Papers by Paola Friedrich
Survival from pediatric cancers in low-middle-income countries is often very low compared to that... more Survival from pediatric cancers in low-middle-income countries is often very low compared to that of high-income countries due to multifactorial etiologies, including late presentation, delayed diagnosis, difficulty with accessing health care, drug unavailability and treatment abandonment. The St. Jude Pediatric Oncology Facility Integrated Local Evaluation Tool (PrOFILE) was developed to identify the strengths and weaknesses of individual institutions, as well as whole countries. Following the completion of data analysis from Kenyan institutions, the first PrOFILE hybrid in-person and virtual workshop was held. Multi-disciplinary stakeholders prioritized recommendations for improving care and developed smart objectives to accomplish identified goals over the following 2 years. Strengths and weaknesses of conducting a hybrid global workshop were identified.
Journal of Clinical Oncology
e18711 Background: High-quality data is needed to assess the effectiveness and impact of quality ... more e18711 Background: High-quality data is needed to assess the effectiveness and impact of quality improvement collaboratives (QICs). The first Mexico in Alliance with St. Jude Golden Hour Collaborative (MAS Collaborative) ran from May 2019 to November 2020 in 23 hospitals across Mexico and improved the percentage of febrile pediatric hematology-oncology patients (P-HOP) presenting to the emergency department (ED) who receive the first dose of antibiotics in ≤60min from 39% to 78%. This study aimed to evaluate the quality of the data collected during the first MAS Collaborative and inform changes to second, larger-scale MAS Collaborative. Methods: Data quality was determined by data availability throughout the reporting . A complete sequence of was required for inclusion in the analysis. Results and data quality reports were created retrospectively and reviewed by three expert panels to better understand challenges related to data collection. A focus group with MAS Collaborative parti...
Blood, 2021
Background: Cancer is the second leading cause of death in Mexico among children 5-14 years. In 2... more Background: Cancer is the second leading cause of death in Mexico among children 5-14 years. In 2017, Mexico in Alliance with St. Jude (MAS), a multi-site intersectoral collaboration, explored reasons for suboptimal outcomes for children with acute lymphoblastic leukemia (ALL). Results showed 82% of patients to be classified as high-risk and 30% of patients be missing standard molecular or minimal residual disease (MRD) studies needed to inform risk- group stratification. Making sense of the molecular characteristics was challenging in the context of variable access and lack of common denominators. These findings led to the development of the "Bridge Project"; a prospective quality improvement demonstration project aiming to bridge this access and quality gap through multi-site collaboration, centralization, and standardization. Methods: Six MAS collaborating hospitals, located in six different states (Mérida, Guadalajara, Sinaloa, Baja California, Chiapas, and Veracruz), ...
Journal of Clinical Oncology, 2021
10053 Background: While great strides have transpired in pediatric cancer management in high-inco... more 10053 Background: While great strides have transpired in pediatric cancer management in high-income countries (HICs), more than 80% of all children with cancer live in low-and middle-income countries (LMICs),where fewer than 20% will be cured. The World Health Organization (WHO) has stated that early integration of palliative care is an ethical responsibility in the management of children with life-limiting illness. While structural barriers impact the ability to deliver pediatric palliative care (PPC), underlying stigma also prevents early integration of PPC. Methods: The Assessing Doctor’s Attitudes on Palliative Treatment (ADAPT) survey was created for physicians of all specialties who care for children with cancer, initially used in Eurasia. Survey questions evaluated provider perceptions on timing of palliative care integration, scope of palliative treatment, physician responsibility, and ethical issues. This survey was adapted for use in Latin America, including translation to...
Journal of Clinical Oncology, 2021
e13530 Background: Pediatric hematology and oncology (PHO) facilities are not all equally equippe... more e13530 Background: Pediatric hematology and oncology (PHO) facilities are not all equally equipped to diagnose and treat the full range of childhood cancers. Proposed facility tier models have been published to facilitate the context-based adaptation of PHO diagnostic and treatment guidelines. However, a tool to assist facilities in identifying their level of PHO care does not exist. We assessed the feasibility of using the St. Jude Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool to identify (1) facility levels as defined by the International Society of Pediatric Oncology (SIOP) and the Lancet Oncology Commission (LOC) for sustainable care for children with cancer, and (2) treatment strata in the Adapted Resource and Implementation Application (ARIA) Guide. Methods: This study employed a multi-step mapping approach. We mapped the 1,279 PrOFILE tool variables to the nine SIOP service lines, ten LOC domains, and ten ARIA resource groups. Mapping was performed by...
Journal of Tumor, 2015
Epithelioid Sarcoma (ES) is a rare non-rhabdomyosarcoma soft tissue sarcoma. It is a high-grade m... more Epithelioid Sarcoma (ES) is a rare non-rhabdomyosarcoma soft tissue sarcoma. It is a high-grade malignancy that most commonly occurs in young adult males. These tumors are characterized for slow growing nodules with predilection for the extremities. A proximal form arising in the deep part of the pelvis, perineum, and genital tract and proximal extremities has been described. Only three cases with localization to the spine have been reported. We report the case of an 11-year old female with a primary ES of the lumbar spine, who presented with antalgic gait and evidence of L3 vertebral collapse on x-rays. She had upfront surgery for spine stabilization and biopsy. Treatment consisted of neoadjuvant chemotherapy with ifosfamide and doxorubicin, local control with radiation therapy, and second-look surgery with complete reconstruction of L3. She tolerated treatment well, without significant toxicities or complications. When this paper was submitted for publication, she had completed 6 ...
SSRN Electronic Journal, 2021
The Lancet Oncology, 2021
The Lancet Oncology, 2020
Journal of Clinical Oncology, 2018
e18891Background: No costing data for comprehensive childhood cancer service delivery in an upper... more e18891Background: No costing data for comprehensive childhood cancer service delivery in an upper-middle income country (UMIC) are available. Further, there are no PCU costing data from any low or ...
Journal of Cancer Policy, 2020
Blood, 2014
Backgrond: Donor selection is a critical step for the success of hematopoietic stem cell transpla... more Backgrond: Donor selection is a critical step for the success of hematopoietic stem cell transplantation (HSCT). Donor/recipient sex-mismatch, donor age, and donor parity have been found to play an important role in the adult setting, and minor histocompatibility antigens (mHCA) encoded by the Y-chromosome presumed to be in the causal pathway. The pediatric sibling HSCT setting offers a special opportunity to evaluate donors and to see whether the observed importance of donor sex and age holds true when the donors are young and presumably immunologically naïve to Y-chromosome mHCAs. We hypothesized that if the presence of acquired T and B cells sensitized to H-Y antigens are in fact a major contributing factor to differences in outcomes between sex-matched and sex -mismatched transplants, there should be no such difference when a non-exposed (non-alloimmunized) female donor is involved. Methods: Retrospective review of pediatric patients receiving myeloablative sibling-donor HSCT fr...
The Lancet Oncology, 2019
Journal of Global Oncology, 2018
Purpose Global data mapping access to essential chemotherapeutics for pediatric cancer are scarce... more Purpose Global data mapping access to essential chemotherapeutics for pediatric cancer are scarce. We report a survey of international pediatric cancer care providers’ access to these medicines. Methods A Web-based survey was sent to pediatric oncologists registered on the Cure4Kids Web portal. We queried chemotherapeutics in the WHO Essential Medicines List for Children, from which the average proportional availability was summarized as each country’s access score. In addition, we examined availability of drug packages defined by the WHO-sanctioned Expert Committee for eight pediatric cancers. We undertook a sensitivity analysis investigating how regimen access would change if the cytotoxics specified in recent agreements between the Clinton Health Access Initiative, American Cancer Society, and pharmaceutical companies were universally available. Results There were significant ( P < .001) differences in the median access scores between World Bank income groups, and 42.9% of res...
JNCI: Journal of the National Cancer Institute, 2017
Biology of Blood and Marrow Transplantation, 2017
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Papers by Paola Friedrich