OBR OncologyCross-border ‘Twinning Programs’ May Reduce Survival Disparities for Childhood Leukemia

Bridging the Gap: Twinning Programs Improve Pediatric Cancer Survival Rates Across Borders

In a world where a few miles can determine the fate of a child with cancer, twinning programs are making a significant difference. These initiatives, which pair hospitals across borders, are helping to bridge the survival gap in pediatric acute leukemia between high-income and lower-income countries.

Key Points:

• Twinning programs, such as the one created in 2008 by Rady Children’s Hospital; the University of California, San Diego; and Hospital General-Tijuana, share resources and expertise to benefit patients in both countries.
• Pediatric acute lymphoblastic leukemia (ALL), the most common childhood cancer, has an 80% survival rate in high-income countries like the US, but survival rates in low-middle income countries can be as low as 10%.
• The twinning program between San Diego and Tijuana addressed not only training but also issues like transportation, housing, and long-term access to medicines, taking a holistic approach to healthcare.
• The survival rate for standard-risk ALL in Tijuana increased from 73% before 2012 to 100% after the program, while survival for high-risk ALL went from 48% to 55%.
• The overall survival rate for all children with ALL in Tijuana increased from 59% to 65% after the program.
• The program also created training opportunities that improved care in Tijuana, despite national trends of improvement making it difficult to isolate the program’s impact.
• Genomic factors may influence survival rates, with research suggesting children of Latino descent tend to have worse outcomes than white children when treated with the same protocols.
• Twinning programs provide opportunities for research into childhood cancers, potentially improving care for all children who carry influential cancer mutations.
• The San Diego-Tijuana twinning program has improved cultural competency in treating Hispanic patients in San Diego, where 50% of patients are Hispanic.