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CHICAGO -- A cancer treatment collaboration between hospitals on the California/Mexico border aimed at improving survival by sharing knowledge, expertise, and resources among children with acute lymphoblastic leukemia (ALL) proved successful.

At Hospital General-Tijuana in Mexico, the 5-year overall survival (OS) rate rose from 59% among the 49 children treated before initiation of the program (2008-2012) to 65% among the 60 children treated in the post-implementation period (2013-2017), reported Paula Aristizabal, MD, MAS, of Rady Children's Hospital-San Diego, during a press briefing ahead of the American Society of Clinical Oncology (ASCO) annual meeting.

Of note, the 5-year OS rate increased from 48% to 55% for patients with high-risk disease, and from 73% to 100% for standard-risk patients.

The increased survival rate among average-risk patients "is really remarkable because that survival is the same as we have in San Diego," Aristizabal said.

Julie Gralow, MD, ASCO's chief medical officer, who moderated the press briefing, said that considering the close proximity between Rady Children's Hospital and Hospital General-Tijuana, the dramatic improvement in survival at the Mexican hospital -- particularly among standard-risk patients -- demonstrated the disparities that can exist across borders.

"As I've heard Princess Dina Mired from Jordan say many times, your zip code should not determine if you survive cancer," Gralow added. "And this is an example of children being so close in proximity and not having the same advantages."

From the pre-implementation period to the post-implementation period, mechanical ventilation days also decreased from 45 to 19 per 1,000-inpatient days, average antibiotic indication time decreased from 67.5 to 35 minutes, and sepsis rates decreased from 30% to 5%. Pediatric blood products transfusion guideline adherence increased from 39% to 80%.

A 'Twinning' Model

In 2008, Hospital General-Tijuana had no dedicated pediatric oncology or intensive care unit, nor any pediatric oncologists or nurses. Treatment options for children with cancer were limited, as was diagnostic equipment and access to medications.

Starting in 2013, the hospital began recruiting pediatric oncologists and pediatricians, while upgrading equipment for the pathology and hematology labs, and building the nursing workforce. At this time, the two hospitals launched their cross-border initiative, in what Aristizabal called a "twinning" approach.

As she explained it, this model involves a center of excellence in a high-income country that collaborates with and mentors a center in a low-middle-income country.

The goal of twinning, she said, is to improve survival for children with cancer through:

• Sharing of knowledge, technology, and organizational skills
• Consultation, education, and research
• Implementation of the World Health Organization (WHO) framework for supporting and strengthening a health system with strategies and activities designed to sustainably improve health systems' performance in access, coverage, quality, and efficiency

According to Aristizabal and her colleagues, changes in delivery of care, staffing, access to essential medicines, information systems, funding, and leadership and governance -- the domains covered by the WHO Framework for Action -- helped improve Hospital General-Tijuana's care delivery system and the outcomes for pediatric patients with ALL.

The Mexican hospital also partnered with a local grassroots foundation, Patronato, to provide psychosocial and nutritional support, lodging for patients' families, and food subsidies in an effort to address issues of financial toxicity and food insecurity.

Among the 109 children, mean age was 7 years, and 50.4% were girls. High-risk patients made up 67% of the group.

Aristizabal said the plan is for the two hospitals to collaborate permanently.

"This is not a marriage that can be dissolved," she said. "We consider our neighbors in Baja to be partners for life and will continue to provide mentorship and support from our center." A main objective of the initiative is to continue improving survival for high-risk ALL patients, "as that is an area that still needs a lot of work."

Aristizabal also noted that efforts at cross-border collaboration include treatment of children with solid tumors. The Cross-Border Neuro-Oncology Program between Rady Children's Hospital and Hospital General-Tijuana provides access to neuro-oncology care, including neurosurgical services, for children with central nervous system tumors, which was shown to .

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