The Development of Pediatric Oncology in Turkey: Improving Childhood Cancer Survival Rate Through Professional Training and Education Prof. Dr. Tezer Kutluk, MD PhD, FAAP UICC president & Hacettepe University Cancer Institute, Department of Pediatric Oncology, Ankara-Turkey Session code: UICC.4.12 www.worldcancercongress.org
Burden of childhood cancer Each year, more than 180,000 children are newly diagnosed with cancer in the world. The exact number of new cases is not known as the number of children with cancer is not registered in many countries. In Turkey, the expected number of childhood cancer is aroun 2500-300 cases per year
Survival in 2628 children participated in 15 consecutive studies at St. Jude Children s Research Hospital N Engl J Med 354:166 178, 2006)
Trends in 5-Relative Survival Rates
Equity for the cancer care Ribeiro RC, et al. The Lancet Oncology August 2008
Number of Oncology Centers in Turkey Kutluk T, National Cancer Congress, Turkey,2007 Total number of the Centers surveyed 55 Medical Oncology 47 (%85,5) Pediatric Oncology 32 (%58,2) Radiation 34 (%61,8) General Surgery (Surgical Oncology) 41 (%74,5) Pathology 49 (%89,1) Research Labs 23 (%58,2)
Number of Oncologists in Turkey, 2007 Kutluk T, National Cancer Congress, Turkey Prof. Assoc. Assitant Instructor Specialist Fellow Resident Total Prof. Prof. Med. Onc. 65 56 16 1 22 45-205 Ped. Onc. 27 29 6-12 12-86 Rad. Onc. 36 43 30 7 74-112 302 Total 128 128 52 8 108 57 112 593
Specialty programs 1974, Regulation of Medical Specialties Subspecialties not mentioned 1983, Recognition of subspecialties in Medicine Pediatric Oncology was accepted as a seperated subspecialty 1987, Centralized specialty examinations in Medicine, (TUS) 2006, Centralized subspecialty examinations in Medicine (YDUS)
Turkish Pediatric Oncology Group Established in 1997 with 65 members (49 PO, 14 PH, 1 PS, 1 Nurse) President, President Elect (Chairman of the scientific Committee, 5 more members; serve two years) Annual meeting, every two years Studies, Registry, Wilms, Neuroblastoma SIOP, SIOPE members Pediatric Oncology Board examination, through an evaluation committee
Turkish Pediatric Oncology Group 2003, Pediatric Oncology Subspecialty program policies & Pediaric Oncology Board
More about pediatric oncology training Infrastructure Content Minimum requirements Number of faculties, Rotations Duration Follow up Evaluation at the end of the fellowship Verbal & thesis
2009, Regulations of Medical & Dental specialties What is new? Pediatric hematology & oncology combined Some new subspecialties were established A national committee on specialty training was established Content of the trainings for all subspecialties were decided Core training program Expanded training program Trainee report card was developed
Pediatric Hematology & Oncology Training in Turkey Latest regulations Standarts for training centers Curriculum for trainees Rotations Obligations
Pediatric Oncology & Pediatric Hematology Focused training or combined training Pediatr Clin N Am 55 (2008) xiii xiv Coppes MJ, Ware RS The formal separation of pediatric hematology and oncology allows specialists to focus on specific hematologic disorders such as sickle cell disease, transfusion medicine, or clotting disorders, to study their pathophysiology in detail, to establish collaborative research studies to optimize treatment, and to develop novel therapeutic approaches. We believe that a focused approach is required to further develop this exciting field of medicine. Pediatr Clin N Am 55 (2008) xv xvi Increasingly, it has become apparent that clear guidelines are needed to ensure that children cured of their cancer have access to health care services tailored to their unique needs, many of which have only recently been identified.
American Board of Pediatrics, 21 Nisan 2010 Response to Professor Kutluk When to the historical origins in of the pediatric US of combined hematology here in and oncology in nature, largely due combined certification in both areas the and discipline has continued the that 1940's-1960's. way since then. The certification process began in 1974 as a design to be combined in order to be All fellowship training programs are required by From time to time the questionaccredited by the US Accreditation Council for Graduate Medical Education and by our here in the US. In internal medicine, where has come one can up whether the disciplines should be separate as is true of adult training period. Each the conclusion of the discussions train in hematology or oncology or a combination of training for a longer that of those certified in pediatric has been the same for pediatrics, that a is no change. Recent surveys Our most recent discussions on this topic hematology/oncology reconfirmed only a minority practice solely hematology (only about 15%). continues to be debate about whether our that initial training should remain combined although there to the focus of a particular practice profile Maintenance (that is more of Certification programs should begin to be more tailored combination for most). For now we hematology for some, more oncology for some and a training would not be a are not changing directions. It should be noted that many feel that to separate the to I hope survive the above independently. viable direction in that there would be too few interested in pure hematology for the latter James A Stockman answers III MD your questions. If not, please feel free to touch base. for the latter to survive independently. I hope the above answers your questions. If not, please feel free to touch base. James A Stockman III MD
Turkish Pediatric Oncology Group & Turkish Pediatric Hemaotology Association, Pediatric Cancer Registry
Turkish Pediatric Oncology Group (TPOG) & Turkish Pediatric Hematolgy Society (TPHD) Pediatric Tumor Registry, 2002-2008 Tumor Type n % I Leukaemia 3795 31,7 II Lymphomas and Reticuloendothelial Neoplasm 2043 17,0 III CNS and Miscellaneous Intracranial & Intraspinal Neoplasm 1606 13,4 IV Sympathetic Nervous System Tumors 895 7,5 V Retinoblastom 372 3,1 VI Renal Tumors 652 5,4 VII Hepatic Tumors 173 1,4 VIII Malignant Bone Tumors 717 6,0 IX Soft-TIissue Sarcomas 772 6,4 X Germ Cell, Trophoblastic & Other Gonadal Neoplasm 562 4,7 XI Carcinomas and Other Malignant Epithelial Neoplasm 333 2,8 XII Other and Unspecified Malignant Neoplasm 66 0,6 Total 11986 100,0 T.Kutluk & A. Yesilipek, on behalf of TPOG/TPHD
Turkish Pediatric Oncology Group (TPOG) & Turkish Pediatric Hematolgy Society (TPHD) Pediatric Tumor Registry, 2002-2008 %65,2 T.Kutluk & A. Yesilipek, on behalf of TPOG/TPHD
Turkish Pediatric Oncology Group (TPOG) & Turkish Pediatric Hematolgy Society (TPHD) Pediatric Tumor Registry, 2002-2008 Tumor types 7. yr(%) I Leukemia 68,7 II Lymphoma & RES tumors 77,9 III CNS & various intracranial/intraspinal 47,1 IV Symphatetic system tumors 55,6 V Retinoblastoma 72,3 VI Renal tumors 74,1 VII Liver tumors 52,6 VIII Malignant bone tumors 44,7 IX Soft tissue sarcomas 52,4 X Germ cell Trophoblastic & other gonadal tumors 80,8 XI Carcinomas & other epithelial tumors 65,9 XII Other unspecified malignant tumors 43,3 T.Kutluk & A. Yesilipek, on behalf of TPOG/TPHD All types 65,2
Future of the Pediatric Oncology programs Standards of Pediatric Oncology Centers Training programs, combined vs focused Program evaluation & monitoring Reducing the inequities