title: Clinical epidemiology of childhood cancer in Central America and Caribbean countries.
abstract: BACKGROUND
  Countries with scarce resources have the right to appropriate essential health care but very few reports discuss how this can be achieved. We assessed the survival of a large cohort of pediatric oncological patients to provide hard data on which to base realistic evaluation and planning schemes.
  
  
  METHODS
  This multicenter retrospective survey covered consecutively diagnosed and treated patients admitted to eight national level hospitals in seven countries in Central America and the Caribbean. The research protocol was discussed extensively, so the data to be collected and the criteria for their evaluation were clearly pre-defined. We analysed 2214 patients diagnosed between 1996 and 1999 with various cancers, classified as hemato-oncological disorders (70%) and solid tumors (30%).
  
  
  RESULTS
  Three-year overall survival was 48.4% [standard error (SE) 1.3]. Detailed analysis of acute lymphoblastic leukemia highlighted the wide intercountry variability: 3-year survival was 62.2% (SE 5.3) in Cuba, 74.2% (SE 3.3) in Costa Rica, 61.7% (SE 4.9) in Nicaragua, and lower in the other four countries.
  
  
  CONCLUSIONS
  The yield of diagnostic-therapeutic protocols depends largely on the context of care in which they are applied. This paper documents the importance of including epidemiological research in interventions for cooperation in complex health areas such as pediatric oncology.
authors.affiliation: Department of Clinical Medicine, Prevention and Biotechnologies, Section of Medical Statistics, University of Milano-Bicocca, Monza, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Valsecchi
authors.forename: G
authors.initials: G
authors.lastname: Tognoni
authors.forename: M
authors.initials: M
authors.lastname: Bonilla
authors.forename: N
authors.initials: N
authors.lastname: Moreno
authors.forename: F
authors.initials: F
authors.lastname: Baez
authors.forename: C
authors.initials: C
authors.lastname: Pacheco
authors.forename: A P
authors.initials: AP
authors.lastname: Hernandez
authors.forename: F
authors.initials: F
authors.lastname: Antillon-Klussmann
authors.forename: S
authors.initials: S
authors.lastname: Machin
authors.forename: R
authors.initials: R
authors.lastname: Cabanas
authors.forename: M
authors.initials: M
authors.lastname: Navarrete
authors.forename: R
authors.initials: R
authors.lastname: Nieves
authors.forename: P
authors.initials: P
authors.lastname: De Lorenzo
authors.forename: G
authors.initials: G
authors.lastname: Masera
mesh_terms: D017691:Caribbean Region / Q000453:epidemiology; D002489:Central America / Q000453:epidemiology; D002648:Child; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis