yr OS. Wilms Tumor analysis noted 78.67% 5 yr OS. Hepatoblastoma analysis revealed 42.8% 2 yr OS and Osteosarcoma analysis revealed 13.58% 5 yr OS. While these survival rates were better than the previously reported 5% for the region, they are still below survival rates in Western developed countries.

The pronounced successes in pediatric cancer survival have been well documented and owe a significant debt to the advent of cooperative groups and a focus on basic research. Specific barriers identified in southern Vietnam included: the lack of a cooperative group structure to provide common treatment regimens amongst institutions, the lack of a central cancer registry, the lack of knowledge of genetic variance and tumor phenoptypes in the population, limited basic science infrastructure and training, the underutilization of reference laboratories, and the inability to ship specimens outside of the country. Political pressure represents a strong influencing factor in how such data is utilized. Importantly, although there are a growing number of young and clearly highly capable physicians interested in pediatric cancer, there are no formal training programs specifically focused on childhood cancer.

Citation Format: Chatchawin Assanasen, Vivienne Rebel, Gail Tomlinson. Challenges in developing pediatric cancer care in Southern Vietnam. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A85.