Ten years after the six International Society of Paediatric Oncology (SIOP) Baseline Standards for Nursing Care in Low- and Middle-Income Countries (LMIC) were published (2014), multiple LMIC nurses have used the standards for practice assessment and change. The WHO Global Initiative for Childhood Cancer has galvanized LMIC member states to prioritize childhood cancer and save one million lives by 2030. The CureALL framework highlights critical nursing practice actions aligned with the nursing standards to meet this goal. SIOP Nursing Network’s Baseline Standards special interest group has a 5-year strategic plan for advocacy, research, and standards implementation through global multidisciplinary collaboration.

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Authors: G.M. Afungchwi1, E. Kiteni2, M. Ndagire3, B. Maliti4, R. Kunkel5, J. Challinor6, R. Hollis71 = Cameroon Baptist Convention Health Services, Bamenda, Cameroon2 = Muhimbili National Hospital, Pediatric Oncology Unit, Tanzania3 = Uganda Cancer Institute, Kampala, Uganda4 = Zambia Cancer Diseases Hospital, Lusaka, Zambia5 = Arkansas Children’s Hospital, Arkansas, USA6 = University of California San Francisco, San Francisco, California, USA7 = Leeds Children’s Hospital, Leeds, UKAddress correspondences to Dr Glenn Mbah Afungchwi, Cameroon Baptist Convention Health Services, Department of Pediatric Oncology, Bamenda, Cameroon. Email: [email protected] Tel: (+237)675959629

Introduction There is lack of diagnostic and treatment resources with variable access to childhood cancer treatment in low- and middle-income countries (LMIC), which may lead to subsequent poor survival. The primary aim of this study is to determine the prevalence and types of T&CM used in Cameroon. Secondarily, we explored determinants of T&CM use, associated costs, perceived benefits and harm, and disclosure of T&CM use to medical team. Method A prospective, cross-sectional survey amongst parents and carers of children younger than 15 years of age who had a cancer diagnosis and received cancer treatment at three Baptist Mission hospitals between November 2017 and February 2019. Results Eighty participants completed the survey. Median patient age was 8.1 years (IQR4.1 – 11.1). There was significant availability (90%) and use (67.5%) of T&CM, while 24% thought T&CM would be good for cancer treatment. Common T&CM remedies included herbs and other plant remedies or teas taken by mouth, prayer for healing purposes and skin cutting. Living more than 5 hours away from the treatment center (p=0.030), anticipated costs (0.028), and a habit of consulting a traditional healer when sick (p=0.006) were associated with the use of T&CM. T&CM was mostly paid for in cash (36.3%) or provided free of charge (20%). Of importance was the fact that nearly half (44%) did not want to disclose the use of TM to their doctor. Conclusion Pediatric oncology patients used T&CM before and during treatment but would be unlikely to disclose to the child’s health care team.

Abstract Background and aims Multidisciplinary team (MDT) meetings provide a regular, structured meeting of a core group of professionals to provide expert decision-making in individual patient care. We describe our experiences in establishing a virtual pediatric oncology MDT between twinning partners in Cameroon (4 hospitals) and the UK. Methods Monthly video conferencing MDT meetings were established in March 2019, initially using Google meet then using Zoom platforms. Case details were circulated using formal proformas. Standard operating procedures were outlined for the MDT conduct. Results There have been 269 discussions of 201 patients in 21 meetings. Patients have been varied in age (up to 24 years). Eighty-seven (43.3%) patients had NHL, 16 (8.0%) had Wilms tumour, 20 (10.0%) had Acute Lymphoblastic Leukaemia, 19 (9.5%) had Retinoblastoma and 59 (29.4%) had other malignancies. Four of the patients did not have a malignancy. The majority of patients had stage 3 (51, 45.1%) or stage 4 (59, 52.2%). Nine patients had relapsed disease. Core team members reported positive benefits from the MDT, including defining goals of care, shared decision making, professional education and team-building. Conclusions Virtual MDT meetings between geographically dispersed teams are possible and have proved particularly valuable during the COVID-19 pandemic when in-person visits are not permitted. Cancer treatment cannot be done in isolation; the regular MDT meetings have paved the way for informed care through regular consultancy.

BACKGROUND The aim of this study was to investigate the progress made with pediatric oncology care in Cameroon from 2000 to 2020. METHOD A literature search was conducted for published articles on childhood cancer in Cameroon and relevant documents and conference abstracts were reviewed. The articles were analysed under eight themes: covering detection, diagnosis, management and program development. RESULTS Forty publications were analysed. Cancer diagnosis was achieved with cytology, histology and simple imaging. Management for common and curable cancers was with use of modified treatment regimens for low- and middle- income settings. There was good collaboration between the pediatric oncology professionals nationally and international partners. Advocacy led to the support of the Ministry of Health with pediatric oncology specific priority actions in the latest national cancer control plan. CONCLUSION Commitment of childhood cancer specialists, non-governmental organizations, and the government can lead to successful childhood cancer management in a low-income country.

As we celebrate 2020 as the Year of the Nurse and the Midwife and recognize the Global Initiative for Childhood Cancer, members of the International Society of Pediatric Oncology (SIOP) Baseline Nursing Standards Taskforce would like to highlight advocacy efforts promoting the baseline nursing standards.1, 2 Your published article, An ethical imperative: safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer(Pergert and colleagues) reveals the importance of ongoing efforts to support implementation of the Baseline Nursing Standards.3 Given that the majority of hospitals are not meeting the standards in low- and middle-income countries (LMIC), as well as some high-income countries (HIC),4, 5 advocacy initiatives are required to raise awareness of the need to meet these standards. During the COVID-19 pandemic, health facilities face new challenges in meeting the standards. To achieve the WHO global initiative’s goal to save one million children’s lives by 2030, it is important to continue efforts to address baseline nursing standards.Pediatric oncology as a subspecialty requires a nursing workforce with specialized education and clinical skills to achieve optimal patient outcomes. Knowledge itself is not enough if nurses lack the resources and support to practice or implement appropriate nursing care in their work settings. The six Baseline Nursing Standards focus on key elements essential to delivering quality and safe care (Table 1). Collectively, they serve as a framework and foundation for positive pediatric oncology nursing practice environments internationally.Advocacy efforts to disseminate the baseline standards are well established. To date, fourteen organizations have endorsed the Standards. Members of the SIOP PODC Nursing Working Group hosted a “Leadership and Advocacy Workshop: Disseminating the Baseline Nursing Standards” prior to the SIOP Conference in October 2017. Twenty-two pediatric hematology/oncology nurse leaders and four stakeholder-group representatives (parent, physicians, advocates) from 14 countries met and established goals and strategic priorities for advocacy of the standards. As a result, the Baseline Nursing Standards Advocacy Toolkit was developed and can be found on the SIOP Nursing Website https://siop-online.org/baseline-nursing-standards-advocacy-toolkit. The toolkit contains practical advocacy resources, including a PowerPoint presentation, an endorsement letter template, publications, podcasts, a social media campaign and examples of elevator speeches for each standard. Furthermore, the Standards have been featured in international presentations, such as a keynote presentation (S. Day) in SIOP Lyon, an award session and nursing abstract presentations at SIOP congresses and continental meetings.To reach the WHO target of doubling the global childhood cancer survival rate to 60%, achievement of baseline nursing standards for pediatric oncology must be prioritized and appropriately resourced by hospital administrators, governments and other stakeholders. Amid a global pandemic where nursing resources are stretched, creative ways to support and advocate for implementation of the standards is needed. In recognition of the recent publication by the Nurse Specialists of the Global Initiative for Childhood Cancer noting the baseline standards, now is the time to act and improve childhood and adolescent cancer outcomes through raising the standard of pediatric oncology nursing practice around the world.Linda Abramovitz, Rehana Punjwani, Glenn M. Afungchwi and Courtney Sullivan and the SIOP PODC Baseline Standards Nursing Task Force.A special thank you to Rachel Hollis for her commitment and ongoing advocacy efforts focused on the baseline nursing standards.ReferencesDay S, Hollis R, Challinor J, Bevilacqua G, Bosomprah E, SIOP PODC Nursing Working Group. Baseline standards for paediatric oncology nursing care in low to middle income countries: position statement of the SIOP PODC Nursing Working Group. Lancet Oncol. 2014; 15(7):681-682 PMID: 24872097.Day S, Challinor J, Hollis R, Abramovitz L, Hanaratri Y, Punjwani R. Paediatric Oncology nursing care in low-and middle-income countries: a need for baseline standards. Cancer Control. 2015;2015:111-116Pergert P, Sullivan CE, Adde M, et al. An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer. Pediatr Blood Cancer. 2019;e28143. https://doi.org/ 10.1002/pbc.28143Morrissey L, Lurvey M, Sullivan C, et al. Disparities in the delivery of pediatric oncology nursing care by country income classification: international survey results. Pediatr Blood Cancer. 2019;66(6):e27663.Sullivan CE, Morrissey L, Day SW, Chen Y, Shirey M, Landier W. Predictors of Hospitals’ Nonachievement of Baseline Nursing Standards for Pediatric Oncology. Cancer Nurs. 2019 Mar 29;