Building a transdisciplinary network to improve survival in children with cancer in Colombia: seeds to forests

ABSTRACT

Childhood cancer mortality is disproportionately higher in low- and middle-income countries than high-income countries. The World Health Organization Global Initiative for Childhood Cancer aims for a survival of 60% by 2030. This initiative prioritizes timely diagnosis, access to standardized therapy and supportive care, and prompt management of treatment-related complications. Collaborative work is linked to better performance of health systems and delivery of high-quality care. While collaborative strategies between high- and lower-income countries can advance cancer care in low- and middle-income countries, local and regional initiatives are essential to improve clinical outcomes. The high treatment-related mortality in children with cancer in low- and middle-income countries highlights the critical need to collaborate. To decrease treatment-related mortality in children with cancer in Colombia, a new model of transdisciplinary collaboration was built among Colombian scientific societies (pediatrics, pediatric hematology/oncology, infectious diseases, critical care), academic institutions, grassroots foundations, and the Colombian Childhood Cancer Clinical Outcomes Surveillance System: VIGICANCER. The network supports resource and knowledge exchange to tackle public health challenges related to accessing cancer care for children. It enables the design of targeted and tiered multilevel interventions to enhance quality of care for Colombian children and adolescents with cancer. This transdisciplinary network aims to improve survival in Colombian children with cancer and close the gap with high-income countries by establishing data-informed targets and developing a strategic roadmap to address sepsis, the most actionable cause of treatment-related mortality. Our ultimate goal is to reduce the number of years of life lost, thereby supporting societal progress in Latin America.

The global burden of childhood cancer is increasing, with more than 200 000 new cases documented each year and 180 000 estimated non-diagnosed cases (1, 2). About 90% of children with cancer live in low- and middle-income countries (3). Cancer survival estimates for children living in high-income countries are above 80% 5 years after diagnosis (4). This high survival is due to effective, interdisciplinary, and comprehensive management in high-quality health care systems, which enables early detection, appropriate diagnosis, access to cutting-edge cancer-directed therapy and supportive care, as well as prompt identification and timely management of treatment-related complications (5). Despite significant advances in childhood cancer treatment, the survival gap between high-income countries and low- and middle-income countries is still strikingly wide (6), with survival probabilities about 40% in low- and middle-income countries (Figure 1). This lower survival is because only 20–30% of children obtain a timely diagnosis and only 45% receive optimal treatment (7). Moreover, treatment-related mortality in high-income countries is about 3–5%, whereas in low- and middle-income countries it is around 7–40% (8). Notably, treatment-related mortality rates in low- and middle-income countries have remained unchanged in recent years, particularly in children with cancer who are admitted to critical care units, despite overall increases in survival (9). The large disparities between high-income countries and low- and middle-income countries stem from the excessively high mortality in children in low- and middle-income countries attributed to delayed diagnosis, inefficient referral pathways, inadequate access to up-to-date treatments and supportive care, and limited research opportunities. Cooperative research provides robust data, which in turn informs public policy and multilevel strategies focused on improving clinical outcomes (3, 6). Yet, engagement in research in low- and middle-income countries is limited due to underdeveloped research infrastructures, work overload, insufficient mentorship to conduct research, and scarce resources (5, 10).

FIGURE 1. Five-year net survival in children (0–14 years) diagnosed with lymphomas, ALL, and CNS tumors, by country in the Americas.

ALL, acute lymphoblastic leukemia; CNS, central nervous system; CI, confidence intervals.

Notes: The figure shows a heat map with color shades representing the corresponding 5-year net survival estimates by country for acute lymphoblastic leukemia and a bar chart of 5-year net survival estimates by country for each cancer type, with 95% CI. No data on CNS tumors were available for Peru.

Source: Created by authors based on data from CONCORD-3 representing the 2010–2014 cohort (7).

Collaborative work enhances the performance of health care systems and the delivery of high-quality care (6, 10). In low- and middle-income countries, collaborative efforts to enhance access to cancer care and clinical outcomes have grown over the past two decades. Many of these endeavors have been influenced by the World Health Organization (WHO) Global Initiative for Childhood Cancer, launched in 2018, to achieve at least a 60% survival for childhood cancer by 2030, which would translate into saving 1 million additional lives annually (11). Achieving this goal requires boosting capacity to provide timely diagnosis and high-quality cancer care. Most global alliances have involved clinical and research initiatives between high-income countries and low- and middle-income countries. Several such efforts have resulted in increased awareness of childhood cancer, optimized systems for timely referrals, enhanced capacity for diagnosis and treatment, and adequately trained health care professionals caring for children with cancer (12–15). Nevertheless, the pervasively high treatment-related mortality in children with cancer in low- and middle-income countries (8) highlights the need to act through harmonization and teamwork.

In this report, we use the metaphor “seed to forests” (Figure 2) to describe the building of a transdisciplinary network aimed at improving survival in Colombian children with cancer and closing the gap with high-income countries by establishing data-informed targets and developing a strategic roadmap to address sepsis, the most actionable cause of treatment-related mortality. This transdisciplinary network has the overarching goal of reducing the number of years of life lost, thereby supporting societal progress in Latin America.

FIGURE 2. Building a transdisciplinary network to improve the survival of children with cancer, Colombia: “seeds to forests” conceptual schematic.

Notes: The figure uses a plant growth metaphor: the “soil” represents the regional collaborative landscape and existing regional societies that provide the foundation; the “seed” is VIGICANCER (the Colombian childhood cancer clinical outcomes surveillance system) that generated actionable, population-level data, and achieved important milestones such as establishing partnerships with foundations and South–South collaborations; the “water for the seed” denotes the Asociación Colombiana de Hematología y Oncología Pediátrica [Colombian Association of Pediatric Hematology and Oncology], Pan American Health Organization, Colombian Ministry of Health, and technical partners whose support enabled scale-up and achievement of data-driven targets and a key milestone (the creation of the MAMUTTS^© network and the development of two protocols focused on sepsis: the National Protocol for the Management of Febrile Neutropenia in Children with Cancer and DETECTO^©: Early Sepsis Detection Protocol for Children with Cancer); and the “forest” depicts the intended longer-term broader network – a strengthened, sustainable, transdisciplinary system of care, regional collaboration, and improved survival. The green upward arrow indicates increased survival and the banner marks the transdisciplinary network that spans stakeholders and disciplines. Logos represent the partner organizations.

Source: Created by the authors based on processes in building the network in Colombia.

COLLABORATIVE LANDSCAPE IN LATIN AMERICA: THE SOIL

While cooperative strategies between high-income countries and low- and middle-income countries can advance cancer care in low- and middle-income countries (3, 12–15), local initiatives are essential to improve clinical outcomes in resource-constrained settings. Building local and regional partnerships in low- and middle-income countries provides an effective framework for resource and knowledge exchanges aimed at tackling public health challenges related to access to care. In addition, such partnerships utilize the South–South context-concordant expertise of teams that have experienced the specific struggles unique to low- and middle-income countries (16).

Some countries in Latin America, such as Argentina, Brazil, and Chile (Table 1) have participated in collaborative work for several years and are examples of how knowledge and expertise can be amplified (10). Efforts include the Grupo Argentino de Tratamiento de la Leucemia Aguda, GATLA [Argentinian Group for the Management of Acute Leukemia], the first cooperative group in pediatric hematology/oncology in Argentina founded in 1967 to develop treatment protocols for leukemia (10, 17). The nationwide standardization of protocols has led to increases in survival in Argentinian children with hematolymphoid malignancies (17, 26). The Group also established an intercontinental alliance with the International Berlin–Frankfurt–Munster group and the International Consortium for Childhood Acute Promyelocytic Leukemia.

TABLE 1. Pediatric oncology collaborative groups in Latin America.

Collaborative group	Year founded	Purpose	Countries involved	Key achievements
GATLA, Grupo Argentino de Tratamiento de la Leucemia Aguda [Argentinian Group for the Management of Acute Leukemia] (https://gatla.com.ar/sobre-nosotros/)	1967	To evaluate clinical trials for acute leukemia and other hematologic malignancies nationwide	Argentina	(i) Improved survival rates for Argentinian children with leukemia; (ii) Served as a foundation for launching Cooperative Latin American Group for Pediatric Hematology-Oncology (10, 17, 18).
SLAOP, Sociedad Latinoamericana de Oncología Pediátrica [Latin American Society of Pediatric Oncology] (https://slaop.net/sobre-slaop/mision-vision-valores/)	1979	To support cooperative groups and evidence-based treatment protocols, increase awareness of childhood cancer, and enhance diagnosis and care throughout Latin America	Argentina, Bolivia (Pluri-national State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela (Bolivarian Republic of)	(i) Positioned as a unifying body for training and policy advocacy for childhood cancer in Latin America (19).
SOBOPE, Sociedade Brasileira de Oncologia Pediátrica [Brazilian Society of Pediatric Oncology] (https://sobope.org.br/about-us/)	1981	To promote awareness of childhood cancer in Brazil, support clinical research with modern multidisciplinary protocols, and develop consensus-guided treatment plans	Brazil	(i) Supported public health policies, professional training, research initiatives, continued education, and national and international collaborations (20).
AHOPCA, Asociación de Hemato-Oncología Pediátrica de Centro América [Central American Pediatric Hematology–Oncology Society]	1988	To deliver education and training, and promote collaborations to strengthen pediatric cancer care in Central America and the Caribbean (21)	Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, Panama	(i) Developed standardized treatment protocols across participating institutions; (ii) Published more than 60 peer-reviewed articles demonstrating improvements in outcomes for children with cancer (21, 22).
PINDA, Programa Infantil Nacional de Drogas Antineoplásicas [National Children's Antineoplastic Drug Program]	1988	To provide access to chemotherapy to Chilean children and adolescents with cancer (23)	Chile	(i) Allowed access to standard-of-care chemotherapy protocols to 100% of children with cancer and public insurance in Chile (23).
ACHOP, Asociación Colombiana de Hematología y Oncología Pediátrica [Colombian Association of Pediatric Hematology and Oncology] (https://achop.org/acerca-de-achop/)	1998	To support initiatives focused on early diagnosis, evidence-based comprehensive care, professional excellence, continued education, and research of children with cancer and hematologic diseases in Colombia	Colombia	(i) Served as the seedbed for pediatric oncology origins in Colombia; (ii) Supported development of context-adapted treatment protocols nationwide; (iii) Fostered collaboration for novel transdisciplinary approaches aimed at reducing preventable deaths (19, 24).
GALOP, Grupo de América Latina de Oncología Pediátrica [Latin American Pediatric Oncology Group] (https://grupogalop.org/es/institucional)	2008	To implement multicenter clinical trials for childhood cancer in South America	Argentina, Brazil, Chile, Uruguay	(i) Developed and implemented protocols for sarcoma, retinoblastoma, and germ cell tumors; (ii) Strengthened regional collaboration in pediatric oncology clinical research in participating countries (25).
CLEHOP, Cooperative Latin American Group for Pediatric Hematology–Oncology	2015	To reduce adverse cancer outcomes and enhance cure rates and quality of life in children and adolescents with cancer (18)	Argentina, Brazil, Ecuador, Mexico, Peru, Venezuela (Bolivarian Republic of)	(i) Developed cooperative clinical trial protocols and promoted regional collaboration in pediatric oncology (10).

Source: Created by the authors based on available data of collaborative groups in Latin America.

A decade later, the Sociedad Latinoamericana de Oncología Pediátrica, SLAOP [Latin American Society of Pediatric Oncology] was founded in 1979 as the Latin American branch of the International Society of Paediatric Oncology (Table 1). The Latin American Society includes 17 countries and supports continued education and the development of evidence-based guidelines for childhood cancer care, thereby strengthening connections across the continent (19). Similarly, the Sociedad Brasileña de Oncología Pediátrica, SOBOPE [Brazilian Society of Pediatric Oncology] was founded in 1981 (20). This society is dedicated to expanding cancer care across Brazil and supports public policy, continued education, research incentives, and national and international cooperation.

Another notable example of cooperation is the Asociación de Hemato-Oncología Pediátrica de Centro America, AHOPCA [Central American Pediatric Hematology–Oncology Society]. This is a scientific society established in 1988 (21) which includes eight countries from Central America and the Caribbean (Table 1). It has developed multidisciplinary guidelines and protocols for the treatment of childhood cancer in the region and pioneered the use of shared web-based databases in low- and middle-income countries. The AHOPCA’s network has published more than 60 peer-reviewed papers highlighting the effect of this cooperative effort on clinical outcomes in children with cancer in the region (21, 22).

In Chile, the Programa Infantil Nacional de Drogas Antineoplásicas, PINDA [National Program on Cancer Drugs for Children] was established in 1988 to provide access to chemotherapy to Chilean children with cancer. The program has become a national cooperative group comprising oncologists and other specialists. It aims to develop treatment guidelines and research projects and harmonize institutional protocols with government health policies (23).

Beyond these local connections, regional partnerships in pediatric oncology have also been established, including the Grupo América Latina de Oncología Pediátrica, GALOP [Latin American Pediatric Oncology Group], founded in 2008 in Uruguay with the support of the Children's Oncology Group (Canada and United States) (27). The objective of GALOP is to implement childhood cancer clinical trials in South America, across six sites in Argentina, 24 in Brazil, 12 in Chile, and one in Uruguay (10). GALOP, in coalition with SOBOPE, has led protocols for the treatment of sarcoma, retinoblastoma, and germ cell tumors (10, 25).

The most recent example involves GATLA. In 2015, GATLA provided a platform for the launch of the multinational clinical trial consortium in Latin America, Consorcio Latinoamericano de Enfermedades Hematooncológicas Pediátricas, CLEHOP [Latin American Consortium of Pediatric Hematological–Oncological Diseases], which has developed several cooperative clinical trial protocols (18).

While pediatric oncology as a specialty has a strong history of cooperative groups in high-income countries that has resulted in remarkable increases in childhood cancer survival over the past five decades (6, 27), emerging interprofessional collaborations have also been formed in other disciplines, such as pediatric critical care (28, 29). Likewise, the Sociedad Latino Americana de Cuidados Intensivos Pediátricos, SLACIP [Latin American Society of Pediatric Critical Care] was established in 1993 by pediatric critical care specialists committed to decreasing treatment-related mortality in children with critical conditions through knowledge exchange, research, and development of working groups (30).

Although considerable progress has been made in the past few decades in cancer care in Latin America through alliances, closing the survival gap in childhood cancer between the region and high-income countries is a challenge. Of the estimated 604 million inhabitants in Latin America, 151 million are younger than 15 years (25% of the population). Additionally, more than 20 000 cases of childhood cancer are estimated to be diagnosed annually, nearly 15% of all childhood cancers worldwide (2, 7). To reduce the morbidity and mortality burden of childhood cancer in Latin America to the levels in high-income countries, transdisciplinary alliances among organizations in low- and middle-income countries that share the same hardships are needed to improve care through the sharing of experiences.

ADDRESSING CANCER CONTROL CHALLENGES: THE VALUE OF TRANSDISCIPLINARITY

Important global public health problems, including the effect of rising socioeconomic inequities on outcomes of chronic conditions such as cancer (6), require multiple stakeholders to unite to find solutions. The present and future challenges in childhood cancer control cannot be addressed by a single discipline alone. Rather, collaboration of multiple sectors and disciplines to combine their knowledge, expertise, and methods is essential. Transdisciplinary approaches are necessary for tackling increasingly complex challenges across global, regional, national, local, and community levels. These challenges include inequities in the quality of health care and disengagement of key stakeholders. Moreover, balancing the dynamics of the private and public sectors, while also addressing inequities and financial crises, is a struggle commonly faced by low- and middle-income countries.

Transdisciplinarity in health care goes beyond interprofessional and multidisciplinary relationships. It requires transcending the boundaries of different disciplines, fostering meaningful exchanges of knowledge and skills, engaging in shared decision-making, focusing on real-world problems, and convening different stakeholders, including patients, their families, and their communities, for careful consideration of their experiences and perspectives (31). A transdisciplinary network centered around pediatric oncology to promote collaboration will catalyze cancer control programs and policies to achieve the goal of improved survival and quality of life for children with cancer in Latin America.

VIGICANCER: THE SEED FOR A COLOMBIAN TRANSDISCIPLINARY NETWORK FOR CHILDHOOD CANCER

Colombia, with more than 52 million inhabitants, is the third most populous country in Latin America (24). Childhood cancer is the second leading cause of death among Colombian children aged 2–19 years, making it an important public health concern (2, 7, 24). Colombia’s Childhood Cancer Clinical Outcomes Surveillance System, VIGICANCER, was established in 2009 in Cali, the third-largest city in the country (32), in an alliance with Cali’s Population-Based Cancer Registry and the Sanofi-Espoir and Pediatras OncoHEMAtólogos (POHEMA) foundations (24). VIGICANCER registers children and adolescents (< 19 years) newly diagnosed with cancer receiving treatment at 27 participating Colombian institutions. VIGICANCER collects demographic and clinical data and conducts quarterly active surveillance to document outcomes, such as death, disease relapse, occurrence of second malignancies, treatment abandonment, and loss to follow-up. VIGICANCER analyzes and disseminates valid, reliable, and timely population-based data on clinical outcomes from more than 12 000 Colombian children with cancer registered to date (24, 32).

VIGICANCER’s results are discussed regularly with Colombian health authorities and disseminated to the scientific and public health communities through publications and presentations at national and international meetings (24). Among the important findings from VIGICANCER were the lower survival of Colombian children with brain tumors compared with comparable cohorts in other regions (33), and the increased early mortality of children with solid tumors during the coronavirus disease 2019 (COVID-19) pandemic, attributed to more advanced stage at presentation and reduced treatment effectiveness due to disruptions in care (34).

VIGICANCER provides important, real-world, comprehensive, actionable population-based information, guides multilevel interventions, and informs local and national public policy. At the same time, it provides timely feedback to clinicians and administrators at participating institutions. Moreover, VIGICANCER has proven to be a springboard for collaborative network-building (24). In 2018, a strategic alliance was formed between VIGICANCER and the Asociación Colombiana de Hematología y Oncología Pediátrica, ACHOP [Colombian Association of Pediatric Hematology and Oncology] (24). This association was established in 1998 as a non-profit scientific society to promote the well-being of Colombian children with hematological and oncological diseases (Table 1). Its work focuses on initiatives centered on timely diagnosis, evidence-based treatments, harmonized clinical practices, continued education, and research (19). With the support of ACHOP, VIGICANCER successfully integrated the two largest cities in the country in its network, reaching about 45% coverage of the childhood population nationwide. VIGICANCER increased its impact by establishing the first transdisciplinary Colombian collaborative network at both national and international levels (24). For instance, in 2022, VIGICANCER partnered with the United States-based Keira Grace Foundation, a significant milestone. This partnership has helped extend the reach of VIGICANCER, which now spans 10 cities and includes about 60% of the childhood population nationwide (24). Furthermore, this partnership has evolved to endorse related initiatives, including patient navigation, to improve access to care for Colombian children with cancer (24).

The strong networks shaped by VIGICANCER have spread to other regions in Latin America. For example, another key milestone is the South–South alliance with the United States–Mexico Binational Health Commission, in Tijuana, Mexico, which has established the first population-based cancer registry in north-western Mexico (BajaREG) and the Pediatric and Adolescent Cancer Registry Surveillance System (PACARSS), modeled after VIGICANCER (16). The successful operation of these two initiatives was achieved through mentoring by the VIGICANCER team on developing needs assessment evaluations, adapting local protocols, and training the Mexican staff in data collection and analysis.

VIGICANCER has made significant contributions locally and regionally by producing valid and reliable population-based data, serving as a foundation for public health prioritization, providing a replicable model for other low- and middle-income countries in Latin America, and advancing scientific and academic progress in the region.

ACHOP: WATER FOR THE SEED TO EXPAND A TRANSDISCIPLINARY NETWORK

Commitment to advancing initiatives aligned with the WHO Global Initiative for Childhood Cancer is growing worldwide (11). In Latin America, the Pan American Health Organization (PAHO), in partnership with St Jude Children’s Research Hospital, developed the CureAll framework (11). This framework was subsequently adapted for the Andean region (Bolivia (Plurinational State of), Chile, Colombia, Ecuador, Peru, and Venezuela (Bolivarian Republic of)) by the Organismo Andino de Salud [Andean Health Agency], Convenio Hipólito Unanue, ORAS-CONHU (11, 35). This process culminated in a guidance document designed to facilitate the execution of the CureAll framework in the Andean region. In Colombia, ACHOP, through its active participation in the Consejo Nacional Asesor en Cáncer Infantil, CONACAI [National Advisory Council on Childhood Cancer], led efforts to put into operation activities promoted by the CureAll framework (24).

Simultaneously, ACHOP, in partnership with VIGICANCER, convened stakeholders from governmental, grassroots, academic, and patient support organizations to build consensus on the implementation of strategic initiatives targeting key milestones to improve childhood cancer survival in Colombia. The key focus areas included early detection of childhood cancer, standardization of cancer-directed and supportive care management, centralization of provision of complex cancer care and optimization of referral pathways, and growth of collaborative clinical research (24). A transdisciplinary leadership team is responsible for directing the development of comprehensive and consensus-based methodological approaches for each initiative.

Therefore, committed to reducing morbidity and mortality in Colombian children with cancer, this partnership between ACHOP and VIGICANCER developed a strategic roadmap and integrated a broader transdisciplinary network, including clinicians from critical subspecialties involved in the care of children with cancer. This approach was informed by VIGICANCER results, which highlighted that treatment-related mortality accounted for a significant proportion of deaths (about 25%) in Colombian children with cancer. Most of these deaths were attributed to preventable causes, with sepsis being responsible for > 95% of treatment-related mortality nationwide in children who were in remission from their cancer (24). In response, and as a first problem to tackle in the roadmap, a horizontal transdisciplinary collaborative network was formed and strategies to reduce sepsis-related mortality were developed. Accordingly, pediatric oncologists, pediatric infectious disease specialists, pediatric critical care physicians, general pediatricians, primary care providers, and nurses from eight Colombian hospitals and academic centers joined together for the first time to embrace a shared objective. With support from PAHO, and in alliance with the Colombian Ministry of Health, this team of key stakeholders met for the first time at the 2024 annual meeting of ACHOP to jointly analyze VIGICANCER data. Data-informed targets were then established to tackle sepsis as the most common actionable cause of treatment-related mortality. With this goal, a new transdisciplinary and cohesive team was formed called MAnejo MUltidisciplinario para el Tratamiento de la neuTropenia febril y Sepsis, MAMUTTS^© [Multidisciplinary management for febrile neutropenia treatment and sepsis].

Initial milestones included convening biweekly meetings (14 were held over 6 months in 2024), followed by monthly/bimonthly meetings (16 were held over 12 months in 2024–2025). In all, 12 agreements were approved between the parties involved and two protocols focused on sepsis were developed: the National Protocol for the Management of Febrile Neutropenia in Children with Cancer, and DETECTO^©: Early Sepsis Detection Protocol for Children with Cancer. Subsequent steps included the standardized implementation of these two protocols over 24 months (2025–2027).

This nascent transdisciplinary network enables the design of targeted multilevel interventions to enhance high-quality care for Colombian children with cancer. Our ultimate goal is to reduce the number of years of life lost and to significantly enhance the health and future of Colombia.

FUTURE EFFORTS IN LATIN AMERICA AND OTHER REGIONS: THE FOREST

Pediatric collaborative networks in high-income countries centered around research or quality-improvement initiatives that integrate several specialties, such as oncology, infectious diseases, and critical care (27–29), have improved patient outcomes and quality of care within frameworks that encourage academic excellence, cooperation, and community engagement (29). However, similar initiatives in low- and middle-income countries are sparse. Our transdisciplinary collaborative network, aligned with the goals of WHO’s Global Initiative for Childhood Cancer (11), is a new model in Colombia, and our experience can be replicated in other low- and middle-income countries. A unique aspect of our network is the engagement of different organizations, particularly a surveillance system (VIGICANCER) and participation of local and international foundations, academic institutions, and scientific pediatric and adult associations (24). These include ACHOP, the Asociación Colombiana de Medicina Crítica y Cuidado Intensivo, AMCI [Colombian Association of Critical and Intensive Care Medicine], the Asociación Colombiana de Infectología, ACIN [Colombian Infectious Diseases Association], and the Sociedad Colombiana de Pediatría, SCP [Colombian Pediatric Society]. This transdisciplinary and intersectoral approach stimulates academic partnerships and builds a strong infrastructure, which capitalizes on existing local resources to strengthen sustainable childhood cancer programs that can be integrated into national cancer control plans. Furthermore, our network has utilized alliances at the national level with the Colombian Ministry of Health and the Colombian National Cancer Institute, as well as with PAHO regionally, and with St. Jude Children’s Research Hospital internationally. Standardized metrics and appraisal frameworks (3, 12, 14, 36, 37) are needed to assess: the success of our transdisciplinary network; the clinical impact and long-term sustainability of the strategies that have been implemented; and the reproducibility of our approach in similar resource-constrained settings. Ongoing active surveillance, monitoring, and outcome evaluation through platforms such as VIGICANCER are crucial for assessing the effectiveness of these collaborative initiatives by ensuring that planned objectives are met.

VIGICANCER’s systematic and meaningful results have positioned this unique surveillance system as a springboard for concerted collaboration between pediatric oncologists, allied clinicians, community stakeholders, and policy-makers, which will greatly benefit Colombian children. Our pioneering network represents a replicable model that serves as a platform for health equity, enabling progress in childhood cancer care.

LESSONS LEARNT WHILE WATERING THE SEED

Although mortality rates in children with cancer in Colombia remain high and significant improvements are needed to close the survival gap between Colombia and high-income countries, implementing collaborative initiatives for effective cancer control, created by VIGICANCER and spearheaded by ACHOP, has taught us valuable lessons (Table 2). First, cooperative efforts in low- and middle-income countries can improve access to high-quality standardized treatments, thereby mitigating the impact of resource constraints on clinical outcomes. Second, clinical research, along with the implementation of population-based cancer registries and surveillance systems in childhood cancer, are essential to obtain reliable and robust information that can inform data-driven interventions. Third, relatively modest investments by governments in low- and middle-income countries can effectively shape public policies on childhood cancer and lead to a reduction in mortality. These initiatives require justification by local data, integration of health systems strengthening frameworks applicable to regional realities, and the design of flexible data-driven, policy-focused strategies to ensure implementation fidelity of such initiatives. Fourth, creating transdisciplinary networks beyond pediatric oncology, by engaging other pediatric specialties in­volved in the care of children with cancer, can significantly affect clinical outcomes. Fifth, transdisciplinary initiatives build South–South capacity, capitalize on established infrastructures to conduct cooperative research, and promote the long-term sustainability of networks.

TABLE 2. Transdisciplinary networks: lessons learnt, challenges, facilitators, and recommendations.

Lessons learnt Cooperative efforts in low- and middle-income countries can substantially improve access to standardized, high-quality cancer care despite resource constraints. Population-based cancer surveillance systems (e.g., VIGICANCER) are essential to generate robust, actionable, data-driven evidence-guided interventions and policies. Even modest governmental investment, when data-informed, can shape effective national childhood cancer policies. Transdisciplinary collaboration beyond oncology (infectious diseases, critical care, pediatrics, nursing) is crucial to reduce treatment-related cancer mortality. Engagement of grassroots foundations and civil society enhances continuity and trust among institutions. South–South partnerships utilize shared experiences and infrastructures, thereby strengthening sustainability and ownership. Local data are key for advocacy and for aligning national priorities with global frameworks such as WHO’s CureAll.

Challenges in low- and middle-income countries Limited research and programmatic infrastructures, mentorship, and funding Fragmented health systems and inconsistent referral pathways between primary and tertiary care Data heterogeneity and under-reporting in many institutions Need for ongoing monitoring and funding to sustain interventions and demonstrate measurable outcomes Difficulty maintaining engagement across different disciplines and institutions Differences in institutional capacity and local leadership commitment High clinical workload limiting clinicians’ dedicated time to improvement initiatives Competing priorities within ministries of health, leading to delayed policy adoption

Facilitators Existence of a robust population-based surveillance system (e.g., VIGICANCER) providing high-quality, longitudinal data Strong scientific societies (ACHOP, ACIN, AMCI, SCP) aligned around a shared goal Collaboration with governmental bodies (ministries of health, national cancer institutes) and regional/global partners (ORAS-CONHU, PAHO, CureALL, St. Jude Children’s Research Hospital) Bidirectional mentorship and knowledge transfer between Colombian and other Latin American programs (e.g., BajaREG). Grassroots and philanthropic foundation support (e.g., POHEMA, Keira Grace Foundation, Foundation-S) Standing meetings, standardized metrics, and transparent communication among stakeholders Research capacity and academic dissemination of results to reinforce legitimacy and replication potential

Recommendations and minimum conditions for replication Use local data to inform targeted interventions; population-based surveillance platforms are ideal to generate valid and meaningful local data. Assemble a multistakeholder leadership team including clinicians, policy-makers, researchers, academics, and patient advocates from inception. Identify a single actionable public health target (e.g., sepsis-related mortality) as a first step. Establish clear monitoring and evaluation systems with predefined metrics for success. Adapt a transdisciplinary framework to the local context, ensuring flexibility and sustainability. Secure institutional and governmental endorsement early to facilitate translation to public policy. Engage key disciplines and maintain momentum to ensure success of planned initiatives. Foster South–South collaboration to strengthen regional ownership and reduce dependence on partners from high-income countries. Prioritize mentorship and research capacity-building to nurture the next generation of leaders and researchers. Promote dissemination of results through national and regional scientific societies and meetings as well as peer-reviewed publications to catalyze replication in similar low- and middle-income countries.

WHO, World Health Organization; ACHOP, Asociación Colombiana de Hematología y Oncología Pediátrica; ACIN, Asociación Colombiana de Infectología; AMCI, Asociación Colombiana de Medicina Crítica y Cuidado Intensivo; SCP, Sociedad Colombiana de Pediatría; ORAS-CONHU, Organismo Andino de Salud, Convenio Hipólito Unanue; PAHO, Pan American Health Organization; BajaREG, Tijuana’s Population-Based Cancer Registry; POHEMA, Fundación de Pediatras OncoHEMAtólogos.

Source: Created by the authors based on analysis of the networks and the experience in Colombia.

Lastly, although our transdisciplinary network is promising in Colombia, we acknowledge that it may only serve as a replicable model in settings with similar contexts, particularly where existing government, academic, and population-based cancer data systems can be utilized, and minimum conditions are met (Table 2). Previous alliances in Latin America have proven that their implementation is feasible. However, we recognize that settings with solid cooperative and research infrastructures, concerted political will, and strong and consistent funding streams – mostly in middle-income and high-income countries – facilitate effective collaborative strategies to improve cancer outcomes. Therefore, networks modeled on ours might not be suitable for some low- and middle-income countries, limiting the generalizability and reproducibility of our experience.

In conclusion, transdisciplinary collaborative networks in pediatric oncology can help integrate key stakeholders into cohesive teams to effectively implement multilevel interventions and shape public policy and cancer control. Furthermore, this strategy can contribute to the objectives set by the WHO Global Initiative for Childhood Cancer. Our transdisciplinary network is a novel approach that contributes to the limited literature in low- and middle-income countries. Future directions include assessment of local institutional needs and potential implementation barriers, and evaluation of the planned initiatives. These should focus on building clinical research capacity within the network as well as on enhancing early detection, referral pathways, and standardizing treatments and supportive care, including the implementation of the recently developed protocols to decrease sepsis-related mortality in Colombian children with cancer (24).

Public health policies and government alliances are being established to achieve our goals and sustain our efforts in the long term, including securing governmental, nongovernmental, and institutional funding streams. The strength and growth of these transdisciplinary collaborative networks will maintain momentum and encourage additional institutions, nongovernmental organizations, and disciplines – specifically nursing, psychology, social work, surgery, radiotherapy, and rehabilitation – to join forces to close the childhood cancer survival gap in low- and middle-income countries. Public health in the 21st century faces important global challenges and transformations, including persistent and increasing social inequities and injustices. These challenges are interlinked and share common features: they are often multifactorial with inherent social and political intricacies, which require engagement of multiple stakeholders. Thus, fostering and strengthening transdisciplinary collaboration to tackle public health problems have the potential to inform national public policies and sustainably improve clinical outcomes in childhood cancer in Colombia and other low- and middle-income countries.

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.