title: Management of children with brain tumors in Paraguay.
abstract: BACKGROUND
  Cure rates among children with brain tumors differ between low-income and high-income countries. To evaluate causes of these differences, we analyzed aspects of care provided to pediatric neuro-oncology patients in a low middle-income South American country.
  
  
  METHODS
  Three methods were used to evaluate treatment of children with brain tumors in Paraguay: (1) a quantitative needs assessment questionnaire for local treating physicians, (2) site visits to assess 3 tertiary care centers in Asunción and a satellite clinic in an underdeveloped area, and (3) interviews with health care workers from relevant disciplines to determine their perceptions of available resources. Treatment failure was defined as abandonment of therapy, relapse, or death.
  
  
  RESULTS
  All 3 tertiary care facilities have access to chemotherapy and pediatric oncologists but lack training and tools for neuropathology and optimal neurosurgery. The 2 public hospitals also lack access to appropriate radiological tests and timely radiotherapy. These results demonstrate disparities in Paraguay, with rates of treatment failure ranging from 37% to 83% among the 3 facilities.
  
  
  CONCLUSIONS
  National and center-specific deficiencies in resources to manage pediatric brain tumors contribute to poor outcomes in Paraguay and suggest that both national and center-specific interventions are warranted to improve care. Disparities in Paraguay reflect different levels of governmental and philanthropic support, program development, and socio-economic status of patients and families, which must be considered when developing targeted strategies to improve management. Effective targeted interventions can serve as a model to develop pediatric brain tumor programs in other low- and middle-income countries.
authors.affiliation: Children’s Center for Cancer and Blood Diseases, Children’s Hospital of Los Angeles, Los Angeles, California, USA. jbaskin@chla.usc.edu
authors.forename: Jacquelyn L
authors.initials: JL
authors.lastname: Baskin
authors.forename: Eva
authors.initials: E
authors.lastname: Lezcano
authors.forename: Bo Sung
authors.initials: BS
authors.lastname: Kim
authors.forename: Diego
authors.initials: D
authors.lastname: Figueredo
authors.forename: Alvaro
authors.initials: A
authors.lastname: Lassaletta
authors.forename: Antonio
authors.initials: A
authors.lastname: Perez-Martinez
authors.forename: Luis
authors.initials: L
authors.lastname: Madero
authors.forename: Miguela A
authors.initials: MA
authors.lastname: Caniza
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Angelica
authors.initials: A
authors.lastname: Samudio
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D001932:Brain Neoplasms / Q000628:therapy*; D019049:Developed Countries; D019468:Disease Management; D054625:Healthcare Disparities; D006801:Humans; D020380:Needs Assessment; D010239:Paraguay; D011379:Prognosis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires