METHODOLOGY In the section CHILDHOOD CANCER IN THE STATE OF RIO DE JANEIRO, for the calculation of the cancer in- cidence estimate we considered the median rate of can- cer incidence adjusted by age for the Southeast Region (INCA, 2016) and the populational estimate for the state in 2016 (DATASUS, 2017). For the calculation of the child and adolescent population, the cases were divided between the health regions by following the percentage distribution from 0 to 19 years from the 2010 Census. The annual average of diagnosed cases was calcu- lated from the database of the hospital-based cancer regis- try in 2017. For the classification of tumors in pediatric can- cer cases, only the variable for location of the tumor was used. Since the large number of cases did not allow for the classification of the database in all of Brazil according to the histology of the tumor along with the location, the test was only done in Rio de Janeiro, which demonstrated little alteration in the percentage between the classification by the location of the tumor and that made by the location and histology of the tumor. The information about deaths by childhood cancer was extracted from the Information System about Mortality – SIM (DATASUS, 2017) and the official report on childhood cancer from International Agency for Research on Cancer (IARC, 2016). For the projection of the annual incidence of childhood cancer, populational estimates were used for the year of 2016 in Brazil, the state and the city (DATASUS, 2017). Other data used was the information that the capital con- centrates 39.5% of the state's population (IBGE, 2010) and the incidence rates in technical publications by the IARC (STELIAROVA, 2017) and by the INCA (2016). The latter con- sidered: the Brazilian incidence average, the median rate of incidence ajusted to the age range of 0 to 14 years in the Southeast Region and the median rate of incidence specific to 15 to 19 year olds in the Southeast Region (INCA, 2016). The information in the section PUBLIC PEDIATRIC CARE was obtained from the National Database on Health Units (old version), considering its validity in April 2017 for primary care units and the distribution of doctors, and in October 2017 for other information. In the section INFRASTRUCTURE FOR DIAGNOSIS AND TREATMENT the following sources were used: Ordi- nance nº 140, 02/27/2014, and its alterations, the National Database on Health Units (valid Oct. 2017), the HBCR data- base (from Oct. 2017), and the information of "Extension Project of School Services in Hospitals: shared knowledge" and the "Humanization Work Group from the 2017 Pediatric Oncology Forum"; as well as consultations done at the hospi- tals so as to update information that, until the final edition of the material, had not been made available by the responsible public entities. The information in MONITORING OF INFORMA- TION was obtained from the HBCR in July 2017 consid- ering analytic cases without previous diagnosis and treat- ment with the first consultation between 2009 and 2013 in the state of Rio de Janeiro, as well as information sup- plied by the Division of Situation Surveillance and Analysis – Conprev/ INCA about the implementation of the Hospi- tal-Based Cancer Registry (HBCR), and sending its criteria to specialized hospitals. REFERENCES BRASIL. INSTITUTO BRASILEIRO DE GEOGRADIA E ESTATÍSTICA (IBGE). Atlas do Censo Demográfico 2010. Caracteríscas gerais da população por residência e faixa etária (online). 2017. MINISTÉRIO DA SAÚDE - CADASTRO NACIONAL DOS ESTABELECIMEN- TOS DE SAÚDE DO BRASIL (CNES). Tabnet - Rede assistencial e Recursos humanos. 2017. MINISTÉRIO DA SAÚDE. DEPARTAMENTO DE INFORMÁTICA DO SUS (DATASUS). Esmava populacional segundo regiões de saúde no Esta- do do Rio de Janeiro (online). Brasília, 2017. MINISTÉRIO DA SAÚDE. Secretaria de Vigilância em Saúde. Sistema de Informações sobre Mortalidade (SIM), 2017. Portaria nº 458, de 24 de fevereiro de 2017. Mantem as habilitações de estabelecimentos de saúde na Alta Complexidade e exclui prazo estabe- lecido na Portaria nº 140/SAS/MS, de 27 de fevereiro de 2014. FONSECA, ES. Hospitais com Escolas no Brasil. Projeto de Extensão Aten- dimento Escolar Hospitalar: saberes parlhados. Faculdade de Educa- ção da UERJ. Mimeo. 2017. INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Registros hos- pitalares de câncer: planejamento e gestão / Instuto Nacional de Cân- cer. 2 ed. – Rio de Janeiro: INCA, 2010. INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Esmava 2016: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2015. INSTITUTO NACIONAL DE CÂNCER JOSÉ ALENCAR (INCA). Incidência, mortalidade e morbidade hospitalar por câncer em crianças, adolescen- tes e adultos jovens no Brasil: informações dos registros de câncer e do sistema de mortalidade. Rio de Janeiro: Inca, 2016. INTERNATIONAL AGENCY FOR RESEARCH ON CANCER (IARC). Internaonal Childhood Cancer Day: Much remains to be done to fight childhood cancer. Press Release N° 241: 2016. STELIAROVA-FOUCHER, Eva et al. Internaonal incidence of childhood cancer, 2001-10: a populaon-based registry study. Lancet Oncol. v.18, p.719-31, 2017. INTRODUCTION General coordination: Laurenice Pires and Evelyn K. Santos Technical revision: Marceli Santos and Rejane Reis General revision: Roberta Costa Marques Textual revision: Veronica Marques Collaborators: Alfredo Scaff, Isabel Rei Madeira, Rafael Vargas, Solange Malfacini. Instuto Desiderata Rua Dona Mariana, 137 - casa 07, Botafogo | Rio de Janeiro, RJ, Brazil - 22280-020. | Tel.: +55 (21) 2540-0066 Information is critical for better planning and ma- nagement practices. With this certainty, we launched the fourth edition of the Pediatric Oncology Bulletin with the objectives of contributing to the consolidation of in- formation and highlighting the challenges that must be overcome in order to specialize the treatment. Led by Instituto Desiderata, this publication was built in collab- oration with professionals from the Cancer Foundation and the National Cancer Institute (INCA). In this edition, we can observe the low comple- tion of some mandatory variables in the Cancer Reg- istry Form of Hospital-Based Cancer Registries (HBCR), among them: "first treatment received in hospital" (57% without information) and "other staging differ- ent from TNM" (65% without information). The low completion of this data can indicate a problem in the process of data collection in the medical records. The information in the medical records must be legible, only in this way will the information accurately repre- sent the treatment that was given. Another point to highlight is the care of 15% of analytic cases 1 , in ages between 15 and 19 years, gi- ven in hospitals not specialized in pediatric oncology. In hospitals specialized in pediatric oncology, treat- ment is administered by a pediatric oncologist, the chemotherapy is given in an exclusive and human- ized room for children and adolescents, among other specifications. On the other hand, the information on the pro- jection of incidence coincides with what is observed globally, as well as the professional areas: nursing, physiotherapy, nutrition, odontology, psy- chology and social service, indicated in the last ordi- nance, are present in practically every hospital, even though it is not possible to say if in ideal amounts. The investment in the lively ambiance of six of the seven chemotherapy rooms used by children and ad- olescents is also a positive highlight. When facing challenges it is necessary to create problem-solving strategies, especially in times of crisis. These challenges include adapting the existing infra- structure, implementing lines of care for childhood can- cer control, and improving the management of the health care network in order to control this type of cancer by focusing on the patient and treatment in a timely man- ner. Information has a fundamental role in decision- making on local and global levels. It is our greatest ally for implementing actions, goals, and results, as well as for monitoring and assessing what is being done for more assertive decision-making in cancer control, wheth- er in children and adolescents, or in adults. 1 Analytic cases are those in which the therapeutic plan, the trea- - tment, and the follow-up are done by the unit responsible for the care of patients. (INCA, 2016) RIO DE JANEIRO, BULLETIN VOL. 4, Nº 4, NOV. 2017 ISSN 2594-6846 — Printed version PANORAMA OF PEDIATRIC ONCOLOGY PANEL OF OPINIONS THE CRISIS AND CHALLENGES FOR THE CONTROL OF PEDIATRIC CANCER In general, mortality by cancer is related to variables such as: economic crises, universal health coverage, public health expenditures, among other factors. An increase in unem- ployment has a direct relationship to an increase in mortality by cancer. The 2008-2010 economic crisis was responsible for about 260,000 more deaths by cancer in European Coun- tries of the OCDE (Organisation of Economic Co-operation and Development). On the other hand, in countries with universal health coverage, that is, with universal access to healthcare, and with greater investments in public health, there is a protective effect that is associated with the reduc- tion of mortality by cancer. It is assumed that the access to healthcare could be at the base of these associations. "United for the Cure" is a project that can face adversities and support the control of pediatric cancer. Currently, more than ever, it is necessary to monitor healthcare services, of- fer training and qualification courses for immediate diagno- sis and strengthen the information/regulation system for the referral of suspected cases. Alfredo Scaff - Health Physician, Fundação do Câncer (Cancer Foundation). ABOUT THE EPIDEMIOLOGICAL TRANSITION OF PEDIATRIC DISEASES TO THE COMMITMENT OF PUBLIC MANAGEMENT WITH CANCER IN CHILDREN AND ADOLESCENTS The profile of mortality in children and adolescents changed greatly in the last decades. The implementation of preven- tive actions reduced the incidence of communicable diseases, and the expansion of urban areas was followed by the in- crease in deaths caused by urban violence and accidents (external causes), especially among the young. We have mo- ved from a scenario of high rates of child mortality due to in- fectious and parasitic diseases, to a new moment in which these diseases are responsible for an ever-decreasing amount of deaths. On the other hand, deaths by external causes in- creased significantly, taking the first place. The second cause of death in children and adolescents are neoplasms, followed by other diseases of chronic evolution. In this way, if external causes are excluded, today cancer represents the first cause of death in this age group. The early detection of cancer in children and adolescents i s included in our agendas as one of the main challenges to be addressed for the organization of a network and the commitment of public management. Solange Malfacini - Doctor, Cancer Manager for the Municipal Health Secretary of Rio de Janeiro. HOSPITAL CANCER REGISTRY: POTENTIALI TIES IN THE MONITORING OF HOSPITAL CARE The World Health Organization (WHO) sustains that having reliable information is crucial for decision-making on all le- vels of the healthcare system. Quality information is essen- tial both from the macro point of view, for the develop- ment of public policies, for example, and for the evaluation of the quality of care in a hospital or healthcare service. The WHO also defends that the information systems should not be restricted only to the evaluation of monitoring, but also must stimulate research, allowing for situation analyses in health and its tendencies. The participation of patients in clinical studies (clinical tri- als) is strongly recommended and is an indicator of the quality of the care. Thus, RHC has a double role in this as- pect. First, to help with the identification of potential pa- tients to be recruited for a clinical trial. Second, to assess the number of patients that participated in the clinical trial. In our RHC we are creating a complementary variable that signals if the patient did or did not participate in a clinical trial. Rafael Vargas - Clinical oncologist, coordinator of the Hospital Cancer Registry (RHC) of the Irmandade da Santa Casa de Misericórdia in Porto Alegre. IN FAVOR OF THE PEDIATRICIAN INTEGRATED IN THE FAMILY HEALTH STRATEGY Public Primary Care for children is currently going through a transition that takes the care from the pediatrician, and hands it to the Family Health Strategy (ESF). In ESF in the State of Rio de Janeiro, pediatricians are not a part of the team. The managers claim that there are not many pedia- tricians, which is not true. We are the most numerous medical specialty in the state. The Medical Residency Pro- gram (PRM) in Pediatrics is the most sought by doctors who have recently graduated. Nothing against ESF, but everything in favor of the inte- grated pediatrician. The Pediatric Society of the State of Rio de Janeiro proposes to insert the pediatrician into the Support Centers for Family Health (NASF). In NASF, each pediatrician, besides offering childcare, would report to a number of ESF teams, for training of primary care for child health and for the mental health matrix. In this way, they would know all of the children under their care, and the strategy teams would have this specialist with more exper- tise be available, including for the care of a sick child, and for the differential diagnosis of cancer, for example. Isabel Rey Madeira - Pediatrician who acts in the area of pediatric endocrinology, president of the Pediatric Society of the State of Rio de Janeiro. The ideas expressed here represent the authors' opinions. To read the complete texts access: www.desiderata.org.br