Guiding Healthcare Workers and Governments on Treating Any Child with Cancer, Anywhere.

Summary

The treatment of childhood cancer is a miracle of modern science. While childhood cancer was universally fatal 60 years ago, today, we can expect to cure four out of every five children who are diagnosed with cancer in the United States. Unfortunately, this level of success is not the case worldwide. Nearly 90% of children who develop cancer are born in countries where healthcare resources are scarce and cancer treatment options are limited or absent. As a result, the World Health Organization (WHO) estimates that only one in five children who develop cancer globally will survive. To address this disparity, the WHO launched the Global Initiative for Childhood Cancer (GICC), underpinned by the CureAll framework which advocates national standards of care.

One way to improve survival for children with cancer is to establish treatment guidelines specifically tailored to meet the needs of children across resource settings and countries. Without such guidelines, healthcare providers must navigate complex treatments like chemotherapy, radiotherapy, and surgery, as well as manage medication toxicities and side effects, without standards to guide their decisions. Healthcare providers with access to treatment guidelines that are adapted to their local context may be able to improve survival rates for children with cancer.

The Adapted Resource and Implementation Application (ARIA) Guide is a new tool in our global fight against childhood cancer. ARIA Guide is designed to provide appropriate cancer management guidelines for every child, everywhere. The guide includes recommendations for treating specific cancers, solving cancer-related medical complications, providing high-quality palliative care, and helping survivors navigate their post-cancer health needs.

Significance

Two major innovations set the ARIA Guide apart from existing cancer treatment guidelines. First, we use an evidence- and consensus-based methodology to develop each guideline. This unique approach incorporates input from healthcare providers across geographic regions and resource-diverse settings, as well as insights from patient and family advocates. Second, each guideline is freely available for any healthcare provider worldwide via the ARIA Guide web portal at: ARIAguide.org.

No other resource like the ARIA Guide exists in the childhood cancer space. To ensure that healthcare workers can trust ARIA Guide recommendations, St. Jude Global and the International Society of Paediatric Oncology (SIOP) partnered together to provide governance and oversight. In addition, foundational partnerships with the Paediatric Radiation Oncology Society (PROS), Childhood Cancer International (CCI), and the International Society of Paediatric Surgical Oncology (IPSO) were established to ensure global multidisciplinary input and representation. The ARIA Guide collaboration represents a major global commitment to support healthcare providers and institutions in delivering safe, effective, and high-quality childhood cancer care.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Created a replicable methodology for producing resource-adapted clinical guidelines and practice recommendations. demonstrated.

Clinical

Guidelines

Increase quality and effectiveness of treatment options by adapting recommendations based on local drug availability. potential.

Clinical

Drugs

Increase access to clinical guidance through the ARIA Guide web portal, which offers offline capabilities following an initial online connection. potential.

Clinical

Software technologies

Increased access to resource-adapted cancer management guidelines through the free ARIA Guide web portal. demonstrated.

Community

Health care accessibility

Improve effective communication and collaboration among multidisciplinary care teams by providing access to a shared source of trusted guidelines and recommendations. potential.

Community

Health care delivery

Increase access to health education resources for childhood cancer care by integrating relevant materials into the free ARIA Guide web portal. potential.

Community

Health education resources

Increase life expectancy and improve quality of life for children with cancer by promoting access to and use of appropriate cancer management guidelines. potential.

Community

Life expectancy & quality of life

Provided a free resource for healthcare providers and institutions to support childhood cancer care. demonstrated.

Economic

Cost savings

Decrease spending on childhood cancer diagnosis, treatment, and side effect management through appropriate use of resources and improved cancer outcomes. potential.

Economic

Cost effectiveness

Engaged healthcare providers from major childhood cancer organizations, societies, and institutions in the development of ARIA Guide’s clinical guidelines. demonstrated.

Policy

Committee participation

Integrate guidelines in national cancer control plans for managing childhood cancer. potential.

Policy

Policies

Gain endorsements from major cancer guideline organizations, including NCCN, ASCO, ACS, ASH, and WHO, to improve global standards for childhood cancer management. potential.

Policy

Standards

This research has clinical, community, economic, and policy implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.

Clinical

The ARIA Guide improves access to the best available clinical guidance for childhood cancer care. Our team expects the ARIA Guide to lead to clinical and medical benefits for patients, including greater life expectancy, fewer cancer-related complications, and improved quality of life. While limited guidance is available currently, once ARIA is fully implemented, we believe it will positively impact not only patients but also families, clinical teams, healthcare centers and systems, government entities, policies, and the community.

Community

Childhood cancer is a global public health priority for more than 75 countries and directly impacts all communities. The ARIA Guide offers trusted, relevant guidance to providers globally. This guidance has the potential to reduce observed health disparities, support government decision-making, and empower clinical teams worldwide with the knowledge to effectively treat childhood cancer in any context. 

Economic

The ARIA Guide will support hospital administrators and government entities to make informed investment decisions related to childhood cancer care. Each guideline provides recommendations for scaling up resources at both the hospital and community levels. Further, as part of our monitoring and evaluation plan, the ARIA Guide team will conduct an adapted health technology assessment for each guideline. Policymakers will be able to use insights from these assessments to make cost-effective decisions specific to their local context.

Policy

The ARIA Guide team intentionally designed this initiative to align with the WHO CureAll framework. All of our guidelines meet the strict methodological criteria put in place by the WHO guideline review committee. As a result, government agencies can use ARIA guidelines to prioritize, forecast, and implement integrated health services. The guidelines can also be used to inform government-led national cancer control planning, monitoring, and evaluation efforts.

Lessons Learned

Developing trust with key collaborators—including healthcare providers, treatment facilities, and professional societies—has been critical to the success of the ARIA Guide. Our leadership team identified confidence in the methodology, purpose, and benefits of the ARIA Guide as the first step to ensuring it can be used to its full potential. The expertise and ongoing support of all the global panel members, patient and family advocates, global pediatric oncology organizations, government entities, guideline organizations, health organizations, non-governmental organizations, mutual health organizations, and the ARIA Guide Coordinating Center team members have contributed to creating a shared belief in the purpose and importance of the ARIA Guide.