First Global Congress on Conflict Medicine

Transcription

1 First Global Congress on Conflict Medicine Cancer in Refugees Management of Syrian Pediatric Cancer Patients at the Children Cancer Center of Lebanon / AUBMC Children s Cancer Center of Lebanon (CCCL) Affiliated with St. Jude Children s Research Hospital (SJCRH) American University of Beirut Medical Center (AUBMC) May 14, 2017 Issam Fares Hall AUBMC

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3 Worldwide Childhood Cancer According to IARC (2015), the reported worldwide incidence of childhood cancer: 215,000 new cases are diagnosed annually in children 14 years and younger 85,000 new cases for years age group (Other cases remain unreported due to a lack of childhood cancer registries in a large number of countries). Source: The International Incidence of Childhood Cancer (IICC) International Agency for Research on Cancer (IARC) International Association of Cancer Registries (IACR)

4 Estimated Worldwide Incidence of Childhood Cancer in 2012 (Age 0-14 years old)- by Diagnosis All cancers excl.non-melanoma skin cancer Africa Asia Europe North America South America Oceania Leukemia Lymphoma Brain, Nervous system Solid Tumor Others Source: GLOBOCAN report of 2012; International Agency for Research on Cancer (IARC):

5 Worldwide Childhood Cancer Estimated Survival Rates: High-income countries: an average of 84%; steadily improving even in less-resourced areas of the world where there is local and international support. Low- and middle-income countries:??? Source: The International Incidence of Childhood Cancer (IICC) International Agency for Research on Cancer (IARC) International Association of Cancer Registries (IACR)

6 Estimated Worldwide Numbers of Cancer Cases and Deaths (thousands) in Age 0-14 years old Source: International Agency for Research on Cancer (IARC)

7 Estimated Cost of Treatment at CCCL Average Estimated Treatment Cost: Leukemia: USD 75,000 Lymphoma: USD 50,000 Solid Tumor: USD 50,000 Brain Tumor: USD 25,000 50,000 Bone Tumor: USD 100,000 Retinoblastoma: USD 50,000 Stem Cell Transplant= USD 85,000 (Allo) USD 45,000 (Auto)

8 Demographics-Lebanon Country Population: Unit Population Size *1000 citizens 3,962 4,036 4,104 4,168 Source: Lebanese Ministry of Public Health (MOPH), ( data available till 2013

9 Growth Domestic Product (GDP) of year 2012 GDP (2012) GDP (2012 preliminary figures, MOF) THE % GDP Public (%) Private (%) Households (Out Of Pocket and contributions) 64,800,000,000 (Amounts in 000 LL) OOP Contributions Employers (contributions) Donors (%) 0.47 Source: National Health Accounts (NHA 2012)-Lebanese Ministry of Public Health (MOPH), ( report of 2012.

10 Hospitals that treat Pediatric Oncology Patients across Lebanon Notre Dame de Secours- Maounat Middle East Institute of Health (MEIH) Nini Hospital Centre Hospitalier Du Nord (CHN) Mazloum American University of Beirut-Medical Center (AUBMC) Lebanese American University Medical Center-Rizk Hospital St. George University Medical Center Rafik Hariri University Hospital (RHUH) Bahman Zahraa Hotel Dieu Geitaoui Makassed Rasoul Al Azam St. Georges Hospital - Hadath Hammoud Al Raii

11 Oncology Diagnosis subtypes National Cancer Registry-Lebanese Ministry of Public Health (MOPH)- Annually by Diagnosis Others Retinoblastoma Bone Tumor Solid Tumor Brain Tumor Lymphoma Leukemia

12 Registered Syrian Refugees in Lebanon Reference:

13 Distribution of Syrian Refugees in Lebanon

14 Facts & Figures (Source: UNHCR, UNRWA) Number of registered Syrian refugees in Lebanon: million Number of Palestine refugees from Syria: Number of Palestine refugees: Number of Iraqi refugees: Unofficial estimate of number of Syrian refugees in Lebanon in 2016 exceeds 1.5 million (Reference: Marco Funk and Roderick Parkes (2016)

15 Established Programs and Collaborations Support Programs: - Medical Programs (SJCRH) - Humanitarian Funds I and II for Displaced patients from the Region (SJCRH) - Kuwaiti Fund for Syrian Refugees

16 Number of New Patients Accepted Annually

17 Humanitarian Fund I

18 Humanitarian Fund I USD 2,000,000 to support displaced children from the region Type of Service Number of Expected non-lebanese patients to be covered Average Cost per Patient (Range $40,000-$80,000) Total Expected Funds Needed Outpatient Services/Consultations and Second Opinion 100 $1,200 $120,000 Surgeries 20 $10,000 $200,000 Full treatment of Newly diagnosed Cases 32 $50,000 $1,600,000 One FTE Clinical Associate (Pediatrician) 1 $60-80,000 $80,000 TOTAL $2,000,000

19 Humanitarian Fund I Total: 69 Patients Full Treatment: 27 patients Consultations Only: 31 patients Surgical Procedures Only: 10 patients Induction Only: 1 patient

20 Humanitarian Fund I Summary on Patients Enrollment Type, Total: Full Treatment Consultation/Diagnostic Tests Surgery Only/Radiation Only 1 Induction

21 Humanitarian Fund II

22 Humanitarian Fund II Table 1: Budget (Fiscal Year Jul-Jun) FY15 FY16 FY17 FY18 FY19 FY20 Total Apr - Jun 15 Jul15-jun16 jul16-jun17 jul17-jun18 jul18-jun19 jul19-jun20 $ - $ 1,119,615 $ 1,925,860 $ 440,448 $ 75,385 $ 23,692 $ 3,580,000 Leukemias Lymphomas Bone Wilms Glioma Medulloblastoma Sarcoma Rare Cancer Total Estimated Total Cost per Patient Number of Enrolled Patients 75,000 40, ,000 20,000 25,000 60,000 50,000 50, Total Budget 900, , , , , , , ,000 3,585,000

23 Humanitarian Fund II (March 2015 till date) Total: 48 Fully Enrolled Patients By Fiscal Year Leukemia Lymphoma Bone Wilms Glioma Medulloblast oma Sarcoma Rare Cancer Other Total Enrolled Patients in 2014/5 (Oct 14 Sep 15) Enrolled Patients in 2015/6 (Oct 15 Sep16) Enrolled Patients in 2016/7 (Oct 16 Sep17) Total

24 Humanitarian Fund II Enrollment of patients started in March patients were enrolled: (37 Syrians, 11 Palestinians) 17 patients in (Oct-Sep) 26 patients in (Oct-Sep) 5 patient in (Oct-Sep)

25 Humanitarian Fund II Distribution of Enrolled Patients by Diagnosis Group

26 Kuwaiti Fund

27 Kuwaiti Fund 2016 $1,000,000 for Syrian Patients: December 2016 December 2018 Enrollment from December 2016 till May 2017: 9 Patients / not fully enrolled Payments: 5 installments (each 4 months) Leukemia Sarcomas Lymphomas Wilm's Tumor

28 Challenges in Lebanon and the Region Unstable political, security and economic situation Access to care (including diagnosis, treatment and follow-up care) Increase in cost of health care for cancer patients Availability and high cost of specific medications and treatment modalities

29 Challenges in Lebanon and the Region Awareness and accurate diagnosis/appropriate treatment (patients, primary care providers, specialists) Increase in the number and complexity of co-morbidities Establishment of common national/regional treatment plans/protocols and centralized provision of specialized tests/procedures/treatment Outpatient vs Inpatient treatment/management Long-term complications and follow-up

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