ABSTRACT

This report provides a summary of childhood cancer and the efforts made in the Dominican Republic to address child and adolescent cancer in line with the World Health Organization’s Global Initiative for Childhood Cancer. Information was obtained by review of recent local and international literature on pediatric oncology. As a result of the Global Initiative, a meeting was held by the Council of Ministers of Health of Central America to support the development of national pediatric cancer plans for each country. The objectives of these plans are to improve overall survival and quality of care for children with cancer through early detection, diagnosis, and treatment. In the Dominican Republic, several steps have been taken in the past 5 years to enhance diagnosis and care of children with cancer. For example, the National Committee of Childhood Cancer, headed by the Ministry of Public Health and including relevant stakeholders, was established to develop the national childhood cancer plan. In addition, a campaign was launched to raise awareness of childhood cancer, and the first early detection manual and public policy on child and adolescent cancer were published. A government initiative has been working to improve the hospital infrastructure and expand the pediatric cancer center, and a national course on early detection of pediatric cancers has been held. In 2023, the National Strategic Childhood Cancer Plan 2023–2030 was launched in the Dominican Republic. The plan will help policy-makers, implementers, researchers, and advocates enhance diagnosis and care of children with cancer.

Keywords
Neoplasms; child; adolescent; public policy; quality of health care; Dominican Republic

RESUMEN

En este informe se presenta un resumen del cáncer infantil y las medidas adoptadas por República Dominicana para abordar el cáncer en la población infantil y adolescente en consonancia con la Iniciativa Mundial contra el Cáncer Infantil de la Organización Mundial de la Salud. La información se obtuvo mediante el análisis de las publicaciones nacionales e internacionales recientes sobre oncología pediátrica. Como resultado de la Iniciativa Mundial, el Consejo de Ministros de Salud de Centroamérica celebró una reunión para brindar apoyo a la elaboración de planes nacionales sobre el cáncer infantil para cada país. Los objetivos de estos planes son mejorar la supervivencia general y la calidad de la atención que se presta a la población infantil con cáncer mediante la detección temprana, el diagnóstico y el tratamiento. En los últimos cinco años, República Dominicana ha adoptado varias medidas para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer. Así, por ejemplo, se creó el Comité Nacional de Cáncer Infantil, encabezado por el Ministerio de Salud e integrado por las partes interesadas pertinentes, para elaborar el plan nacional sobre el cáncer infantil. Además, se puso en marcha una campaña de sensibilización sobre el cáncer infantil y se publicaron el primer manual de detección precoz y la primera política pública sobre el cáncer en la población infantil y adolescente. Mediante una iniciativa gubernamental se ha buscado mejorar la infraestructura hospitalaria y ampliar el centro de atención a pacientes oncológicos pediátricos, al tiempo que se ha impartido un curso nacional sobre detección precoz del cáncer infantil. En el 2023, República Dominicana puso en marcha el Plan Estratégico Nacional sobre Cáncer Infantil 2023-2030. Este plan será útil a los responsables de la formulación de políticas, las personas encargadas de su ejecución, los investigadores y los promotores para mejorar el diagnóstico y la atención prestada a la población infantil con cáncer.

Palabras clave
Neoplasias; niño; adolescente; política pública; calidad de la atención de salud; República Dominicana

RESUMO

Este relatório fornece um resumo sobre o câncer infantil e os esforços da República Dominicana para enfrentar a doença em crianças e adolescentes, em consonância com a Iniciativa Global para o Câncer Infantil da Organização Mundial da Saúde. As informações foram obtidas por meio de uma revisão da literatura local e internacional recente sobre oncologia pediátrica. Em consequência da Iniciativa Global, o Conselho de Ministros da Saúde da América Central se reuniu para apoiar a elaboração de planos nacionais de câncer pediátrico para cada país. Os objetivos desses planos são melhorar a sobrevida global e a qualidade da atenção a crianças com câncer por meio de detecção, diagnóstico e tratamento precoces. Na República Dominicana, várias medidas foram tomadas nos últimos cinco anos para melhorar o diagnóstico e a atenção a crianças com câncer. Por exemplo, o Comitê Nacional de Câncer Infantil, que é chefiado pelo Ministério da Saúde e inclui as partes interessadas pertinentes, foi criado para elaborar o plano nacional de câncer infantil. Foi lançada uma campanha de conscientização sobre o câncer infantil no país. Além disso, foram publicados o primeiro manual de detecção precoce e a política pública de câncer infantojuvenil. Uma iniciativa do governo vem trabalhando para melhorar a infraestrutura hospitalar e ampliar o centro de câncer pediátrico e ministrou um curso nacional sobre a detecção precoce de cânceres pediátricos. Em 2023, foi lançado o Plano Estratégico Nacional de Câncer Infantil 2023–2030 na República Dominicana. O plano ajudará formuladores de políticas, implementadores, pesquisadores e defensores da causa a aprimorar o diagnóstico e a atenção a crianças com câncer.

Palavras-chave
Neoplasias; criança; adolescente; política pública; qualidade da assistência à saúde; República Dominicana

Cancer disrupts physical, mental, and emotional well-being and socioeconomically impacts many people around the world; children unfortunately do not escape this disease. In children and adolescents, certain warning signs and symptoms can suggest malignant disease. It is essential to know these signs to make an early diagnosis and offer timely treatment. The month of September has been designated as Childhood Cancer Awareness Month to raise awareness about the reality of children with cancer around the world (¹1. Día Internacional del Niño con Cáncer [International Day of Children with Cancer] [internet] [cited 2023 Jan 25]. Available from: https://www.diainternacionalde.com/ficha/dia-internacional-cancer-nino
https://www.diainternacionalde.com/ficha... ).

Cancer in children and adolescents cannot be prevented. It is predicted that each year 14 out of 100 000 children will be diagnosed with malignant diseases and about 400 000 children and adolescents between 0 and 19 years around the world will have cancer. Although cancer is rare in children (²2. Oliveira Friestino JK, Mendonça D, Oliveira P, Oliveira CM, de Carvalho Moreira Filho D. Childhood cancer: incidence and spatial patterns in the city of Campinas, Brazil, 1996–2005. Salud Colect. 2018;14(1):51–63. https://doi.org/10.18294/sc.2018.1200
https://doi.org/10.18294/sc.2018.1200... ), it is the second most common cause of death in children older than 1 year in high-income countries (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ). Therefore, the health system and society in general should be alert to this situation because early detection of the disease can result in improved survival rates – higher than 70% in developing countries – through the administration of treatments adapted to local realities and a trans-disciplinary approach (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ). Delayed referral of a cancer patient and late initiation of treatment can mean the difference between life and death (²2. Oliveira Friestino JK, Mendonça D, Oliveira P, Oliveira CM, de Carvalho Moreira Filho D. Childhood cancer: incidence and spatial patterns in the city of Campinas, Brazil, 1996–2005. Salud Colect. 2018;14(1):51–63. https://doi.org/10.18294/sc.2018.1200
https://doi.org/10.18294/sc.2018.1200... , ⁴4. International Agency for Research on Cancer. Global cancer observatory. Cancer today [internet]. Lyon: IARC; [cited 2023 Jan 25]. Available from: https://gco.iarc.fr/
https://gco.iarc.fr/... ).

The Dominican Republic, as a developing country, has similar epidemiological patterns for childhood cancer as other Latin American countries. In addition, the country shares similar challenges including: limited access to health resources; high cost of chemotherapy, radiotherapy, and diagnostics; insufficient trained personnel; non-availability of bone marrow transplant and other more complex interventions; and sociocultural factors that result in late diagnosis, poor adherence to treatment, and a high likelihood of dropping out of treatment (⁵5. Instituto Nacional del Cáncer Rosa Emilia Sánchez Pérez de Tavares. Cáncer infantil: conocerlo puede cambiar la historia de un niño [Childhood cancer: knowing about it can change a child's history] [Internet]. Santa Domingo: INCART; 2019 [cited 2024 Jan 13]. Available from: https://www.incart.gob.do/blog/cancer-infantil-conocerlo-puede-cambiar-la-historia-de-un-nino/
https://www.incart.gob.do/blog/cancer-in... ).

The objective of this report is to provide a summary of: (i) childhood cancer and the World Heath Organization’s (WHO’s) Global Initiative for Childhood Cancer and (ii) the steps that the Dominican Republic has taken in the past 5 years to address childhood cancer in line with the Global Initiative.

METHODS

We reviewed the following material: international literature on pediatric oncology; global, regional, and local reports on actions taken by the Dominican Republic as part of the Global Initiative for Childhood Cancer; and WHO/Pan American Health Organization (PAHO) reports on progress made in the country. The Dominican Republic does not have a formal cancer registry but the three main pediatric oncology units in the country have a hospital registry with relevant data, which we reviewed. The lack of formally published local literature has been a limitation of the present report. The review was performed between September 2023 and January 2024.

RESULTS AND DISCUSSION

Childhood cancer

The most common cancers in childhood and adolescence in order of incidence are: leukemia; brain tumors; lymphomas; retinal tumors; abdominal tumors (Wilms tumor, neuroblastoma, and germ cell tumors); muscle tumors (sarcomas); and bone tumors (osteosarcoma). The symptoms and treatment will depend on the type of cancer and how advanced the disease is (⁶6. Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: a population-based registry study. Lancet Oncol. 2017;18(6):719–31. https://doi.org/10.1016/S1470-2045(17)30186-9
https://doi.org/10.1016/S1470-2045(17)30... ).

In children, cancer usually simulates other diseases since the symptoms can be similar to those found in infections or other illnesses. Therefore, doctors must be alert to warning signs and symptoms, such as fever, weight loss, paleness, fatigue, and bleeding or bruising without apparent cause, which may raise suspicion of leukemia, lymphomas or metastatic diseases. In addition, it is crucial to evaluate masses in or growth of lymph nodes in any part of the body – in the neck, armpits, supraclavicular regions, and inguinal regions – as these may suggest lymphomas or bone tumors (⁷7. Asociación Colombiana de Hematología y Oncología Pediátrica. Material educativo [Educational material] [internet]. ACHOP; 2021 [cited 2023 Jan 25]. Available from: https://achop.org/material-educativo/
https://achop.org/material-educativo/... ). Some patients may have pain in the long bones and/or joints, as well as spontaneous fractures for no apparent reason during daily activities (e.g., playing, walking), which can suggest leukemia or bone cancers such as osteosarcoma. Children with ocular symptoms such as white spots in the eye, strabismus (double vision), enlarged eyeball, blindness, or loss of vision should be immediately referred to a pediatrician or oncologist as such symptoms occur in retinoblastoma (⁷7. Asociación Colombiana de Hematología y Oncología Pediátrica. Material educativo [Educational material] [internet]. ACHOP; 2021 [cited 2023 Jan 25]. Available from: https://achop.org/material-educativo/
https://achop.org/material-educativo/... ). Neurological signs and symptoms including changes in behavior, loss of balance, alteration of gait, headaches, and vomiting, predominantly in the morning and projectile, can occur in children with brain masses (e.g., gliomas or medulloblastoma) (²2. Oliveira Friestino JK, Mendonça D, Oliveira P, Oliveira CM, de Carvalho Moreira Filho D. Childhood cancer: incidence and spatial patterns in the city of Campinas, Brazil, 1996–2005. Salud Colect. 2018;14(1):51–63. https://doi.org/10.18294/sc.2018.1200
https://doi.org/10.18294/sc.2018.1200... ).

These signs are usually present in at least 85% of cases of cancer. Hence, children who present with any of these symptoms persistently must be investigated promptly and evaluated by a pediatric oncologist to reach an accurate diagnosis. This diagnosis should be based on clinical history, physical examination, and the necessary tests, procedures (e.g., spinal cord aspirates or biopsies) or imaging studies to determine the type of lesion and the stage of the disease (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ). At the same time, it is essential to investigate the existence of possible metastases to be able to offer a treatment adapted to the stage and degree of the disease.

Childhood cancers are not treated in the same way as adult cancers. Pediatric oncology offers specialized knowledge and different types of treatments, including surgery, chemotherapy, and radiotherapy (⁷7. Asociación Colombiana de Hematología y Oncología Pediátrica. Material educativo [Educational material] [internet]. ACHOP; 2021 [cited 2023 Jan 25]. Available from: https://achop.org/material-educativo/
https://achop.org/material-educativo/... ). It should be noted that these therapeutic options should always be applied based on the diagnosis, the child’s age, weight and height, stage of the cancer, and risks to the child (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ). Childhood cancer can be cured and has a good prognosis when diagnosed early. If it is detected at an early stage, the treatment of the disease is more effective, thus increasing a child's chances of cure (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ).

Childhood cancer in numbers

Estimates suggest that 14 out of 100 000 children will be diagnosed with malignant diseases annually (⁸8. Steliarova-Foucher E. Cancer in children. In: Jemal A, Torre L, Soerjomataram I, Bray F, editors. The cancer Atlas, third edition. Atlanta: Georgia, American Cancer Society; 2019 [cited 2023 Jan 25]. Available from: http://canceratlas.cancer.org/od2
http://canceratlas.cancer.org/od2... ). In Latin America and the Caribbean, 29 057 new cases of childhood cancer and more than 16 066 deaths due to cancer in children younger than 19 years are registered each year (⁴4. International Agency for Research on Cancer. Global cancer observatory. Cancer today [internet]. Lyon: IARC; [cited 2023 Jan 25]. Available from: https://gco.iarc.fr/
https://gco.iarc.fr/... , ⁹9. Pan American Health Organization. Infographic – childhood cancer country profile: Dominican Republic [internet]. PAHO; 2021 [cited 2023 Oct 27]. Available from: https://www.paho.org/en/documents/childhood-cancer-profiles-dominican-republic
https://www.paho.org/en/documents/childh... ). In the Dominican Republic, about 392 new cases of cancer in children are diagnosed each year (⁹9. Pan American Health Organization. Infographic – childhood cancer country profile: Dominican Republic [internet]. PAHO; 2021 [cited 2023 Oct 27]. Available from: https://www.paho.org/en/documents/childhood-cancer-profiles-dominican-republic
https://www.paho.org/en/documents/childh... ).

Eight in 10 children with cancer live in low- and middle-income countries but in these countries, one in two children affected by cancer does not receive a timely diagnosis, treatment or referral to a pediatric oncologist (¹⁰10. Harvard T.H. Chan School of Public Health Nearly half of childhood cancers worldwide undiagnosed [internet]. Harvard T.H. Chan School of Public Health; 2019 [cited 2023 Jan 25]. Available from: https://www.hsph.harvard.edu/news/press-releases/nearly-half-of-childhood-cancers-worldwide-undiagnosed/
https://www.hsph.harvard.edu/news/press-... ). As a result, cure rates are often estimated at as low as 20% (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... ).

Global Initiative for Childhood Cancer

The Global Initiative for Childhood Cancer, launched in September 2018 by WHO, the International Pediatric Oncology Society, and St Jude Children's Research Hospital, announced a collaboration to transform child cancer care around the world to cure at least 60% of children with the six most common types of cancer by 2030, namely, acute lymphoblastic leukemia, Hodgkin lymphoma, Burkitt lymphoma, kidney tumors, retinal tumors, and low-grade gliomas (³3. World Health Organization. CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives. Geneva: WHO; 2021 [cited 2023 Oct 27]. Available from: https://iris.who.int/handle/10665/347370
https://iris.who.int/handle/10665/347370... , ¹¹11. International Society of Paediatric Oncology. WHO global initiative for childhood cancer [Internet]. SIOP; 2018 [cited 2023 Jan 25]. Available from: https://siop-online.org/who-global-initiative-for-childhood-cancer/
https://siop-online.org/who-global-initi... ).

In response to this global movement, health ministries of countries in Central America and the Caribbean sought to identify initiatives that could be implemented in the region to focus attention on children and adolescents with cancer (¹²12. Sistema de la Integración Centroamericana. SE-COMISCA participa en el taller para la elaboración de una hoja de ruta y planes para el abordaje del Cáncer Pediátrico en Centroamérica, República Dominicana y Haití. [SE-COMISCA participates in the workshop to develop a roadmap and plans to address pediatric cancer in Central America, the Dominican Republic and Haiti] [internet]. SICA; 2019 [cited 2023 Oct 28]. Available from: https://www.sica.int/noticias/se-comisca-participa-en-el-taller-para-la-elaboracion-de-una-hoja-de-ruta-y-planes-para-el-abordaje-del-cancer-pediatrico-en-centroamerica-republica-dominicana-y-haiti_1_119109.html
https://www.sica.int/noticias/se-comisca... ). To this end, the Executive Secretariat of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) participated in a workshop in Costa Rica in 2019 for the development of a roadmap and plan to address pediatric cancer in Central America, the Dominican Republic, and Haiti (¹²12. Sistema de la Integración Centroamericana. SE-COMISCA participa en el taller para la elaboración de una hoja de ruta y planes para el abordaje del Cáncer Pediátrico en Centroamérica, República Dominicana y Haití. [SE-COMISCA participates in the workshop to develop a roadmap and plans to address pediatric cancer in Central America, the Dominican Republic and Haiti] [internet]. SICA; 2019 [cited 2023 Oct 28]. Available from: https://www.sica.int/noticias/se-comisca-participa-en-el-taller-para-la-elaboracion-de-una-hoja-de-ruta-y-planes-para-el-abordaje-del-cancer-pediatrico-en-centroamerica-republica-dominicana-y-haiti_1_119109.html
https://www.sica.int/noticias/se-comisca... ).

Among the workshop's goals were to: (i) increase political commitment to the diagnosis and treatment of childhood cancer; (ii) review existing tools to guide the planning and implementation of interventions related to early diagnosis and treatment of, and palliative and survivor care for childhood cancers; and (iii) improve access to essential and affordable medicines and technologies for pediatric cancer (¹³13. Campos MDLA, Alvayero KE, Fuentes-Alabi S. Collaborative effort to catalyze the implementation of the Global Initiative for Childhood Cancer in the Central American subregion. Rev Panam Salud Pública. 2023;47:e145. https://doi.org/10.26633/RPSP.2023.145.
https://doi.org/10.26633/RPSP.2023.145... ).

Dominican Republic’s response to the Global Initiative

Table 1 shows the various stakeholders involved in addressing childhood cancers in the Dominican Republic, their sphere of activity, and level of involvement and influence. Figure 1 summarizes in chronological order the actions taken on childhood cancer in the Dominican Republic.

As a result of the workshop, the National Committee of Childhood Cancer was created in the Dominican Republic that has been developing a proposal for a national childhood cancer plan. The committee is led by representatives of the Department of Chronic Noncommunicable Diseases of the Ministry of Public Health, members of the National Health Service, representatives from PAHO, oncologists and hemato-oncologists in the health network, and members of civil society such as the Friends Against Childhood Cancer Foundation (¹⁴14. Fundación Amigos Contra el Cáncer Infantil [website]. FACCI; 2023 [cited 2023 Jan 25]. Available from: https://www.facci.org.do/
https://www.facci.org.do/... ). This foundation, through a strategic alliance with St Jude Children's Research Hospital, has worked to increase survival of children with cancer, which has risen from 16% in 2004 to 60% today in the Oncology Unit of the Dr. Robert Reid Cabral Children's Hospital (¹⁵15. Pan American Health Organization. Se realiza taller de validación del Plan Estratégico Nacional de Cáncer Infantil en la República Dominicana [The validation workshop of the National Strategic Plan for Childhood Cancer held in the Dominican Republic] [internet]. PAHO; 2021 [cited 2023 Jan 25]. Available from: https://www.paho.org/es/noticias/27-1-2021-se-realiza-taller-validacion-plan-estrategico-nacional-cancer-infantil-republica
https://www.paho.org/es/noticias/27-1-20... ).

Steps were also taken to raise awareness of this important topic in the country. In September 2021, the childhood cancer awareness campaign was launched. In September 2022, the first early detection manual and public policy on cancer in children and adolescents were circulated between primary health care teams affiliated to the Ministry of Public Health and provincial health officers (¹⁶16. Escuela de medicina. Revista anales de medicina PUCMM [PUCMM Annals of medicine] [website]. Escuela de medicina; 2023 [cited 2023 Jan 25]. Available from: https://medicina.pucmm.edu.do/investigaciones/revistas/
https://medicina.pucmm.edu.do/investigac... , ¹⁷17. Presidencia de la República Dominicana. Salud pública insta a identificar señales que conduzcan a la detección temprana del cáncer infantile [Public health urges identification of signs that lead to early detection of childhood cancer] [internet]. Presidencia de la República Dominicana; 2023 [cited 2023 Oct 27]. Available from: https://presidencia.gob.do/noticias/salud-publica-insta-identificar-senales-que-conduzcan-la-deteccion-temprana-del-cancer
https://presidencia.gob.do/noticias/salu... ). The objectives of the awareness campaigns, the manual on early detection of childhood, and the public policy on childhood cancer were to increase the timely diagnosis of cancer in children and adolescents, and hence the number of cases diagnosed with lower stages of disease. In turn, this would make it possible to offer less toxic treatment, which would positively impact the quality of life of children and their families, and increase the chance of cure. The Ministry of Public Health plans to implement surveillance on the time taken to diagnose cancer in children.

At the same time, a governmental initiative has been working to improve the hospital infrastructure of the Dominican Republic National Cancer Institute. In fact, the expansion of the pediatric center is currently being carried out with the joint support of the Cabinet of Childhood & Adolescents, led by the First Lady of the Dominican Republic, Mrs. Raquel Arbaje de Abinader, and the Central American Bank for Economic Integration. The new pediatric oncology unit will provide specialized assistance to children and adolescents from vulnerable social sectors (¹⁸18. Banco Centroamericano de Integración Económica. BCIE apoya lucha contra el cáncer infantil en la República Dominicana [BCIE supports the fight against childhood cancer in the Dominican Republic] [internet]. BCIE; 2021 [cited 2023 Oct 27]. Available from: https://www.bcie.org/novedades/noticias/articulo/bcie-apoya-lucha-contra-el-cancer-infantil-en-la-republica-dominicana
https://www.bcie.org/novedades/noticias/... ). This unit will have 37 beds, a procedure area, two surgical rooms, four intensive care cubicles, six outpatient offices, a day hospital with 10 beds, a mother's room, and an interactive recreational waiting room for the children, among other areas (¹⁹19. Presidencia de la República Dominicana. Primera dama anuncia construcción de una Unidad Oncopedriátrica en el Incart [First Lady announces construction of an oncopediatric unit in Incart] [internet]. Presidencia de la República Dominicana; 2021 [cited 2023 Oct 27]. Available from: https://presidencia.gob.do/noticias/primera-dama-anuncia-construccion-de-una-unidad-oncopedriatrica-en-el-incart
https://presidencia.gob.do/noticias/prim... ).

To provide support to pediatricians of the Dominican Republic, in March 2022, the oncology chapter of the Dominican Pediatric Society was established, allowing oncologist to share information about early signs and symptoms of childhood cancer around the country (²⁰20. DiarioSalud. Juramentan Capítulo de Oncología Sociedad Pediatría [Pediatric Society Oncology Chapter sworn in] [internet]. DiarioSalud; 2022 [cited 2023 Oct 27]. Available from: https://www.diariosalud.do/noticias/juramentan-capitulo-de-oncologia-sociedad-pediatria/
https://www.diariosalud.do/noticias/jura... ). In February 2023, headed by the Ministry of Public Health, the Academic Society of Pediatrics, and relevant stakeholders, the first national course on early detection of pediatric cancers was held for more than 75 physicians, pediatricians, and first-level health personnel around the country (²¹21. DiarioSalud. Realizarán curso en detección temprana de cáncer infantile [Take a course in early detection of childhood cancer] [internet]. DiarioSalud; 2023 [cited 2023 Oct 27]. Available from: https://www.diariosalud.do/noticias/realizaran-curso-en-deteccion-temprana-de-cancer-infantil/
https://www.diariosalud.do/noticias/real... ).

Since its establishment in 2019, the National Committee of Childhood Cancer has worked to develop the childhood cancer plan for the Dominican Republic. During the process, the committee faced some challenges, such as the coronavirus disease 2019 (COVID-19) pandemic in 2020, which hindered their work as efforts in the country focused on dealing with the pandemic (²²22. Proyecto Mesoamérica. República Dominicana COVID-19 [internet]. Proyecto Mesoamérica; 2022 [cited 2024 Jan 13]. Available from: http://proyectomesoamerica.org/index.php/republica-dominicana-covid-19
http://proyectomesoamerica.org/index.php... ). Despite this situation, the committee switched to working online and held virtual meetings to continue planning the childhood cancer plan. In addition, there was a change in government so the work done up to the change had to be presented to the new authorities and the committee was reformed with new members in August 2020. PAHO provided support during the transition (¹⁵15. Pan American Health Organization. Se realiza taller de validación del Plan Estratégico Nacional de Cáncer Infantil en la República Dominicana [The validation workshop of the National Strategic Plan for Childhood Cancer held in the Dominican Republic] [internet]. PAHO; 2021 [cited 2023 Jan 25]. Available from: https://www.paho.org/es/noticias/27-1-2021-se-realiza-taller-validacion-plan-estrategico-nacional-cancer-infantil-republica
https://www.paho.org/es/noticias/27-1-20... ).

The main objectives of the Dominican Republic’s National Strategic Childhood Cancer Plan 2023–2030 are to facilitate prompt detection of childhood cancer, provide appropriate interventions, and reduce the morbidity and mortality from childhood cancer, thus improving the quality of life of children and their families in the face of this terrible disease (¹⁶16. Escuela de medicina. Revista anales de medicina PUCMM [PUCMM Annals of medicine] [website]. Escuela de medicina; 2023 [cited 2023 Jan 25]. Available from: https://medicina.pucmm.edu.do/investigaciones/revistas/
https://medicina.pucmm.edu.do/investigac... ). The plan was evaluated and validated in August 2023 by a working group of experts from the Health System Unit and the Global Initiative team of St Jude Children's Research Hospital. It was also validated by WHO/PAHO headquarters officers who identified 10 critical components that must be considered when developing cancer plans (¹¹11. International Society of Paediatric Oncology. WHO global initiative for childhood cancer [Internet]. SIOP; 2018 [cited 2023 Jan 25]. Available from: https://siop-online.org/who-global-initiative-for-childhood-cancer/
https://siop-online.org/who-global-initi... , ²³23. World Health Organization. WHO and St. Jude to dramatically increase global access to childhood cancer medicines [internet]. WHO; 2021 [cited 2023 Oct 27]. Available from: https://www.who.int/news/item/13-12-2021-who-and-st.-jude-to-dramatically-increase-global-access-to-childhood-cancer-medicines
https://www.who.int/news/item/13-12-2021... ).

On September 28, 2023, the Dominican Republic National Strategic Childhood Cancer Plan 2023–2030 was launched by the Ministry of Public Health (²⁴24. Pan American Health Organization. República Dominicana lanza Plan Estratégico Nacional de Cáncer Infantil [Dominican Republic launches National Strategic Plan for Childhood Cancer]. [internet]. PAHO; 2023 [cited 2023 Oct 27]. Available from: https://www.paho.org/es/noticias/29-9-2023-republica-dominicana-lanza-plan-estrategico-nacional-cancer-infantil
https://www.paho.org/es/noticias/29-9-20... , ²⁵25. Ministry of Public Health and Social Assistance. Plan estratégico nacional de cáncer infantil, 2023-2030 [National strategic plan for childhood cancer, 2023–2030]. Santa Domingo: Ministry of Public Health and Social Assistance; 2023 [cited 2023 Oct 27]. Available from https://cdn2.me-qr.com/pdf/17881720.pdf
https://cdn2.me-qr.com/pdf/17881720.pdf... ). With this significant milestone, addressing childhood cancer has been formalized and become a reality for the Dominican Republic. The plan has different components including: a national framework for response to childhood cancer; a legal framework; an outline of the situation of childhood cancer in Dominican Republic (e.g., health system response, human resources, early detection, and childhood cancer registry); lines of action of the plan (e.g., policy, financing and advocacy, service provision, palliative care, and surveillance); and monitoring and evaluation of the plan, among others. The components will support different initiatives from government, hospitals, oncology units, and nongovernmental organizations to effectively manage childhood cancer.

The plan also has eight indicators for evaluation and follow-up, namely: policies and finances; early detection; diagnosis; treatment and rehabilitation; palliative care; surveillance and research; family support; and community. In the future, it is planned to follow up on each indicator to improve childhood cancer care and explore the impact of the plan in the Dominican Republic.

Overall, the childhood cancer plan will be invaluable for policy-makers, implementers, researchers, and advocates at the local, national, regional, and global levels. Achievements made in childhood cancer in the country will serve to support the plan and academic and advocacy initiatives around the country.

Disclaimer.

The authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública / Pan American Journal of Public Health and/or those of the Pan American Health Organization and the World Health Organization.

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