Pediatric Medical Tourism: International Patients Seeking Treatment in the United States for Malignancy and Serious Hematologic Disorders. A Review of the St Jude Experience.

Abstract

Medical tourism is defined as travel outside one's home country to seek medical care. International travel for medical care can have financial, logistical, and ethical implications for patients, families, and accepting institutions. Data on medical tourism in pediatrics are sparse, especially for care of rare or life-threatening diseases such as cancer. To our knowledge, this study provides the first description of international patients seeking medical care in the United States for oncologic and hematologic diseases. We performed a retrospective review of international patients seen at St Jude Children's Research Hospital from August 2, 2009, through June 30, 2019. These included patients with acceptance obtained through the referral process and those who arrived without approval (walk-in patients). Demographic and clinical data were collected and analyzed using descriptive statistics. Of the 372 international patients seen, most identified as White (n = 258; 69.4%) and not Hispanic (n = 232; 62.4%). A minority (n = 23; 6.2%) arrived as walk-in patients. The highest number of patients was from the Latin America and Caribbean region (n = 181; 48.7%) and from upper-middle-income countries (UMICs) (n = 182; 48.9%). Six patients (1.6%) were from low-income countries (LICs). Oncologic diagnoses were the most common reason for referral, with a similar distribution of accepted patients across hematologic, CNS, and non-CNS solid tumors although hematologic malignancies predominated among walk-in patients (n = 17; 81%). International patients came to the United States from across the world, mostly through formal acceptance. However, there were more patients from UMICs at our institution than from low- and middle-income countries and LICs. Additional studies are needed to investigate this observation which supports the continuous need for global capacity-building collaborations in pediatric oncology.