In the realms of future: new frontiers of ‘techno-oncology’ as a platform for global improvement in the outcomes of childhood cancer

Abstract

The survival outcome of childhood cancers in developing nations has failed to keep pace with that of developed nations. Technological advances offer a unique and radical opportunity to develop programs and strategies to improve outcomes of childhood cancer globally. The novel field of ‘techno-oncology’ has a broad scope and the potential to phenomenally impact, revamp and model the care of pediatric cancer patients in the developing world. Many frontiers and opportunities in the area remain to be explored as well as many challenges to be surmounted.

Keywords:

• abandonment
• developing nation
• financial
• global
• survival outcome
• techno-oncology

Despite ongoing efforts and improvements, survival outcome of childhood cancers in developing nations remains significantly inferior to the cure rates in developed nations [1,2]. Several factors including higher rates of mortality, relapse, abandonment of therapy and socioeconomic factors have been deemed contributory [3–5]. Traditionally, the efforts were directed toward directly transplanting aggressive protocols from developed nations to developing nations in desperate attempts to improve survival [6]. However, recently, efforts in the endeavor to improve the cancer outcomes in developing nations have diversified. Remarkable success has been achieved by twinning programs, partner sites in high-income countries (HIC), shared care and training of local personnel and health care workers to build expertise in pediatric oncology [7–9]. Clearly, a holistic and multimodal approach addressing a multitude of issues, including high rates of therapy abandonment, relapse and mortality in developing nations; complex financial and socioeconomic factors in developing nations; social and cultural factors influencing therapy decisions; local health care system and personnel issues and development of sustainable, adaptable and successful local research and health care system is needed to improve the outcomes of pediatric oncology patients in developing nations.

Moreover, rapid advances in technology have opened new doors into the realms of future [9]. Thus, the novel field of techno-oncology has been conceived. ‘Techno-oncology’ may be defined as the development and use of appropriate technology(ies) (including but not limited to telecommunication, computer hardware and software technology, laboratory technology and medical equipment) to improve survival outcome in oncology. Of the distinct types of technologies, telecommunication is likely to immediately and significantly impact outcome of childhood cancers in developing nations. Clearly, it is now feasible to conduct real-time meetings and conferences spanning multiple time zones across the world [1]. Techno-oncology has allowed us to be able to transplant technological and laboratory advances to the developing world that was once considered to be logistically improbable. Techno-oncology has the potential of being a key tool to improve the outcome of childhood cancer in developing nations.

Rivera et al. have discussed their successful experience with the use of minimal residual disease, an advanced laboratory tool, in the management of acute lymphoblastic leukemia in developing nations [1]. Use of technology can allow for the development and transfer of minimal residual disease laboratory technique across the world. Either the necessary laboratory equipment can be shared or transported or technology can be developed and validated locally in low-middle-income countries (LMICs) with real-time expert support (through telecommunication) from developed nations.

Rivera et al. suggest step-down therapy in low-risk patients in LMICs. This is a major step toward risk stratification in the developing world [1]. The goal in developing nations has been traditionally to intensify therapy, which likely caused increased morbidity and mortality in low-risk patients. The ‘step back approach’ has been largely enabled by techno-oncology. However, the implications, especially long term, on therapy adherence, relapse, mortality and survival outcome remain to be assessed.

One of the important impediments to improvement in the outcomes of childhood cancers in developing nations is therapy abandonment [4]. Only in recent years has therapy abandonment been recognized as one of the single most important contributors to inferior survival outcome. Techno-oncology can assist in developing specific studies and interventions targeted toward reducing abandonment, through novel techniques and appropriate use of technology [10]. Through technology, patient-tracking softwares can be developed and shared with LMIC cancer treatment centers to track patients and families through their cancer therapy. Cell phones can be provided to the patients and families in developing nations to facilitate tracking. Excellent epidemiological data can be collected through appropriate use of advanced database softwares to identify locally relevant problems in developing nations. Thus, techno-oncology may directly assist in reducing or preventing abandonment of therapy.

Despite its positive potential, several challenges remain to surface and be surmounted in the emerging field of techno-oncology. Moreover, its role is still only being explored and is in its infancy. The barriers to progress and success of techno-oncology may be classified as: country level; local issues; health care delivery system issues; and personal and personnel issues. However, several of these barriers are intricately linked to each other.

Access to and availability of modern technology remains limited in several developing nations [11]. Even where access is present, it may be intermittent and limited [12]. Logistic constraints and funding for technology are limiting factors in several LMICs. Several modern and expensive technologies (including, for instance, minimal residual disease technology, cytogenetics, flow cytometry, molecular diagnostics and state-of-the art blood bank) are necessary to improve the outcome of childhood cancers. Currently, acquiring all these technologies remains a significant challenge to many nations across the world. Complex solutions and planning are required to surmount the barriers concerning technology acquisition by developing nations. The availability of sustainable funding to support technical advances remains to be resolved [13]. These country-level issues need to be addressed to further techno-oncology as a key tool to improve the survival outcome of pediatric cancer patients in developing nations.

Communication technology is often locally available, to some degree, and can be relatively inexpensive in several developing nations. Prior to acquisition of more complex and expensive technology, the locally available resources of technology may need to be capitalized upon. Prioritizing the resource acquisition is also a key in achieving the full scope and potential of techno-oncology.

At the level of nations or even continents, the legal and ethical implications of techno-oncology remain to be elucidated [14]. With easy and rapid transmission of information, issues related to patient confidentiality remain to be addressed. It may be difficult to establish clear guidelines in the area.

An important frontier of techno-oncology is developing solutions to locally relevant problems and strengthening local health systems in the developing nations [3]. Such efforts need to be all-inclusive to incorporate infrastructure, personnel, support systems, funding and technology [1–3]. Several successful training and education/fellowship programs for physicians, nurses and ancillary personnel are available through partner sites in HICs. Strengthening of the local health systems with focus on local issues is the key barrier that needs to be surmounted in realizing the potential of techno-oncology in the area. For further developing the field of techno-oncology, focus also needs to be on providing better public access to technology, information and telecommunication. This barrier exists at all levels, including country, local and health care system level.

Furthermore, techno-oncology can allow conduct of local medical and translational research in LMICs. Grassroots level research has the potential of unraveling locally relevant prognostic factors and other parameters of local significance that may be of no relevance in developed nations [3]. Through technology partnership programs, knowledge regarding development of patient databases and study of cancer epidemiology could be shared with developing nations. For instance, patient tracking software programs developed in HICs could be made available to developing nations at nominal costs. The HICs can provide funding to jump-start some of the technologies in developing nations.

At a personal level, technology can aid the development of novel ideas to provide social support systems and education for families facing the burden of a child with cancer. Cancer-treating centers in LMICs need to develop strategies to cater directly to the individual needs of the families facing the burden of a child with cancer [15]. Ongoing family-centered care sympathetic to the local language and culture is quintessential to build trust between the family and the treating team [12,16]. Expanding the local use and scope of techno-oncology is a desirable goal. With the help of twinning and partnership programs, several cancer treatment centers are assessing successful use of patient tracking software programs and cell phones in improving patient compliance and its impact on abandonment [17].

Socioeconomic factors are well known to impact the decisions of the family regarding continuing cancer care [13]. Hence efforts to improve cancer awareness and burst the myths surrounding pediatric cancers in LMICs are of paramount importance. Misdirected faith in alternate systems of medicine, false sense of incurability and such other challenges specifically need to be targeted and addressed [12]. Once again, techno-oncology can aid the development of specific and directed solutions through knowledge translation and awareness.

Financial challenges are a major impediment to development of sustainable cancer treatment centers in LMICs [18]. Due consideration needs to be given to generation of local funding through novel ideas and concepts that tap into local resources [19]. Similarly, partner sites from HICs may have access to granting agencies that support international work in the field of oncology. Such options need to be aggressively evaluated and accessed. Such start-up funds may be vital to jump-start cancer care services in LMICs until such time that locally sustainable funding is generated.

How techno-oncology will adapt to the rapid ongoing progress and evolving science of oncology is currently unknown. Developing a sustainable model for growth and development of pediatric cancer programs is a relevant goal for techno-oncology. In fact, the ultimate long-term goal of transfer of technology, collaboration and partnerships should be to build self-sustainable pediatric cancer treatment centers in LMICs [7,9]. The foundation building blocks need to be laid with such a vision. Hence, the scope of technology sharing and partnership programs is truly much larger than the immediate impact on survival outcome. The scope encompasses building local capacity, generating novel ideas and tools and generating technology that is usable and adaptable in LMICs.

It must be remembered that the improvement in pediatric cancer outcomes in resource-constrained nations clearly needs a holistic approach [3]. No one solution or strategy could cater to the diverse and complex challenges in pediatric cancer care across all the continents and replace the need of a holistic approach. However, technology is more than likely to play an integral role in the endeavor. It must be remembered that techno-oncology alone cannot replace a holistic approach and solely improve the outcomes of childhood cancer in developing nations.

In summary, techno-oncology has a very broad scope and has enormous potential to positively impact pediatric cancer outcomes in developing nations. The pediatric oncologists need to embrace this potential with open arms and explore the realms of future, with the ultimate aim of developing self-sustainable and successful cancer treatment centers in developing nations.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.