Pediatric Hematology/Oncology in Brazil: where are we at?

Francianne Andrade, PhD is a SIOP Young Investigator and an active member of the Blog committee. She was able to have a very interesting conversation with Dr. Suzuki who works as a pediatric oncologist in Rio de Janeiro. See below for their Q&A! 

Can you tell us a bit more about you Arissa? Where do you work? 

My name is Arissa Ikeda Suzuki. I completed my training in Pediatric Oncology at the Brazilian National Cancer Institute in Rio de Janeiro (INCA) in 2004. I got Master’s degree in 2007 in which I studied Neuroblastoma biology. Now, I'm studying for doctorate degree and my research is in rhabdomyosarcoma biology and prognostic factors. Since 2007, I am medical assistant of the Pediatric Oncology Department at INCA. My main interest in on pediatric solid tumors. INCA is a branch of the Ministry of Health for the development and coordination of integrated actions for cancer prevention and control in Brazil. 

What is your clinical practice like? 

INCA is a referral center for Pediatric Oncology and annually 180 new pediatric patients with solid tumors are admitted. The practice in pediatric oncology is multidisciplinary and focused on patient care. The main objective of treatment is to cure patients with less sequelae. Over the years, we have seen refinement of treatments with incorporation of biology in risk stratification of the patients. Since our country is an upper middle income country, we still have to deal with socioeconomic difficulties of the patients besides treatment and supportive care. Unfortunately we still receive patients with advanced disease, although we participate in many educational projects on early detection of childhood cancer for the primary care professionals. Abandonment of treatment is low in our institution due to an organized program to prevent it. All over the years there have been great breakthroughs in radiotherapy, interventional radiology and molecular biology, for example, besides the appearance of new subspecialities like palliative care and late effects which have shown improvements in Pediatric Oncology treatments and have offered better quality of life to patients.

How long does it take for a patient to get a diagnosis and initiate the treatment? 

Please summarize your experience. We receive patients diagnosed with cancer or with a strong suspicion of cancer. When the patient arrives at our institution, every effort is made to make a correct diagnosis, staging and start treatment as soon as possible. In our center, it takes patients 2-3 weeks to initiate the treatment. We have some difficulties to scheduling imaging studies, biopsy with anesthesia and surgeries, and also there is a time requirement for laboratory diagnosis. 

How much does the treatment cost for the patient’s family? 

At INCA medical and hospital care is provided directly and completely free of charge to cancer patients, within the country's Unified Health System, known as SUS. Also patients have support from ONG with transport, food basket and shelter. 

Do you have data on the survival/prognosis of the patients? If not, according to your personal opinion, does it sound like the overall rate is good? 

The overall survival rate is around 65%. There is a survival gap between high income countries and low and middle income countries. We have been working hard to improve the results. 

Are there Brazilian institutions in pediatric hematology/oncology that promote clinical trials, organize annual conferences and certify specialists? 

The Brazilian Society of Pediatric Oncology (SOBOPE) promotes Brazilian cooperative groups in pediatric oncology on many types of childhood cancer, some of which work in partnership with international groups. Many pediatric institutions in the country participate in these clinical studies. At INCA, we have an infrastructure for clinical research in pediatric oncology and we participate in clinical trials national and internationally. SOBOPE organizes and promotes biannual conferences and organize meetings to discuss how to approach new studies. The Brazilian Society of Pediatrics confers the certification in pediatric oncology. 

What are your perspectives for the pediatric hematology/oncology field in Brazil? 

Increase the quality of treatments and the possibility of cure with fewer side effects. Brazil is a country of continental dimensions, there is a need for homogeneous treatment in the various regions of Brazil. Encourage early diagnosis. More access to cancer treatment. Greater participation in cooperative studies, associated with molecular studies and translational research. It is needed more investment, be that public or private, to develop and improve treatment and our knowledge of pediatric tumors.