System of medical care for children with cancer in the United States as compared with that in the Czech Republic.

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Klin Onkol 1995; 8(5): 157-158.

Summary: Medical care for children with cancer is in established university or university-affiliated hospitals in the US Physicians caring for these patients are boardcertified in general pediatrics and pediatric hematology/oncology. The time required for this specialized training is 6 years beyond medical school. Therapeutic protocols used in treating patients are standard cooperative group plans and are available to all children. University hospitals in the US require the physicians to be active in clinical or basic research activity in addition to the clinical care of the children. In contrast to the US university hospitals, those in the Czech Republic have markedly fewer support people such as secretaries, laboratory technicians, data managers, pharmacists and social workers to help nurses and doctors. The system of postgraduate education also differs markedly. Training requirements in the US emphasize the childhood cancer specialist is trained in pediatrics plus the subspeciality for six years. However, in the Czech Republic oncologists who treat children may have either pediatric or internal medicine background. Most pediatric oncologists in the Czech Republic are not involved in basic or clinical research. Efforts should be made to improve training programs. Also in this regard, the recent tendency in the Czech Republic to decentralize care of children with cancer into community hospitals is a regressive move which places children at risk for suboptimal care and outcome.